Naloxegol

Naloxegol

Clinical data
Trade names	Movantik, Moventig
AHFS/Drugs.com	movantik
License data	US FDA: Movantik
Pregnancy category	US: C (Risk not ruled out)
Routes of administration	Oral
ATC code	A06AH03 (WHO)
Legal status
Legal status	US: ℞-only
Pharmacokinetic data
Protein binding	~4.2%
Metabolism	Hepatic (CYP3A)
Biological half-life	6–11 h
Excretion	Feces (68%), urine (16%)
Identifiers
IUPAC name (5α,6α)-4,5-epoxy-6-(3,6,9,12,15,18,21-heptaoxadocos-1-yloxy)-17-(2-propen-1-yl)morphinan-3,14-diol
Synonyms	NKTR-118
CAS Number	854601-70-0
PubChem CID	56959087
ChemSpider	28651656
UNII	44T7335BKE
KEGG	D10479
ChEBI	CHEBI:82975
Chemical and physical data
Formula	C34H53NO11
Molar mass	651.785 g/mol
3D model (Jmol)	Interactive image
SMILES COCCOCCOCCOCCOCCOCCOCCO[C@H]1CC[C@]2([C@H]3Cc4ccc(c5c4[C@]2([C@H]1O5)CCN3CC=C)O)O
InChI InChI=1S/C34H53NO11/c1-3-9-35-10-8-33-30-26-4-5-27(36)31(30)46-32(33)28(6-7-34(33,37)29(35)25-26)45-24-23-44-22-21-43-20-19-42-18-17-41-16-15-40-14-13-39-12-11-38-2/h3-5,28-29,32,36-37H,1,6-25H2,2H3/t28-,29+,32-,33-,34+/m0/s1 Key:XNKCCCKFOQNXKV-ZRSCBOBOSA-N

Naloxegol (INN; PEGylated naloxol; trade names Movantik and Moventig) is a peripherally-selective opioid antagonist developed by AstraZeneca, licensed from Nektar Therapeutics, for the treatment of opioid-induced constipation. It was approved in 2014 in adult patients with chronic, non-cancer pain. Doses of 25 mg were found safe and well tolerated for 52 weeks. When given concomitantly with opioid analgesics, naloxegol reduced constipation-related side effects, while maintaining comparable levels of analgesia.

Chemically, naloxegol is a pegylated (polyethylene glycol-modified) derivative of α-naloxol. Specifically, the 5-α-hydroxyl group of α-naloxol is connected via an ether linkage to the free hydroxyl group of a monomethoxy-terminated n=7 oligomer of PEG, shown extending at the lower left of the molecule image at right. The "n=7" defines the number of two-carbon ethylenes, and so the chain length, of the attached PEG chain, and the "monomethoxy" indicates that the terminal hydroxyl group of the PEG is "capped" with a methyl group. The pegylation of the 5-α-hydroxyl side chain of naloxol prevents the drug from crossing the blood-brain barrier (BBB). As such, it can be considered the antithesis of the peripherally-acting opiate loperamide which is utilized as an opiate-targeting anti-diarrheal agent that does not cause traditional opiate side-effects due to its inability to accumulate in the central nervous system in normal subjects.