Naloxegol

MOVANTIK

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Pronunciation: nal-OX-ee-gol

Naloxegol ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Naloxegol ballicule

Naloxegol MOVANTIK mascot mnemonic cartoon — Visual mnemonic: Naloxegol mascot
**“Nail locks seagull (for) Movin’ antics”**
dilated pupils → opioid antagonist

What it isPeripherally restricted mu antagonist; opioid-induced constipation.

Why this onePEGylation keeps it out of the CNS, so it reverses gut opioid effects without reversing analgesia.

What limits itGI perforation risk, so avoid in known or suspected obstruction. CYP3A4-dependent; take on an empty stomach.

Naloxegol molecular structure (skeletal formula) — Molecular structure: Naloxegol

Naloxegol prescription history

Animated chart of estimated U.S. prescriptions per year, Constipation meds (1900–2026). Naloxegol enters in 2015 (estimated).

FDA-approved for

opioid-induced constipation (2014)

Principal riskGI perforation; opioid withdrawal

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityDiarrhea, dehydration and electrolyte disturbance, especially with excessive or prolonged use.

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Opioid-induced constipation (chronic non-cancer pain)	Adults	25 mg QD (morning)	25 mg QD	25 mg QD

Renal CLcr <60 mL/min: start 12.5 mg QD, may increase to 25 mg QD if tolerated; no adjustment in mild impairment

Hepatic Mild-moderate: no adjustment; avoid in severe (Child-Pugh C, not evaluated)

If 25 mg not tolerated, reduce to 12.5 mg QD

Instructions

Take on empty stomach ≥1 h before first meal of day or 2 h after
Discontinue maintenance laxatives before starting; may resume after 3 days if needed
If unable to swallow, tablet may be crushed and mixed in water or given via NG tube
Avoid grapefruit / grapefruit juice
Discontinue if opioid pain medication is discontinued

Available strengths

tab 12.5, 25 mg

Contraindications

Known/suspected GI obstruction or at risk of recurrent obstruction (GI perforation risk)
Concomitant strong CYP3A4 inhibitors (may precipitate opioid withdrawal)

Cautions

Opioid withdrawal (esp. with blood-brain barrier disruption)
Severe abdominal pain and/or diarrhea — discontinue if severe
GI perforation with peripherally acting opioid antagonists

Adverse reactions

Abdominal pain
Diarrhea
Nausea
Flatulence
Vomiting
Headache
Hyperhidrosis

Pregnancy May precipitate opioid withdrawal in mother and fetus; human data insufficient

Lactation Breastfeeding not recommended (opioid withdrawal risk in infant)

Cost

Naloxegol (MOVANTIK)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	brand $/mo	CostPlus
12.5 mg	tab	30 qd	—	$437.96	not offered
25 mg	tab	30 qd	—	$438.40	not offered

Generic entry2032 est.

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Self-check

Why does naloxegol spare central analgesia?
PEGylation keeps it out of the CNS.
How should naloxegol be taken relative to food?
On an empty stomach.