Adults: Discontinue all laxative therapy prior to initiation; may use as needed if suboptimal response after 3 days. Discontinue if opioid pain therapy is also discontinued. Swallow whole. Take on an empty stomach. 25mg once daily in the AM; may reduce to 12.5 mg once daily if unable to tolerate. Moderate, severe, or end-stage renal impairment (CrCl <60mL/min): 12.5 mg once daily; may increase to 25 mg once daily if well tolerated and symptoms continue. Concomitant moderate CYP3A4 inhibitors: if unavoidable, reduce naloxegol to 12.5 mg once daily; monitor.

Children: Not established.

Contraindication(s): Known or suspected GI obstruction. Patients at increased risk of recurrent obstruction. Concomitant strong CYP3A4 inhibitors (eg, clarithromycin, itraconazole, ketoconazole).

Warnings/precautions: Risk of GI perforation in those with conditions associated with reduction in structural integrity of the GI tract wall (eg, peptic ulcer disease, Ogilvie’s syndrome, diverticular disease, infiltrative GI tract malignancies, or peritoneal metastases). Monitor for severe, persistent or worsening abdominal pain; discontinue if occurs. Monitor for symptoms of opioid withdrawal (esp. patients receiving methadone or having disruptions to the blood brain barrier). Severe hepatic impairment (Child-Pugh Class C); avoid. Pregnancy (Category C). 

Nursing mothers: not recommended.

Interaction(s): See Contraindications. Avoid concomitant moderate CYP3A4 inhibitors (eg, diltiazem, erythromycin, verapamil): if unavoidable, reduce dose (see Adults). Avoid concomitant other opioid antagonists, grapefruit, or grapefruit juice. Concomitant strong CYP3A4 inducers (eg, rifampin, carbamazepine, St. John’s Wort): not recommended.

Adverse reaction(s): Abdominal pain, diarrhea, nausea, flatulence, vomiting, headache, hyperhidrosis.

How supplied: Tabs—30, 90

For more information, call (800) 236-9933 or visit 

This article originally appeared on Clinical Advisor