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Heroin Addiction and Related Clinical Problems: 2025, 27, 23

Naldemedine’s Role in Relieving Opioid-Induced Constipation Among Patients on Opioid Agonist Treatment

Stefano Sacco, Carolina Cappa, Fabio Sacco, Michele Scarzella, and Luigi Bartoletti

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-23

Summary: Background: Opioid medications are extensively employed in clinical practice for managing moderate to severe pain and for treating drug addiction through agonist therapy. However, their long-term use can lead to a range of adverse effects that may diminish patients’ quality of life. Among these, constipation is one of the most common manifestations of opioid-induced bowel dysfunction. This condition poses significant challenges for patients, necessitating effective management strategies to improve gastrointestinal health. Methods: This study evaluated the effect of naldemedine on a group of patients undergoing opioid agonist therapy primarily with methadone and levomethadone. Naldemedine, the most recently introduced PAMORA, has demonstrated efficacy in improving both small and large bowel movements in patients with chronic OIC. The effect on alleviating OIC symptoms was assessed starting 5 months after the initiation of therapy. Results: Naldemedine demonstrated efficacy in alleviating OIC in the majority of patients undergoing therapy, with significant improvements observed during the clinical assessment conducted at 5 months following treatment initiation. The therapeutic effects were sustained for the subsequent 36 months, and no significant adverse effects were reported throughout the treatment period. Conclusions: Naldemedine has proven effective and is associated with minimal side effects in the treatment of opioid-induced constipation (OIC) among patients undergoing drug addiction therapy through agonist treatment. This is the first study to demonstrate its long-term efficacy in patients receiving opioid agonist therapy, highlighting its potential as a sustained therapeutic option in this population.

Keywords: Opioids; addiction; opioid-Induced Constipation (OIC); PAMORA; quality of life