What is the recommended dose of Movantik (naloxegol) for opioid-induced constipation?

Movantik (Naloxegol) Dosing for Opioid-Induced Constipation

The recommended dose of Movantik (naloxegol) for opioid-induced constipation is 25 mg once daily in the morning, taken on an empty stomach at least 1 hour before the first meal of the day or 2 hours after a meal. 1, 2

Standard Dosing Recommendations

• Take Movantik on an empty stomach at least 1 hour prior to the first meal of the day or 2 hours after the meal 2
• Discontinue all maintenance laxative therapy prior to initiation of Movantik 2
• Laxatives can be used as needed if there is a suboptimal response to Movantik after three days 2
• Avoid consumption of grapefruit or grapefruit juice during treatment with Movantik 2

Dosage Adjustments

• If patients cannot tolerate the 25 mg dose, reduce to 12.5 mg once daily 2
• For patients with creatinine clearance (CLcr) <60 mL/min (moderate, severe, or end-stage renal impairment), start with 12.5 mg once daily 2
• If using concomitant moderate CYP3A4 inhibitors (e.g., diltiazem, erythromycin, verapamil), reduce the dose to 12.5 mg once daily 2
• Avoid use with strong CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole) as they can significantly increase naloxegol exposure and precipitate opioid withdrawal symptoms 2

Efficacy and Clinical Response

• Naloxegol has demonstrated efficacy in treating OIC with response rates of 41.9% compared to 29.4% with placebo in non-cancer pain patients 1
• The 25 mg dose has shown the most consistent efficacy in clinical trials 3
• Response typically includes improved spontaneous bowel movement frequency and reduced straining during defecation 1

Administration in Special Situations

• For patients unable to swallow the tablet whole, it can be crushed to a powder, mixed with 4 ounces (120 mL) of water, and drunk immediately 2
• Movantik can also be administered via nasogastric tube following specific instructions for preparation 2
• Discontinue Movantik if treatment with the opioid pain medication is also discontinued 2

Common Side Effects and Safety Considerations

• Most common adverse effects include abdominal pain (17.8%), diarrhea (12.9%), nausea (9.4%), headache (9.0%), and flatulence (6.9%) 4
• Gastrointestinal side effects typically occur early in treatment and are usually mild to moderate and transient 4
• Naloxegol does not reverse central analgesic effects when used as directed 5
• Contraindicated in patients with known or suspected gastrointestinal obstruction due to risk of perforation 2

Treatment Algorithm for OIC Management

1. First try conventional laxatives (stimulant laxatives, stool softeners) 6
2. If constipation persists despite laxative therapy, consider naloxegol 25 mg once daily 6
3. If 25 mg dose is not tolerated, reduce to 12.5 mg once daily 2
4. For patients with renal impairment or on moderate CYP3A4 inhibitors, start with 12.5 mg 2
5. Monitor for response and adjust therapy as needed 2

Naloxegol's peripherally-acting mechanism allows it to antagonize μ-opioid receptors in the gastrointestinal tract without affecting central analgesia, making it an effective option for OIC when traditional laxatives fail 7.