II. Indications

  1. Opioid Induced Constipation (chronic non-Cancer Pain)
    1. Severe refractory Constipation due to Opioids

III. Contraindications

  1. Severe liver disease

IV. Mechanism

  1. Block Opioid binding in the intestinal tract
  2. Decreases mu-Opioid receptor mediated bowel paralysis

V. Dosing

  1. General
    1. No renal dose adjustment needed
    2. May take with or without food
  2. Take 0.2 mg orally once daily while taking Opioid

VI. Efficacy

  1. See Gastrointestinal Opioid Antagonist
  2. Best efficacy in those on Opioids for >4 weeks
  3. Refractory Opioid Induced Constipation in Cancer and Palliative Care
    1. Both oral Naldemedine (Symproic) and SQ Methylnaltrexone (Relistor) are effective with benefits outweighing harms
    2. Brown (2023) Am Fam Physician 107(2):131-2 [PubMed]

VII. Adverse Effects

VIII. Safety

  1. Unknown safety in pregnancy
  2. Contraindicated in Lactation

IX. Drug Interactions

  1. Strong CYP3A4 inducers
  2. Strong CYP3A4 Inhibitors
  3. P-Glycoprotein Inhibitors

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Related Studies

Cost: Medications

symproic (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
SYMPROIC 0.2 MG TABLET $13.31 each