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Naldemedine PAMORA for OIC — SCE Palliative Medicine MCQ

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ModeratePain ManagementNaldemedine PAMORA for OICSCE Palliative Medicine

A 68‑year‑old woman with advanced ovarian cancer has opioid‑induced constipation despite regular laxatives. Her palliative care team considers naldemedine as an alternative to naloxegol. What is naldemedine?

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Correct answer: A — A peripherally‑acting mu‑opioid receptor antagonist (PAMORA) that blocks GI opioid receptors without crossing the blood–brain barrier, thereby preserving analgesia

Naldemedine is a peripherally‑acting mu‑opioid receptor antagonist (PAMORA) licensed in the UK to treat opioid‑induced constipation in adults after laxative treatment. It blocks opioid receptors in the gut, reversing opioid‑induced bowel dysfunction, but does not penetrate the central nervous system, preserving analgesia and minimizing withdrawal risk. It is not a laxative stimulant, stool softener, prokinetic agent, or an opioid agonist. This is in line with NICE TA651 recommendations and the SmPC mechanism of action.

Reference: NICE TA651: Naldemedine for treating opioid‑induced constipation (2020) and SmPC Rizmoic (naldemedine) mechanism section (2025)