Naldemedine

Aka: Naldemedine, Symproic

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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

  1. Abdominal Pain
  2. Opioid Withdrawal

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

X. Resources

  1. Naldemedine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b1a1256c-a1eb-4abe-ab1e-30e4711afd16

XI. References

  1. (2017) Presc Lett 24(12): 70
  2. Portenoy (2008) J Pain Symptom Manage 35(5): 458-68 [PubMed]
  3. Thomas (2008) N Engl J Med 358(22): 2332-43 [PubMed]

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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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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