Product review: NICE recommends naldemedine for opioid-induced constipation

NICE has recommended naldemedine (Rizmoic), within its marketing authorisation, as an option for treating opioid-induced constipation in adults who have had laxative treatment.

Opioid-induced constipation (OIC) is a prevalent and distressing side-effect of opioid therapy, which does not respond reliably to treatment with conventional laxatives. The condition can affect over 80% of cancer patients receiving opioids, according to an independent expert who gave evidence to the NICE appraisal panel, and affects around half (41-57%) of patients with chronic, non-cancer pain.

It is often associated with a reduction in workplace productivity, greater use of health services and a significant impact on a patient’s quality of life.

NICE considered naldemedine to be a cost-effective use of NHS resources as the presence of OIC is also associated with significantly higher healthcare costs compared to patients without OIC in both cancer and non-cancer pain.

Opioid-induced constipation is often overlooked

Naldemedine is an oral peripherally acting mu-opioid receptor antagonist (PAMORA) for adults who have had laxative treatment. It blocks opioid receptors in the peripheral nervous system, including in the gut to reduce the incidence of constipation associated with opioid analgesia. Unlike other PAMORAs, it can initially be taken in combination with a laxative.

The clinical evidence shows that naldemedine increases the frequency of bowel movements compared with no treatment and other PAMORAs.

Professor Anton Emmanuel, Consultant Neuro-Gastroenterologist, University College London Hospital and the National Hospital for Neurology and Neurosurgery said: “I welcome this positive NICE recommendation as it provides clinicians with an alternative treatment option for patients with OIC, a chronic and distressing condition that is often overlooked and under-managed by the health community.”