Moventig (Naloxegol)
Peripherally acting mu-opioid receptor antagonist for opioid-induced constipation
Quick Facts About Moventig
Key Takeaways About Moventig
- Treats opioid-induced constipation: Moventig is specifically designed for constipation caused by opioid pain medications when laxatives alone have not worked
- Does not reduce pain relief: Unlike systemic opioid antagonists, naloxegol acts only in the gut, preserving the analgesic effects of your opioid medication
- Take on an empty stomach: Take once daily in the morning, at least 30 minutes before or 2 hours after your first meal for optimal absorption
- Critical drug interactions: Must not be combined with strong CYP3A4 inhibitors (ketoconazole, clarithromycin, HIV protease inhibitors) as they significantly increase naloxegol levels
- Watch for serious symptoms: Stop and contact your doctor immediately if you develop severe, persistent, or worsening abdominal pain, as this may indicate gastrointestinal perforation
What Is Moventig and What Is It Used For?
Moventig (naloxegol) is a prescription medication used to treat opioid-induced constipation (OIC) in adults who are taking opioid pain medications such as morphine, oxycodone, fentanyl, tramadol, or codeine on a regular basis. It belongs to a class of drugs called peripherally acting mu-opioid receptor antagonists (PAMORAs) and is prescribed when laxatives alone have not provided adequate relief.
Opioid-induced constipation is one of the most common and troublesome side effects of opioid therapy, affecting an estimated 40–80% of patients who take opioids regularly for chronic pain. Unlike many other opioid side effects, tolerance to constipation rarely develops over time, meaning that the problem persists for as long as opioid therapy continues. This can significantly reduce quality of life and may even lead some patients to reduce or discontinue their pain medication.
Naloxegol is a PEGylated (polyethylene glycol-modified) derivative of naloxone, a well-known opioid antagonist. The PEGylation process is critical to the drug's mechanism: by attaching a polyethylene glycol polymer to the naloxone molecule, the resulting compound (naloxegol) is too large and too polar to readily cross the blood-brain barrier. This means that naloxegol can block opioid receptors in the gastrointestinal tract — reversing the constipating effects of opioids on the gut — while leaving the pain-relieving effects of opioids in the central nervous system intact.
Opioid-induced constipation can produce a range of distressing symptoms, including:
- Abdominal pain and bloating — uncomfortable fullness and cramping in the abdomen
- Excessive straining — needing to push very hard to pass stool, which can also cause pain in the anal area
- Hard, pellet-like stools — stools that are dry and difficult to pass
- Incomplete evacuation — a persistent feeling that stool remains in the rectum after a bowel movement
- Reduced frequency — fewer than three spontaneous bowel movements per week
In clinical trials, Moventig demonstrated statistically significant improvements in spontaneous bowel movement frequency compared to placebo in patients with OIC who had an inadequate response to laxatives. The pivotal KODIAC-04 and KODIAC-05 trials showed that naloxegol 25 mg produced a significantly higher response rate (defined as three or more spontaneous bowel movements per week with an increase of at least one from baseline) compared to placebo over 12 weeks of treatment.
Moventig is not a general laxative. It works specifically by blocking opioid receptors in the gut wall. If your constipation is not caused by opioid use, Moventig will not be effective. Your doctor will assess whether your constipation is truly opioid-induced before prescribing this medication.
What Should You Know Before Taking Moventig?
Before starting Moventig, it is essential to inform your doctor about all medical conditions, current medications, and whether you are pregnant or breastfeeding. Moventig is contraindicated in patients with known or suspected bowel obstruction and must not be used with strong CYP3A4 inhibitors.
Contraindications
You must not take Moventig in the following situations:
- Allergy to naloxegol or any excipients: If you are allergic to naloxegol, similar medications, or any of the inactive ingredients in the tablet
- Known or suspected bowel obstruction: If your intestines are blocked or at risk of becoming blocked, Moventig could worsen the condition
- Gastrointestinal cancer: If you have cancer of the bowel, peritoneum, advanced or recurrent ovarian cancer, or are taking anti-cancer agents such as VEGF inhibitors (e.g., bevacizumab)
- Concurrent use of strong CYP3A4 inhibitors: Ketoconazole, itraconazole (antifungals), clarithromycin, telithromycin (antibiotics), or ritonavir, indinavir, saquinavir (HIV protease inhibitors)
Cases of gastrointestinal perforation have been reported in patients taking opioid receptor antagonists. Stop taking Moventig and contact your doctor immediately if you develop severe, persistent, or worsening abdominal pain. This can be a symptom of damage to the intestinal wall and may be life-threatening.
Warnings and Precautions
Talk to your doctor, pharmacist, or nurse before taking Moventig if any of the following apply to you:
- You have stomach ulcers, Crohn's disease, diverticulitis, cancer of the bowel or peritoneum, or any other condition that may damage the intestinal lining
- You currently have unusually severe, persistent, or worsening abdominal pain
- The natural blood-brain barrier has been compromised — for example, if you have brain cancer, central nervous system cancer, or a CNS disease such as multiple sclerosis or Alzheimer's disease. In such cases, naloxegol may cross into the brain and potentially interfere with opioid analgesia or trigger withdrawal symptoms
- You are taking methadone, as there may be an increased risk of opioid withdrawal
- You have had a heart attack within the past six months, have heart failure, or other serious cardiovascular problems with daily symptoms
- You have kidney problems — your doctor may prescribe a lower dose (see dosage section)
- You have severe liver disease
While taking Moventig, contact your doctor if you experience symptoms of opioid withdrawal syndrome. This can include a combination of three or more of the following: low mood, nausea, vomiting, muscle aches, increased tear production, runny nose, dilated pupils, goosebumps, excessive sweating, diarrhoea, yawning, fever, or difficulty sleeping. Your doctor may need to discontinue Moventig if these symptoms occur.
Pregnancy and Breastfeeding
Moventig is not recommended during pregnancy due to insufficient safety data in pregnant women. If you are pregnant, think you may be pregnant, or are planning to have a baby, consult your doctor before taking this medication.
It is not known whether naloxegol passes into breast milk. Therefore, you should not use Moventig while breastfeeding. Discuss alternative treatment options with your doctor if you are breastfeeding.
Children and Adolescents
Moventig is not recommended for children and adolescents under 18 years of age as it has not been studied in these age groups. The safety and efficacy of naloxegol in the paediatric population have not been established.
Driving and Operating Machinery
Moventig is not expected to affect your ability to drive or operate machinery. No studies on the effects on the ability to drive and use machines have shown impairment attributable to naloxegol.
Sodium Content
Moventig contains less than 1 mmol (23 mg) sodium per 12.5 mg or 25 mg tablet, meaning it is essentially sodium-free. This is relevant for patients on a controlled sodium diet.
How Does Moventig Interact with Other Drugs?
Moventig has clinically significant interactions with several drug classes, particularly CYP3A4 inhibitors and inducers. Strong CYP3A4 inhibitors are absolutely contraindicated, while moderate inhibitors may require dose adjustment. CYP3A4 inducers may reduce Moventig's effectiveness.
Naloxegol is primarily metabolised by the cytochrome P450 3A4 (CYP3A4) enzyme system. Drugs that inhibit or induce this enzyme can significantly alter naloxegol blood levels, potentially leading to increased toxicity or reduced efficacy. It is critical to inform your doctor about all medications you are taking, including prescription drugs, over-the-counter medicines, and herbal supplements.
Major Interactions (Contraindicated)
The following drugs must not be taken together with Moventig, as they are strong CYP3A4 inhibitors that can dramatically increase naloxegol blood levels:
| Drug | Drug Class | Reason |
|---|---|---|
| Ketoconazole | Antifungal | Strong CYP3A4 inhibitor; increases naloxegol exposure approximately 12.9-fold |
| Itraconazole | Antifungal | Strong CYP3A4 inhibitor; significantly increases naloxegol levels |
| Clarithromycin | Macrolide antibiotic | Strong CYP3A4 inhibitor; markedly increases drug exposure |
| Telithromycin | Ketolide antibiotic | Strong CYP3A4 inhibitor; markedly increases drug exposure |
| Ritonavir | HIV protease inhibitor | Strong CYP3A4 inhibitor; contraindicated combination |
| Indinavir | HIV protease inhibitor | Strong CYP3A4 inhibitor; contraindicated combination |
| Saquinavir | HIV protease inhibitor | Strong CYP3A4 inhibitor; contraindicated combination |
Moderate Interactions (Dose Adjustment Required)
If you take any of the following medications, your doctor may reduce your Moventig dose to 12.5 mg daily:
- Diltiazem — a moderate CYP3A4 inhibitor used for high blood pressure or angina. Co-administration increased naloxegol exposure approximately 3.4-fold in studies
- Verapamil — a moderate CYP3A4 inhibitor used for high blood pressure, angina, or certain heart rhythm disorders
Your doctor may later increase your dose to 25 mg depending on how you respond to treatment and how well you tolerate the medication.
Other Important Interactions
- Rifampin (rifampicin) — a strong CYP3A4 inducer used as an antibiotic. It significantly reduces naloxegol levels and may make Moventig ineffective. You may need to discontinue Moventig
- Carbamazepine — a strong CYP3A4 inducer used for epilepsy. May substantially reduce naloxegol blood levels
- St. John's Wort (Hypericum perforatum) — a strong CYP3A4 inducer. Herbal supplement for mild depression that may reduce Moventig's effectiveness
- Grapefruit juice — a moderate CYP3A4 inhibitor. Avoid consuming large quantities of grapefruit juice while taking Moventig
- Other laxatives — Moventig can be used alongside laxatives. Your doctor will advise whether to continue your current laxative regimen
- Methadone — use with caution due to the potential risk of opioid withdrawal symptoms
- Opioid antagonists (naltrexone, naloxone) — concomitant use may increase the risk of opioid withdrawal
What Is the Correct Dosage of Moventig?
The recommended dose of Moventig is 25 mg once daily, taken in the morning on an empty stomach. A reduced dose of 12.5 mg may be prescribed for patients with kidney impairment or those taking moderate CYP3A4 inhibitors. Always follow your doctor's instructions.
Adults
Standard Dosing
Recommended dose: 25 mg once daily
When to take: In the morning, to avoid the need to use the toilet during the night
How to take: On an empty stomach — at least 30 minutes before your first meal, or at least 2 hours after your first meal
Duration: Continue for as long as you are taking opioid pain medication. Stop Moventig when opioid therapy is discontinued
Reduced Dose (12.5 mg)
Your doctor may prescribe the lower 12.5 mg dose if:
- You have moderate or severe kidney impairment (the starting dose in renal impairment is 12.5 mg; may be increased to 25 mg if tolerated)
- You are taking diltiazem or verapamil (moderate CYP3A4 inhibitors)
| Patient Group | Starting Dose | Maximum Dose | Notes |
|---|---|---|---|
| Adults (normal kidney function) | 25 mg once daily | 25 mg once daily | Standard dose; take on empty stomach |
| Moderate renal impairment | 12.5 mg once daily | 25 mg once daily | May increase if tolerated and needed |
| Severe renal impairment | 12.5 mg once daily | 25 mg once daily | Monitor closely; increase with caution |
| On diltiazem/verapamil | 12.5 mg once daily | 25 mg once daily | May increase based on tolerability |
| Mild hepatic impairment | 25 mg once daily | 25 mg once daily | No dose adjustment required |
| Severe hepatic impairment | Not recommended | N/A | Insufficient data; avoid use |
Children and Adolescents
Moventig is not recommended for use in children and adolescents under 18 years of age. Safety and efficacy have not been established in this population. If a child or adolescent requires treatment for opioid-induced constipation, the prescribing physician should consider alternative therapies with established paediatric data.
Elderly Patients
No dose adjustment is required based on age alone. However, elderly patients are more likely to have impaired kidney function, so renal function should be assessed before starting Moventig. Your doctor will determine the appropriate dose based on your individual kidney function.
Difficulty Swallowing
If you have difficulty swallowing the tablet, you may crush it and mix it with water:
- Crush the tablet into a fine powder
- Pour the powder into half a glass of water (approximately 120 ml)
- Stir and drink immediately
- Rinse the glass with another half glass of water (120 ml) and drink the rinse to ensure you receive the full dose
Missed Dose
If you miss a dose, take it as soon as you remember. However, if it is less than 12 hours before your next scheduled dose, skip the missed dose and take your next dose at the regular time. Do not take a double dose to make up for a forgotten one.
Overdose
If you have taken more Moventig than prescribed, contact a doctor or go to the nearest hospital immediately. Symptoms of overdose may include an increase in gastrointestinal side effects such as abdominal pain and diarrhoea, as well as symptoms of opioid withdrawal.
What Are the Side Effects of Moventig?
Like all medicines, Moventig can cause side effects, although not everybody gets them. The most common side effects are abdominal pain and diarrhoea. Most side effects are gastrointestinal in nature and tend to be mild to moderate in severity, often improving over time.
Clinical trials involving over 2,500 patients have established the safety profile of naloxegol. The majority of adverse events were related to the gastrointestinal tract, which is expected given the drug's mechanism of action in the gut. Below is a comprehensive overview of reported side effects organised by frequency.
You develop symptoms of opioid withdrawal syndrome (a combination of three or more of: low mood, nausea, vomiting, muscle aches, increased tear production, runny nose, dilated pupils, goosebumps, excessive sweating, diarrhoea, yawning, fever, or difficulty sleeping). These symptoms usually appear within the first few days of starting treatment. Opioid withdrawal may occur in up to 1 in 100 people.
Very Common
May affect more than 1 in 10 people
- Abdominal pain (stomach pain, cramping)
- Diarrhoea (frequent, watery stools)
Common
May affect up to 1 in 10 people
- Flatulence (intestinal gas)
- Nausea
- Vomiting
- Nasopharyngitis (runny or stuffy nose)
- Headache
- Hyperhidrosis (excessive sweating)
Uncommon
May affect up to 1 in 100 people
- Opioid withdrawal syndrome (combination of mood changes, nausea, muscle aches, sweating, diarrhoea, and other symptoms)
Not Known
Frequency cannot be estimated from available data
- Allergic reactions (hypersensitivity)
- Gastrointestinal perforation (development of a hole in the intestinal wall)
Most gastrointestinal side effects occur during the first few days of treatment and tend to diminish over time as the body adjusts. If you experience persistent or severe abdominal pain, it is important to contact your doctor, as this may indicate a more serious complication. Your doctor may recommend reducing the dose to 12.5 mg or discontinuing the medication if side effects are intolerable.
If you experience any side effects, including any not listed above, talk to your doctor, pharmacist, or nurse. You can also report side effects directly to your national pharmacovigilance authority (e.g., the Yellow Card Scheme in the UK, MedWatch in the US, or EudraVigilance in the EU). Reporting helps to continuously monitor the benefit-risk balance of this medicine.
How Should You Store Moventig?
Store Moventig at temperatures below 25°C (77°F) in the original packaging. Keep out of the sight and reach of children. Do not use after the expiry date printed on the carton.
Proper storage of medication is essential to maintain its effectiveness and safety. Follow these guidelines for storing Moventig:
- Temperature: Store at or below 25°C (77°F). Do not freeze
- Location: Keep in a dry place away from direct sunlight and moisture
- Child safety: Store out of the sight and reach of children
- Expiry date: Do not use Moventig after the expiry date shown on the carton (marked "EXP"). The expiry date refers to the last day of that month
- Disposal: Do not dispose of medications via wastewater or household waste. Ask your pharmacist about proper disposal methods to help protect the environment
What Does Moventig Contain?
Each Moventig tablet contains naloxegol (as naloxegol oxalate) as the active ingredient, available in 12.5 mg and 25 mg strengths. The tablets are pink, oval, and film-coated.
Active Ingredient
The active substance is naloxegol (present as naloxegol oxalate):
- Each 12.5 mg film-coated tablet contains 12.5 mg naloxegol
- Each 25 mg film-coated tablet contains 25 mg naloxegol
Inactive Ingredients (Excipients)
Tablet core: Mannitol (E421), microcrystalline cellulose (E460), croscarmellose sodium (E468), magnesium stearate (E470b), propyl gallate (E310).
Film coating: Hypromellose (E464), titanium dioxide (E171), macrogol (E1521), red iron oxide (E172), black iron oxide (E172).
Appearance and Pack Sizes
Moventig 12.5 mg: Pink, oval film-coated tablet measuring 10.5 × 5.5 mm, debossed with "nGL" on one side and "12.5" on the other.
Moventig 25 mg: Pink, oval film-coated tablet measuring 13 × 7 mm, debossed with "nGL" on one side and "25" on the other.
Available in aluminium blister packs of 10, 30, or 90 tablets (non-perforated), or as 10 × 1, 30 × 1, 90 × 1, or 100 × 1 tablets in perforated unit-dose blisters. Not all pack sizes may be marketed in all countries.
Frequently Asked Questions About Moventig
Moventig (naloxegol) is used to treat opioid-induced constipation (OIC) in adults who are taking opioid pain medications regularly, such as morphine, oxycodone, fentanyl, tramadol, or codeine. It is prescribed when laxatives alone have not provided adequate relief. Moventig works by blocking opioid receptors in the gut without affecting pain relief in the brain, thus helping to restore normal bowel function.
Take one tablet once daily in the morning on an empty stomach. This means at least 30 minutes before your first meal or 2 hours after your first meal. Taking it in the morning helps avoid night-time bowel movements. Swallow the tablet whole with water, or crush it and mix with water if you have difficulty swallowing. The standard dose is 25 mg, but your doctor may prescribe 12.5 mg based on your kidney function or other medications.
The most common side effects are abdominal pain and diarrhoea, which affect more than 1 in 10 people. Other common side effects include flatulence (gas), nausea, vomiting, nasopharyngitis (stuffy or runny nose), headache, and excessive sweating. These side effects are usually mild to moderate and often improve within the first few days of treatment as your body adjusts to the medication.
Moventig has several important drug interactions. You must not take it with strong CYP3A4 inhibitors such as ketoconazole, itraconazole, clarithromycin, telithromycin, or HIV protease inhibitors (ritonavir, indinavir, saquinavir). If you take diltiazem or verapamil, your dose may need to be reduced to 12.5 mg. Strong CYP3A4 inducers such as rifampin, carbamazepine, or St. John's Wort may reduce Moventig's effectiveness. You should also avoid large amounts of grapefruit juice. Moventig can be taken alongside most laxatives.
No, you do not need to stop your laxatives unless your doctor specifically tells you to. When you start Moventig, you can continue using your current laxatives. Your doctor will advise you on whether to adjust or discontinue laxatives based on how your bowel function responds to Moventig. Some patients find they need fewer laxatives once Moventig takes effect, but this should be discussed with your healthcare provider.
Moventig is not recommended during pregnancy due to limited safety data. It is also not known whether naloxegol is excreted in breast milk, so breastfeeding is not recommended during Moventig treatment. If you are pregnant, planning to become pregnant, or breastfeeding, discuss alternative treatment options with your doctor before starting Moventig.
References
- European Medicines Agency (EMA). Moventig (naloxegol) – Summary of Product Characteristics. Available at: EMA EPAR Moventig. Last updated 2024.
- Chey WD, Webster L, Sostek M, Lappalainen J, Barker PN, Tack J. Naloxegol for opioid-induced constipation in patients with noncancer pain. N Engl J Med. 2014;370(25):2387-2396. doi:10.1056/NEJMoa1310246
- Webster L, Chey WD, Tack J, Lappalainen J, Diva U, Sostek M. Randomised clinical trial: the long-term safety and tolerability of naloxegol in patients with pain and opioid-induced constipation. Aliment Pharmacol Ther. 2014;40(7):771-779.
- Brenner DM, Argoff CE, Fox SM, et al. American Gastroenterological Association Institute Technical Review on the medical management of opioid-induced constipation. Gastroenterology. 2019;156(1):229-253.
- Crockett SD, Greer KB, Heidelbaugh JJ, et al. American Gastroenterological Association Institute Guideline on the medical management of opioid-induced constipation. Gastroenterology. 2019;156(1):218-226.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List (2023). Geneva: World Health Organization; 2023.
- National Institute for Health and Care Excellence (NICE). Naloxegol for treating opioid-induced constipation. Technology appraisal guidance [TA345]. Published July 2015.
- British National Formulary (BNF). Naloxegol. Available at: BNF Online. Accessed February 2026.
Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, a multidisciplinary group of licensed physicians and pharmacologists with expertise in pain management, gastroenterology, and clinical pharmacology.
All content is reviewed by board-certified physicians following international clinical guidelines (EMA, FDA, WHO, AGA) and the GRADE evidence framework.
Evidence Level 1A based on systematic reviews and randomised controlled trials. All references are from peer-reviewed journals and regulatory agencies.
No commercial funding. No pharmaceutical sponsorship. All editorial decisions are made independently by the medical team.
This article is regularly reviewed and updated to reflect the latest evidence, guidelines, and safety information.