II. Indications
- Severe refractory Constipation due to Opioids
- FDA approved for non-cancer, Opioid-Induced Constipation
III. Contraindications
- See Drug Interactions below (esp. CYP3A4 Inhibitors)
- Severe liver disease
- Bowel Obstruction
IV. Mechanism
V. Dosing: Adults
-
General
- May crush tablet and give with water orally or via Nasogastric Tube
- Take on an empty Stomach >1 hour before OR 2 hours after first meal of the day
- Take 25 mg orally once daily in morning
- Indications for reduced dosing (12.5 mg)
- Renal Dosing: eGFR <60 ml/min
- Full dose not tolerated
VI. Adverse Effects
VII. Safety
- Pregnancy Category C
- Contraindicated in Lactation
VIII. Efficacy
- See Gastrointestinal Opioid Antagonist
- Best efficacy in those on Opioids for >4 weeks
IX. Drug Interactions
- Strong CYP3A4 Inhibitors (e.g. Clarithromycin, Ketoconazole)
- Strong CYP3A4 Inducers
- Grapefruit Juice
- Avoid with other opioid Antagonists
- Stop other Laxatives while taking Methylnaltrexone (may restart as needed in 3 days)
X. Resources
XI. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- (2023) Management of Constipation, Presc Lett, #390108
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Related Studies
| movantik (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MOVANTIK 12.5 MG TABLET | $12.26 each | |
| MOVANTIK 25 MG TABLET | $12.30 each | |