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From The Medical Letter on Drugs and Therapeutics
January 12, 2016

Naloxegol (Movantik) for Opioid-Induced Constipation

JAMA. 2016;315(2):194-195. doi:10.1001/jama.2015.17459

The FDA has approved naloxegol (Movantik – AstraZeneca), a pegylated derivative of the opioid antagonist naloxone, for oral treatment of opioid-induced constipation in adults with chronic noncancer pain. It is the only oral opioid antagonist approved for this indication in the US.

Laxatives and stool softeners are commonly used, often in combination, for initial treatment of opioid-induced constipation, but their efficacy is limited. Methylnaltrexone (Relistor), a subcutaneously injected opioid antagonist, and lubiprostone (Amitiza), an oral chloride channel activator, are effective in increasing the frequency of bowel movements in patients with opioid-induced constipation and are FDA-approved for such use.1-3 Alvimopan (Entereg), an oral mu-opioid receptor antagonist, has also been shown to be effective in patients with opioid-induced constipation, but it is approved only for short-term in-hospital treatment of postoperative ileus because of a possible risk of myocardial infarction with long-term use.4