- Injection 20mg/ml (£21.05 = 0.6ml vial)
- Opioid-induced constipation in adult patients receiving palliative care, when response to other laxatives is inadequate
- By subcutaneous injection, for adults:
- Body-weight up to 38kg, 150 micrograms/kg once daily on alternate days
- Body-weight 38–61kg, 8mg once daily on alternate days
- Body-weight 62–114kg, 12mg once daily on alternate days
- Body-weight 115kg and over, 150 micrograms/kg once daily on alternate days
- The interval between administrations may be varied but not more than once a day
- Treatment can result in the rapid onset of a bowel movement (i.e. within 30 to 60 minutes)
- In palliative care patients, treatment is added to usual laxative therapy which may subsequently require review.
- Consult Summary of Product Characteristics (SPC) for dosing adjustments in renally impaired patients.
- The SPC states that methylnaltrexone bromide has not been studied in adult patients with advanced illness in clinical trials beyond 4 months.
- Tablets 12.5mg, 25mg (£51.52 = 25mg daily)
- Naloxegol is recommended in accordance with NICE TA345 (July 2015) for the treatment of opioid induced constipation in adults whose constipation has not adequately responded to laxatives.
- An inadequate response to laxatives is defined as opioid-induced constipation symptoms of at least moderate severity in at least 1 of the 4 stool symptom domains (that is, incomplete bowel movement, hard stools, straining or false alarms) while taking at least 1 laxative class for at least 4 days during the prior 2 weeks.
- 25mg once daily, to be taken in the morning
- Certain patients may require a dose reduction to 12.5mg daily; consult manufacturers SPC for further details.
- Naloxegol should be used in accordance with NICE TA345 (July 2015)
- Naloxegol should only be initiated in patients in whom opioids are effectively treating the pain.
- For use in primary care following recommendation from a member of the palliative care team only. In all other indications, naloxegol should be restricted to secondary care use.
Patients should be advised to report severe, persistent or worsening gastro-intestinal effects (such as abdominal pain)
- NICE TA651: Naldemedine (Rizmoic) is recommended, within its marketing authorisation, as an option for treating opioid-induced constipation in adults who have had laxative treatment (September 2020)
1. Gastrointestinal >
1.6 Laxatives >
1.6.6 Peripheral opioid-receptor antagonists
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