Naloxegol (Movantik)


Indications for Prior Authorization:

  • Treatment of opioid-induced constipation (OIC) in adult patients with chronic non-cancer pain

Prior authorization criteria:

  • Patient is at least 18 years old, AND
  • OIC use is not due to cancer-related pain, AND
  • Patient does not have gastrointestinal obstruction or is at increased risk of recurrent obstruction, due to the potential for gastroinestinal perforation, AND
  • Will not be used concomitantly with strong CYP3A4 inhibitors, AND
  • Patient has tried and failed a stool softener plus a stimulant laxative and at least one other class of laxative, AND
  • Will not be used concomitantly with other opioid antagonists


  • 25 mg once daily; if not tolerated, reduce to 12.5 mg once daily
  • Renal impairment (CLcr < 60 mL/min): 12.5 mg once daily; increase to 25mg once daily if tolerated and monitor for adverse reactions
  • Discontinue maintenance laxative therapy before starting Movantik; may resume laxatives if patients have OIC symptoms after taking Movantik for 3 days
  • Alteration in analgesic dosing regimen prior to starting Movantik is not required


  • One year

Last review date: November 14, 2019

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