Drug Action
Naldemedine is a peripherally acting opioid receptor antagonist. It therefore decreases the constipating effects of opioids without altering their central analgesic effects.
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Drug reference
Naldemedine is a peripherally acting opioid receptor antagonist. It therefore decreases the constipating effects of opioids without altering their central analgesic effects.
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Opioid-induced constipation [previous treatment with a laxative] ▶BY MOUTH ▶Adult: 200 micrograms once daily
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Increased risk of recurrent obstruction (risk of gastro-intestinal perforation). known or suspected gastro-intestinal obstruction (risk of gastro- intestinal perforation)
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Conditions with impaired integrity of the gastro-intestinal wall (risk of gastro-intestinal perforation) . treatment initiation in patients aged 75 years and over (limited information available) CAUTIONS, FURTHER INFORMATION ▶Disruptions to blood-brain barrier Manufacturer advises caution in patients with clinically important disruptions to the blood-brain barrier (e.g. advanced Alzheimer’s disease, active multiple sclerosis, primary brain malignancies)— risk of opioid withdrawal or reduced analgesia. ▶Cardiovascular disorders Safety and efficacy has not been established in patients with these conditions.
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Scottish Medicines Consortium (SMC) decisions SMC No. SMC2242 The Scottish Medicines Consortium has advised (April 2020) that naldemedine (Rizmoic ®) is accepted for use within NHS Scotland for the treatment of opioid-induced constipation in adults who have previously been treated with a laxative.
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→Appendix 1: naldemedine
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▶Common or very common Diarrhoea. gastrointestinal discomfort. nausea. vomiting
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Manufacturer advises avoid unless potential benefit outweighs risk— animal studies do not indicate toxicity; risk of opioid withdrawal in fetus. Gastro-intestinal system
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Manufacturer advises avoid—present in milk in animal studies; theoretical risk of opioid withdrawal in breast-fed neonate.
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Manufacturer advises avoid in severe impairment (no information available).
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There can be variation in the licensing of different medicines containing the same drug. Tablet A ▶Naldemedine (non-proprietary) Naldemedine (as Naldemedine tosylate) 200 microgram Rizmoic 200microgram tablets | 28 tablet P £41.72
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Manufacturer advises patients and carers to report severe, persistent or worsening gastro-intestinal effects (such as abdominal pain) to their prescriber. Manufacturer advises patients and carers should be counselled on the risk of opioid withdrawal syndrome and to seek medical advice if this occurs.
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200 micrograms once daily
First-line fragment. Read the complete Indications and Dose section above.
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