Symproic
Symproic (naldemedine) is a prescription opioid antagonist. More specifically, it's a peripherally acting mu-opioid receptor antagonist (PAMORA) that targets opioid receptors in the gut. It's a first-choice treatment option for opioid-induced constipation in adults. It comes as a tablet that's taken by mouth once per day with or without food. Side effects include stomach pain, diarrhea, and nausea. Symproic (naldemedine) is brand name only and not available as a generic.
What is Symproic (naldemedine)?
What is Symproic (naldemedine) used for?
Constipation from opioid pain medications in adults with long-term pain not due to cancer
How Symproic (naldemedine) works
People who take opioid medications for pain commonly experience constipation as a side effect. This is because opioid receptors are found in the brain and the gut. Opioid medications ease pain by affecting the receptors in the brain, but they cause constipation when they affect the receptors in the gut.
Symproic (naldemedine) is a peripherally acting mu-opioid receptor antagonist (PAMORA). This means that it blocks opioid receptors in the gut only, but not in the brain. As a result, Symproic (naldemedine) relieves constipation from opioid medications, without affecting their pain-relieving actions.
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What are the side effects of Symproic (naldemedine)?
Common Side Effects
- Stomach pain (11%)
- Diarrhea (7%)
- Nausea (6%)
Other Side Effects
- Vomiting
- Gut inflammation
Serious Side Effects
- Stomach tear: severe, persistent, or worsening stomach pain
- Opioid withdrawal: mood changes, anxiety, irritability, restlessness, stomach cramps, sweating, chills
- Serious allergic reaction: rash, swelling in the face or throat, trouble breathing
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Stomach pain that is severe, does not go away, or gets worse
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Symproic (naldemedine)
Pros
Good option if over-the-counter stool softeners or laxatives don't work well
Taken by mouth once a day
Most people have bowel movement within 24 hours
Cons
Tablet only; might be hard to take for people who have trouble swallowing
Only for adults
Raises your risk for opioid withdrawal
Pharmacist tips for Symproic (naldemedine)
You can take Symproic (naldemedine) with or without food. If it's hurting your stomach, try taking it with food to help.
Your healthcare will ask you to stop taking Symproic (naldemedine) once you no longer need to take opioid pain medications. Opioid-related constipation will go away on its own when you stop taking opioids.
Your prescriber might recommend taking Symproic (naldemedine) alone for a few days to see how you respond to the medication. If you're still constipated, ask your prescriber if you should use other laxatives with Symproic (naldemedine).
Seek medical help if you experience severe, continuous stomach pain. This can be a sign of a serious stomach tear that Symproic (naldemedine) can rarely cause. You'll need to be seen and treated urgently.
Symproic (naldemedine) can sometimes cause diarrhea. Make sure to stay hydrated if you have diarrhea while you're taking this medication. Seek medical help if you feel dizzy, lightheaded, or if your symptoms don't get better after a few days.
Make sure to tell your care team about all of the prescription and over-the-counter medication you take. Symproic (naldemedine) interacts with many medications, and these interactions can be harmful.
Frequently asked questions about Symproic (naldemedine)
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What are the risks and warnings for Symproic (naldemedine)?
Symproic (naldemedine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Gastrointestinal (stomach or intestinal) injury
Risk factors: Gastrointestinal cancer | Recent gastrointestinal surgery | Gastrointestinal inflammation such as Crohn's disease, diverticulitis, or colitis
In some rare cases, people who've taken Symproic (naldemedine) reported having stomach or gut problems, including inflammation or a tear in the wall of the gut. This can be dangerous and require hospitalization. Before you start Symproic (naldemedine), let your prescriber know if you have a history of bowel or gut-related problems. Notify your healthcare team right away if you have severe stomach pain, stomach pain that doesn't go away, worsening stomach pain, chills, or fever.
Opioid withdrawal
Risk factors: Brain injury | Stroke
Although rare, some people who took Symproic (naldemedine) experienced withdrawal symptoms, such as sweating, chills, diarrhea, stomach pain, anxiety, and irritability. In some rare cases, you might also get less pain relief from your opioid medication. People who have medical conditions that affects the blood–brain barrier (BBB), such as stroke or brain injury, are at higher risk for these side effects. Talk to your prescriber if you experience any withdrawal symptoms or if your pain medication isn't working as well anymore.
Symproic (naldemedine) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 0.2mg | 30 tablets | $472.20 | $15.74 |
Typical dosing for Symproic (naldemedine)
Adults: The typical dose is 0.2 mg by mouth once a day.
How much does Symproic (naldemedine) cost?
Symproic (naldemedine) contraindications
Known or suspected blockage in the gut
What are alternatives to Symproic (naldemedine)?
Constipation from opioid pain medications in adults with long-term pain not due to cancer
Constipation due to opioid pain medications
Symproic (naldemedine) images
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References
Best studies we foundBioDelivery Sciences International Inc. (2022). Symproic- naldemedine tablet [package insert]. DailyMed.
Carlin, M. G., et al. (2020). Opium alkaloids in harvested and thermally processed poppy seeds. Frontiers in Chemistry.
Crockett, S. D., et al. (2019). American Gastroenterological Association Institute Guideline on the medical management of opioid-induced constipation. Gastroenterology.
MedlinePlus. (2024). Gastrointestinal perforation.
Pergolizzi, J. V., Jr, et al. (2020). The use of peripheral μ-opioid receptor antagonists (PAMORA) in the management of opioid-induced constipation: An update on their efficacy and safety. Drug Design, Development and Therapy.
Profaci, C. P., et al. (2020). The blood-brain barrier in health and disease: Important unanswered questions. Journal of Experimental Medicine.
U.S. Drug Enforcement Administration and U.S. Department of Justice. (2017). Schedules of controlled substances: Removal of naldemedine from control. Federal Register.
Wild, J., et al. (2019). Onset of action of naldemedine in the treatment of opioid-induced constipation in patients with chronic noncancer pain: Results from 2 randomized, placebo-controlled, phase 3 trials. Pain.
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