Details of the Drug

General Information of Drug (ID: DML0B41)

• Drug Name: Naloxegol
• Synonyms: NKTR-118

Indication

Disease Entry	ICD 11	Status	REF
Opioid-induced constipation	DB32.1	Approved	[1]

• Affected Organisms: Humans and other mammals
• ATC Code:
  A06AH03: Naloxegol
  A06AH: Peripheral opioid receptor antagonists
  A06A: DRUGS FOR CONSTIPATION
  A06: DRUGS FOR CONSTIPATION
  A: ALIMENTARY TRACT AND METABOLISM
• Drug Type: Small molecular drug
• #Ro5 Violations (Lipinski): 3:
  Molecular Weight (mw); 651.8
  Logarithm of the Partition Coefficient (xlogp); -1
  Rotatable Bond Count (rotbonds); 24
  Hydrogen Bond Donor Count (hbonddonor); 2
  Hydrogen Bond Acceptor Count (hbondacc); 12
• ADMET Property:
  Absorption Tmax: The time to maximum plasma concentration (Tmax) is 2 h []
  Clearance: The drug is cleared by the feces and urine []
  Half-life: The concentration or amount of drug in body reduced by one-half in 6 - 11 hours [2]
  Metabolism: The drug is metabolized via the cytochrome P450 enzym 3A4 enzyme system and undergoes enterohepatic recycling []
  Vd: The volume of distribution (Vd) of drug is 968-2140 L []
• Chemical Identifiers:
  Formula: C34H53NO11
  IUPAC Name: (4R,4aS,7S,7aR,12bS)-7-[2-[2-[2-[2-[2-[2-(2-methoxyethoxy)ethoxy]ethoxy]ethoxy]ethoxy]ethoxy]ethoxy]-3-prop-2-enyl-1,2,4,5,6,7,7a,13-octahydro-4,12-methanobenzofuro[3,2-e]isoquinoline-4a,9-diol
  Canonical SMILES: COCCOCCOCCOCCOCCOCCOCCO[C@H]1CC[C@]2([C@H]3CC4=C5[C@]2([C@H]1OC5=C(C=C4)O)CCN3CC=C)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
  InChIKey: XNKCCCKFOQNXKV-ZRSCBOBOSA-N
• Cross-matching ID:
  PubChem CID: 56959087
  ChEBI ID: CHEBI:82975
  CAS Number: 854601-70-0
  UNII: 44T7335BKE
  DrugBank ID: DB09049
  TTD ID: D07LCF
  VARIDT ID: DR01266
  INTEDE ID: DR1126
  ACDINA ID: D00454

Molecular Interaction Atlas of This Drug

Drug Therapeutic Target (DTT)

DTT Name	DTT ID	UniProt ID	MOA	REF
Opioid receptor mu (MOP)	TTKWM86	OPRM_HUMAN	Modulator	[3]

Drug Transporter (DTP)

DTP Name	DTP ID	UniProt ID	MOA	REF
P-glycoprotein 1 (ABCB1)	DTUGYRD	MDR1_HUMAN	Substrate	[4]

Drug-Metabolizing Enzyme (DME)

DME Name	DME ID	UniProt ID	MOA	REF
Cytochrome P450 3A4 (CYP3A4) Main DME	DE4LYSA	CP3A4_HUMAN	Substrate	[5]

Molecular Expression Atlas of This Drug

• The Studied Disease: Opioid-induced constipation
• ICD Disease Classification: DB32.1

Molecule Name	Molecule Type	Gene Name	p-value	Fold-Change	Z-score
Opioid receptor mu (MOP)	DTT	OPRM1	5.94E-01	-0.02	-0.17
P-glycoprotein 1 (ABCB1)	DTP	P-GP	7.83E-01	4.69E-02	1.89E-01
Cytochrome P450 3A4 (CYP3A4)	DME	CYP3A4	6.06E-01	-2.42E-02	-1.64E-01

Drug-Drug Interaction (DDI) Information of This Drug

Coadministration of a Drug Treating the Disease Different from Naloxegol (Comorbidity)

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Comorbidity	REF
Ivosidenib	DM8S6T7	Moderate	Increased metabolism of Naloxegol caused by Ivosidenib mediated induction of CYP450 enzyme.	Acute myeloid leukaemia [2A60]	[6]
Gilteritinib	DMTI0ZO	Minor	Decreased clearance of Naloxegol due to the transporter inhibition by Gilteritinib.	Acute myeloid leukaemia [2A60]	[6]
Troleandomycin	DMUZNIG	Major	Decreased metabolism of Naloxegol caused by Troleandomycin mediated inhibition of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[7]
Erdafitinib	DMI782S	Moderate	Decreased clearance of Naloxegol due to the transporter inhibition by Erdafitinib.	Bladder cancer [2C94]	[8]
Pexidartinib	DMS2J0Z	Moderate	Increased metabolism of Naloxegol caused by Pexidartinib mediated induction of CYP450 enzyme.	Bone/articular cartilage neoplasm [2F7B]	[6]
HKI-272	DM6QOVN	Minor	Decreased clearance of Naloxegol due to the transporter inhibition by HKI-272.	Breast cancer [2C60-2C6Y]	[6]
Tucatinib	DMBESUA	Major	Decreased metabolism of Naloxegol caused by Tucatinib mediated inhibition of CYP450 enzyme.	Breast cancer [2C60-2C6Y]	[7]
Alpelisib	DMEXMYK	Minor	Decreased clearance of Naloxegol due to the transporter inhibition by Alpelisib.	Breast cancer [2C60-2C6Y]	[6]
PF-04449913	DMSB068	Minor	Decreased clearance of Naloxegol due to the transporter inhibition by PF-04449913.	Chronic myelomonocytic leukaemia [2A40]	[6]
Osilodrostat	DMIJC9X	Minor	Decreased metabolism of Naloxegol caused by Osilodrostat mediated inhibition of CYP450 enzyme.	Cushing syndrome [5A70]	[6]
Lumacaftor	DMCLWDJ	Major	Increased metabolism of Naloxegol caused by Lumacaftor mediated induction of CYP450 enzyme.	Cystic fibrosis [CA25]	[9]
MK-8228	DMOB58Q	Major	Decreased metabolism of Naloxegol caused by MK-8228 mediated inhibition of CYP450 enzyme.	Cytomegaloviral disease [1D82]	[9]
Stiripentol	DMMSDOY	Major	Decreased metabolism of Naloxegol caused by Stiripentol mediated inhibition of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[9]
Eslicarbazepine	DMZREFQ	Moderate	Increased metabolism of Naloxegol caused by Eslicarbazepine mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[6]
Tazemetostat	DMWP1BH	Moderate	Increased metabolism of Naloxegol caused by Tazemetostat mediated induction of CYP450 enzyme.	Follicular lymphoma [2A80]	[6]
Daclatasvir	DMSFK9V	Minor	Decreased clearance of Naloxegol due to the transporter inhibition by Daclatasvir.	Hepatitis virus infection [1E50-1E51]	[6]
Cobicistat	DM6L4H2	Major	Decreased metabolism of Naloxegol caused by Cobicistat mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[7]
Berotralstat	DMWA2DZ	Major	Decreased metabolism of Naloxegol caused by Berotralstat mediated inhibition of CYP450 enzyme.	Innate/adaptive immunodeficiency [4A00]	[9]
Brigatinib	DM7W94S	Minor	Decreased clearance of Naloxegol due to the transporter inhibition by Brigatinib.	Lung cancer [2C25]	[6]
Ceritinib	DMB920Z	Major	Decreased metabolism of Naloxegol caused by Ceritinib mediated inhibition of CYP450 enzyme.	Lung cancer [2C25]	[7]
PF-06463922	DMKM7EW	Moderate	Increased metabolism of Naloxegol caused by PF-06463922 mediated induction of CYP450 enzyme.	Lung cancer [2C25]	[6]
Capmatinib	DMYCXKL	Minor	Decreased metabolism of Naloxegol caused by Capmatinib mediated inhibition of CYP450 enzyme.	Lung cancer [2C25]	[6]
Selpercatinib	DMZR15V	Minor	Decreased metabolism of Naloxegol caused by Selpercatinib mediated inhibition of CYP450 enzyme.	Lung cancer [2C25]	[6]
Idelalisib	DM602WT	Major	Decreased metabolism of Naloxegol caused by Idelalisib mediated inhibition of CYP450 enzyme.	Mature B-cell leukaemia [2A82]	[7]
GDC-0199	DMH0QKA	Minor	Decreased metabolism of Naloxegol caused by GDC-0199 mediated inhibition of CYP450 enzyme.	Mature B-cell leukaemia [2A82]	[6]
IPI-145	DMWA24P	Major	Decreased metabolism of Naloxegol caused by IPI-145 mediated inhibition of CYP450 enzyme.	Mature B-cell leukaemia [2A82]	[9]
Lasmiditan	DMXLVDT	Moderate	Decreased clearance of Naloxegol due to the transporter inhibition by Lasmiditan.	Migraine [8A80]	[10]
Fedratinib	DM4ZBK6	Major	Decreased metabolism of Naloxegol caused by Fedratinib mediated inhibition of CYP450 enzyme.	Myeloproliferative neoplasm [2A20]	[9]
Rolapitant	DM8XP26	Minor	Decreased clearance of Naloxegol due to the transporter inhibition by Rolapitant.	Nausea/vomiting [MD90]	[6]
Entrectinib	DMMPTLH	Minor	Decreased metabolism of Naloxegol caused by Entrectinib mediated inhibition of CYP450 enzyme.	Non-small cell lung cancer [2C25]	[6]
Rucaparib	DM9PVX8	Minor	Decreased clearance of Naloxegol due to the transporter inhibition by Rucaparib.	Ovarian cancer [2C73]	[6]
Istradefylline	DM20VSK	Minor	Decreased metabolism of Naloxegol caused by Istradefylline mediated inhibition of CYP450 enzyme.	Parkinsonism [8A00]	[6]
Abametapir	DM2RX0I	Moderate	Decreased metabolism of Naloxegol caused by Abametapir mediated inhibition of CYP450 enzyme.	Pediculosis [1G00]	[11]
Lefamulin	DME6G97	Moderate	Decreased metabolism of Naloxegol caused by Lefamulin mediated inhibition of CYP450 enzyme.	Pneumonia [CA40]	[6]
Voxelotor	DMCS6M5	Major	Decreased metabolism of Naloxegol caused by Voxelotor mediated inhibition of CYP450 enzyme.	Sickle-cell disorder [3A51]	[9]
Telotristat ethyl	DMDIYFZ	Moderate	Increased metabolism of Naloxegol caused by Telotristat ethyl mediated induction of CYP450 enzyme.	Small intestine developmental anomaly [DA90]	[9]
Larotrectinib	DM26CQR	Minor	Decreased metabolism of Naloxegol caused by Larotrectinib mediated inhibition of CYP450 enzyme.	Solid tumour/cancer [2A00-2F9Z]	[6]
LEE011	DMMX75K	Major	Decreased metabolism of Naloxegol caused by LEE011 mediated inhibition of CYP450 enzyme.	Solid tumour/cancer [2A00-2F9Z]	[9]
Fostamatinib	DM6AUHV	Moderate	Decreased clearance of Naloxegol due to the transporter inhibition by Fostamatinib.	Thrombocytopenia [3B64]	[12]
Elagolix	DMB2C0E	Moderate	Increased metabolism of Naloxegol caused by Elagolix mediated induction of CYP450 enzyme.	Uterine fibroid [2E86]	[6]

Drug Inactive Ingredient(s) (DIG) and Formulation(s) of This Drug

DIG

DIG Name	DIG ID	PubChem CID	Functional Classification
Mannitol	E00103	6251	Diluent; Flavoring agent; Lyophilization aid; Plasticizing agent; Tonicity agent
Propyl gallate	E00075	4947	Antimicrobial preservative; Antioxidant
Carmellose sodium	E00625	Not Available	Disintegrant
Eisenoxyd	E00585	56841934	Colorant
Ferric oxide black	E00522	16211978	Colorant
Ferrosoferric oxide	E00231	14789	Colorant
Hypromellose	E00634	Not Available	Coating agent
Magnesium stearate	E00208	11177	lubricant
Polyethylene glycol 400	E00653	Not Available	Coating agent; Diluent; Ointment base; Plasticizing agent; Solvent; Suppository base; lubricant
Polyethylene glycol 4000	E00654	Not Available	Coating agent; Diluent; Ointment base; Plasticizing agent; Solvent; Suppository base; lubricant
Titanium dioxide	E00322	26042	Coating agent; Colorant; Opacifying agent
Water	E00035	962	Solvent
Haematite red	E00236	14833	Colorant
Cellulose microcrystalline	E00698	Not Available	Adsorbent; Suspending agent; Diluent

Pharmaceutical Formulation

Formulation Name	Drug Dosage	Dosage Form	Route
Naloxegol 12.5 mg tablet	12.5 mg	Oral Tablet	Oral
Naloxegol 25 mg tablet	25 mg	Oral Tablet	Oral
Naloxegol Oxalate eq 12.5mg base tablet	eq 12.5mg base	Tablet	Oral
Naloxegol Oxalate eq 25mg base tablet	eq 25mg base	Tablet	Oral

Jump to Detail Pharmaceutical Formulation Page of This Drug

References

• [1] URL: http://www.guidetopharmacology.org Nucleic Acids Res. 2015 Oct 12. pii: gkv1037. The IUPHAR/BPS Guide to PHARMACOLOGY in 2016: towards curated quantitative interactions between 1300 protein targets and 6000 ligands. (Ligand id: 7539).
• [2] Trend Analysis of a Database of Intravenous Pharmacokinetic Parameters in Humans for 1352 Drug Compounds
• [3] 2014 FDA drug approvals. Nat Rev Drug Discov. 2015 Feb;14(2):77-81.
• [4] Tarascon Pocket Pharmacopoeia 2018 Classic Shirt-Pocket Edition.
• [5] Naloxegol: treatment for opioid-induced constipation in chronic non-cancer pain. Ann Pharmacother. 2015 Mar;49(3):360-5.
• [6] Product Information. Movantik (naloxegol). Astra-Zeneca Pharmaceuticals, Wilmington, DE.
• [7] Cerner Multum, Inc. "Australian Product Information.".
• [8] Product Information. Balversa (erdafitinib). Janssen Products, LP, Horsham, PA.
• [9] Cerner Multum, Inc. "UK Summary of Product Characteristics.".
• [10] Product Information. Reyvow (lasmiditan). Lilly, Eli and Company, Indianapolis, IN.
• [11] Product Information. Xeglyze (abametapir topical). Dr. Reddy's Laboratories Inc, Upper Saddle River, NJ.
• [12] Product Information. Tavalisse (fostamatinib). Rigel Pharmaceuticals, South San Francisco, CA.