In practice

• In patients with troublesome constipation associated with the use of an opioid, despite laxatives and non-drug measures, naloxegol has a beneficial effect on intestinal transit but provokes abdominal symptoms that are probably as troublesome as constipation.
   
• The impact of naloxegol on the analgesic effect of opioid therapy is unclear. It is plausible that naloxegol reduces this analgesic effect in a dose-dependent manner, sometimes even at doses of only 25 mg per day.
   
• In practice, in the absence of a better alternative, it seems preferable to continue to obtain the maximum relief possible from laxatives and lifestyle measures.
   
•  NOTHING NEW  In patients who have troublesome constipation linked to opioid therapy despite the use of laxatives, the evaluation of naloxegol does not tell us whether the drug actually alleviates the discomfort. Naloxegol has a beneficial effect on intestinal transit, but it provokes abdominal symptoms that are probably as troublesome as constipation. The degree to which naloxegol interferes with the analgesic effect of opioid therapy is unclear. It seems better to obtain the maximum relief possible through well-managed lifestyle measures and laxative therapy than to use naloxegol.

 ©Prescrire 1 October 2017

"Naloxegol (Moventig°) and opioid-induced constipation. Its abdominal adverse effects are probably as troublesome as constipation" Prescrire Int 2017; 26 (186): 229-231. (Pdf, subscribers only)