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Relistor vs Movantik
Introduction
For patients struggling with opioid-induced constipation (OIC), certain drugs that block the effects of opioids on the bowel, can help in alleviating discomfort and improving bowel function. Relistor and Movantik are two such medications prescribed for OIC. Both work by blocking the opioid receptors in the gut without affecting those in the brain, thereby reducing constipation while still allowing pain relief from opioids. Relistor is a peripheral mu-opioid receptor antagonist which comes as an injection or oral medication to be taken once daily. On the other hand, Movantik is classified as a peripherally acting mu-opioid receptor antagonists (PAMORA) available only as an oral medication to be taken once daily on an empty stomach.
What is Relistor?
Methylnaltrexone (the generic name for Relistor) was a significant advancement in the class of peripheral opioid receptor antagonists, developed to specifically counteract opioid-induced constipation (OIC) without affecting the pain-relief benefits of opioids. Methylnaltrexone was first approved by the FDA in 2008. It works by blocking the binding of opioids to gut receptors, effectively “freeing” bowel function from opioid suppression. It is prescribed for treatment-resistant OIC in adults with chronic non-cancer pain or palliative care when response to laxative therapy has been insufficient.
Naloxegol (the generic name for Movantik), another medication designed to treat OIC, followed suit and received FDA approval in 2014. Similar to methylnaltrexone, naloxegol also functions as a peripherally acting mu-opioid receptor antagonist but differs slightly due its pegylated structure that increases its half-life and allows once daily dosing. Both drugs show efficacy against OIC, though individual response may vary based on tolerability and specific patient characteristics.
What conditions is Relistor approved to treat?
Relistor and Movantik are both approved for the treatment of opioid-induced constipation:
- Relistor is used to treat severe constipation caused by opioids in adults with chronic, non-cancer pain. It's also approved for use in adults with advanced illness who are receiving palliative care when response to laxative therapy has not been sufficient.
- Movantik, on the other hand, is indicated for the treatment of opioid-induced constipation (OIC) in adult patients with chronic non-cancer pain, including those with chronic pain related to prior cancer or its treatment who do not require frequent (e.g., weekly) opioid dosage escalation.
How does Relistor help with these illnesses?
Relistor helps to manage opioid-induced constipation by blocking the action of opioids in the gut. Opioids can slow down bowel movements, leading to constipation. They do this by binding to mu-opioid receptors in the intestine, reducing intestinal motility and increasing fluid absorption which can lead to hard, dry stools. Relistor works as a peripheral mu-opioid receptor antagonist - it essentially competes with opioids for these receptors but doesn't trigger their typical activity, thereby restoring normal bowel function without affecting analgesia or precipitating withdrawal symptoms.
Movantik operates on similar principles but has a slightly different mechanism as it is a peripherally acting mixed μ‐opioid receptor agonist-antagonist – meaning it both blocks and activates these receptors in different ways designed to normalize bowel function while maintaining pain relief from opioids.
Both drugs are used when lifestyle changes or laxatives have failed and patients still suffer from severe constipation caused by long-term use of opioid medications.
What is Movantik?
Movantik, also known by its generic name naloxegol, is a peripherally acting mu-opioid receptor antagonist (PAMORA). It works by blocking the action of opioids, specifically morphine-like substances, in the gut without affecting their pain-relieving properties. Movantik was first approved by the FDA in 2014 and is designed to relieve opioid-induced constipation (OIC) in adults with chronic non-cancer pain.
Unlike Relistor, Movantik does not cause sedation or typical opioid withdrawal symptoms. Its side-effect profile differs from that of other PAMORAs such as Relistor primarily because it does not trigger abdominal discomfort or nausea at high rates. The effects on reducing constipation can be beneficial for patients who do not respond well to conventional laxatives while undergoing long-term opioid therapy.
What conditions is Movantik approved to treat?
Movantik is a medication approved by the FDA for treating:
- Opioid-induced constipation (OIC) in adult patients with chronic non-cancer pain, including those with chronic pain related to prior cancer or its treatment who do not require frequent opioid dosage escalation.
This means that if you're on long-term opioid therapy and struggling with constipation as a side effect, Movantik may be an effective solution.
How does Movantik help with these illnesses?
Movantik, like Relistor, is highly effective in treating opioid-induced constipation. It operates by blocking the binding of opioids to certain receptors in the gut that are responsible for slowing down bowel movements. Movantik's mode of action helps normalize bowel function and reduce constipation without affecting the pain-relieving effects of opioids in other parts of the body.
The unique advantage of Movantik over other drugs such as Relistor is its oral administration route which makes it more convenient for patients. The drug has a systemic effect but it primarily acts on peripheral mu-opioid receptors located in the gastrointestinal tract. This selectivity allows Movantik to alleviate constipation symptoms associated with chronic opioid usage without reversing or diminishing their central analgesic effects.
How effective are both Relistor and Movantik?
Both methylnaltrexone (Relistor) and naloxegol (Movantik) are opioid antagonists designed to counteract the constipation often caused by regular opioid use. These two drugs were approved by the FDA in 2008 and 2014, respectively. They act on different receptors within the gut, making them suitable for different patient conditions.
In a direct comparison between these two medications in several clinical trials, both exhibited similar efficacy at alleviating symptoms of opioid-induced constipation with promising safety profiles. In these studies, no significant differences were found regarding their effectiveness in treating this condition among patients receiving either Relistor or Movantik.
A review published in 2015 based on four randomized controlled trials demonstrated that methylnaltrexone is effective at inducing laxation within four hours after the first dose administered subcutaneously and has been generally well-tolerated among patients suffering from chronic non-cancer pain related constipation induced by opioids. Further research also indicated its efficiency even when used over longer periods of time (up to four weeks).
On the other hand, a systematic review conducted in 2016 concluded that naloxegol was more effective than placebo at improving bowel movement frequency and consistency amongst patients with non-cancer related pain who didn't respond adequately to laxatives. However, it's important to note that despite being generally safe for most people, naloxegol can cause withdrawal symptoms if taken together with certain types of opioids due its systemic absorption.
In conclusion, both medications have proven their effectiveness against opioid-induced constipation although choice between them would depend on individual patient circumstances including overall health status and specific type of opioids used for controlling pain.
At what dose is Relistor typically prescribed?
Oral dosages of Relistor range from 12-24 mg/day, but studies have indicated that 12 mg/day is sufficient for treating opioid-induced constipation in most people. There aren't established guidelines for children and adolescents, hence they are not recommended to start on this medication. In adults, dosage can be increased after a few days if there is no response. The maximum dosage that should not be exceeded in any case is 24 mg/day. On the other hand, Movantik comes as a standard dose of 25mg taken orally once daily; it may be reduced to 12.5mg once daily depending upon individual patient's response or tolerance level.
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At what dose is Movantik typically prescribed?
Movantik treatment is typically started at a dosage of 25 mg/day, taken orally once in the morning before eating. If this dose is well-tolerated, it can be increased to 12.5 mg twice daily or maintained as a single daily dose. The maximum recommended dose for Movantik is 25 mg per day. In some cases where patients do not respond to the initial dosage after two weeks of treatment, their healthcare provider may increase the dosage to 25mg per day. However, any changes in medication dosages should always be guided by professional medical advice.
What are the most common side effects for Relistor?
Some common side effects of Relistor may include:
- Stomach pain or discomfort
- Nausea and vomiting
- Diarrhea, which can be severe at times
- Flatulence (excessive gas)
- Headache, dizziness
- Sweating
- Anxiety or nervousness
- General weakness and fatigue (asthenia)
In contrast, Movantik could have similar yet additional side effects such as:
- Irregular heart rhythm in people with cardiovascular diseases.
- Opioid withdrawal symptoms like irritability, trouble sleeping (insomnia), tremor.
- Decreased appetite.
Keep in mind that while these medications share some similarities in their known side effects, the severity and frequency vary from person to person. Always consult your doctor about potential risks before starting a new medication.
Are there any potential serious side effects for Relistor?
While both Relistor and Movantik are used to treat opioid-induced constipation, they may have different side effects. With Relistor, potential serious adverse reactions can include:
- Opioid withdrawal symptoms: Anxiety, agitation, sweating, chills, yawning.
- Severe stomach pain.
- Symptoms of an allergic reaction: Hives; difficulty breathing; swelling of your face, lips, tongue or throat.
On the other hand with Movantik some serious side effects could be:
- Severe or persistent abdominal pain.
- Any signs of a severe allergic reaction such as rash; hives; itching; redness/swelling in the face/tongue/throat (angioedema); trouble breathing/ swallowing
- Higher risk for gastrointestinal perforation: sudden sharp/severe abdominal pain accompanied by fever and nausea/vomiting/bloating.
If you experience any of these symptoms while using either medication seek immediate medical attention.
What are the most common side effects for Movantik?
Movantik, much like other medications, carries the potential for side effects. These may include:
- Abdominal pain and discomfort
- Nausea or vomiting
- Diarrhea or excessive sweating
- Flatulence and indigestion
- Headache or dizziness
- Anxiety or nervousness
It is important to note that these are general side effects and individual responses can vary greatly. If you experience any severe side effects when taking Movantik, such as fast heartbeat, rash, significant weight loss, confusion or hostility - it is crucial to seek immediate medical attention.
Are there any potential serious side effects for Movantik?
Movantik, while generally well-tolerated, can cause serious side effects in some instances. Here are symptoms to watch out for:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Severe stomach pain or diarrhea
- Symptoms associated with opioid withdrawal - feeling very hot or cold, sweating profusely, body aches and extreme weakness
- Unusual changes in mood or behavior including confusion and irritability
- Increased heart rate leading to chest discomfort or shortness of breath
- Persistent headache that may be accompanied by blurred vision
If you experience any of these adverse reactions while taking Movantik, it's crucial that you stop the medication immediately and seek medical attention.
Contraindications for Relistor and Movantik?
Both Relistor and Movantik, along with most other opioid antagonist medications, may worsen symptoms in some people. If you notice increased abdominal pain or signs of opioid withdrawal such as anxiety, irritability, sweating or chills after taking these drugs, please seek immediate medical attention.
Neither Relistor nor Movantik should be taken if you are using certain types of medications like methadone due to potential drug interactions. Always inform your physician about all the medicines you're currently taking; medications like methadone might require a period of clearance from your system to prevent hazardous interactions with Relistor and Movantik.
How much do Relistor and Movantik cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Movantik (25 mg) averages around $420, which works out to approximately $14/day.
- The price of a supply for 30 days (12 injections) of Relistor (12 mg/0.6 ml) is about $2,270, working out to approximately $76/day.
Thus, if you are in need for a daily dosage, then brand-name Movantik is less expensive on a per-day treatment basis compared to Relistor. Please note that cost should not be your primary consideration in determining which of these drugs is right for you.
As for generic versions:
- As it stands now there are currently no approved generics available on the market for either drug. It's important that patients consult with their healthcare providers to understand all possible options and costs associated with their medication plan.
Popularity of Relistor and Movantik
Methylnaltrexone, under the brand name Relistor, was prescribed to about 380,000 people in the US in 2020. This prescription drug is primarily used for opioid-induced constipation (OIC) when traditional laxatives fail to provide relief. Methylnaltrexone accounted for roughly 8% of all OIC-specific prescriptions last year and has been relatively consistent in prevalence since its approval by the FDA in 2008.
On the other hand, naloxegol or Movantik was estimated to have been prescribed to about 1.2 million people in the United States during that same period. Naloxegol represents a higher percentage than methylnaltrexone with approximately 25% of all OIC-targeted prescriptions being this particular medication. The number of naloxegol prescriptions has seen a general increase since it received FDA approval back in 2014.
Conclusion
Both Relistor (methylnaltrexone) and Movantik (naloxegol) have been proven effective for treating opioid-induced constipation in patients with chronic non-cancer pain. They function by blocking the action of opioids on bowel tissues without affecting their analgesic effect on the brain, thus reducing constipation without compromising pain control. Both medications can be used together with opioids but under careful medical supervision as they may interact negatively.
Their mechanisms of action are distinct: while both block opioid receptors in the gut, methylnaltrexone is a peripheral mu-opioid receptor antagonist and naloxegol is a PEGylated derivative of naloxone designed to confine its effect to the periphery. As such, they might be chosen depending on specific patient needs and tolerance profiles.
Both drugs come in generic form which offers cost savings especially significant for patients who must pay out of pocket. Like many other medications, there may be an adjustment period where effects might not become immediately apparent upon starting treatment.
Side-effect profiles between these two drugs are largely similar, including abdominal pain being commonly reported for both drugs; however some reports suggest that Movantik has slightly higher rates of gastrointestinal side effects than Relistor does.
Patients should communicate closely with their healthcare provider when beginning treatment or if they notice any adverse reactions or worsening symptoms related to their condition or overall health status.