When Symproic Isn't Available, You Still Have Options

If you've been prescribed Symproic (Naldemedine) for opioid-induced constipation (OIC) but can't find it in stock — or can't afford it — you may be wondering what else is out there. The good news is that there are several other FDA-approved medications that treat OIC.

This guide covers what Symproic is, how it works, and the best alternatives you can discuss with your doctor.

What Is Symproic and What Does It Treat?

Symproic is the brand name for Naldemedine, a medication approved by the FDA in 2017 for the treatment of opioid-induced constipation in adults with chronic non-cancer pain.

If you take opioid pain medications — like Oxycodone, Hydrocodone, Morphine, or Fentanyl — one of the most common side effects is constipation. Opioids slow down the movement of your digestive system, making it difficult to have regular bowel movements. This is opioid-induced constipation, and it affects a large percentage of people who take opioids regularly.

For a full overview of the medication, see our post on what Symproic is and how to take it.

How Does Symproic Work?

Symproic belongs to a class of drugs called peripherally-acting mu-opioid receptor antagonists (PAMORAs). Here's what that means in plain language:

• Opioid medications work by binding to opioid receptors throughout your body — including in your brain (for pain relief) and in your gut (causing constipation)
• Symproic blocks the opioid receptors only in your gut
• It does not cross the blood-brain barrier significantly, so it doesn't reduce the pain-relieving effects of your opioid medication

The result: your gut starts moving normally again, while your pain medication keeps working. For a deeper explanation, check out how Symproic works.

Alternatives to Symproic for Opioid-Induced Constipation

If you can't find or afford Symproic, here are the main alternatives your doctor may consider. Each works a bit differently, so the best option depends on your specific situation.

1. Movantik (Naloxegol)

Drug class: PAMORA (same class as Symproic)

How it works: Like Symproic, Movantik blocks opioid receptors in the gut without affecting pain relief in the brain. It's taken as a 25 mg tablet once daily on an empty stomach, at least 30 minutes before the first meal of the day.

Key differences from Symproic:

• Must be taken on an empty stomach (Symproic can be taken with or without food)
• Available as 12.5 mg and 25 mg tablets
• Cash price is in a similar range (approximately $400–$600 per month)
• Some insurance plans may prefer Movantik over Symproic, or vice versa

Approved for: OIC in adults with chronic non-cancer pain

2. Relistor (Methylnaltrexone)

Drug class: PAMORA

How it works: Relistor also blocks opioid receptors in the gut. What makes it unique is that it's available as both a subcutaneous injection (12 mg) and an oral tablet (450 mg).

Key differences from Symproic:

• The injection form works quickly — often within 30 minutes to a few hours
• The oral tablet dose is much larger (450 mg vs. Symproic's 0.2 mg)
• The injection is often used in patients who haven't responded to laxatives
• May be a good option if you have difficulty swallowing or need faster relief

Approved for: OIC in adults with chronic non-cancer pain (tablets); also approved for OIC in patients with advanced illness receiving palliative care (injection)

3. Amitiza (Lubiprostone)

Drug class: Chloride channel activator (different mechanism from PAMORAs)

How it works: Amitiza doesn't block opioid receptors at all. Instead, it works by increasing fluid secretion in the intestines, which softens stool and promotes bowel movements. It's taken as a 24 mcg capsule twice daily with food.

Key differences from Symproic:

• Different mechanism of action — works on chloride channels, not opioid receptors
• Taken twice daily instead of once daily
• Must be taken with food and water
• Common side effects include nausea and diarrhea
• May be covered by different insurance tiers

Approved for: OIC in adults with chronic non-cancer pain; also approved for chronic idiopathic constipation and IBS with constipation

4. Linzess (Linaclotide)

Drug class: Guanylate cyclase-C (GC-C) agonist

How it works: Linzess increases fluid in the intestines and speeds up gut motility. While it's primarily approved for irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC), some doctors prescribe it off-label for OIC.

Key differences from Symproic:

• Not specifically FDA-approved for OIC (off-label use)
• Taken once daily on an empty stomach, at least 30 minutes before the first meal
• Available in multiple strengths (72 mcg, 145 mcg, 290 mcg)
• May be more readily available at pharmacies since it's prescribed for more common conditions

Important note: Since Linzess is not specifically approved for OIC, insurance may not cover it for that purpose. Talk to your doctor about whether this is an appropriate option.

Over-the-Counter Options

Before or alongside a prescription medication, many doctors recommend trying over-the-counter laxatives for OIC. In fact, most insurance plans require a trial of laxatives before they'll cover a prescription OIC medication (this is called step therapy). Common OTC options include:

• Polyethylene glycol (MiraLAX) — an osmotic laxative that draws water into the colon
• Docusate sodium (Colace) — a stool softener
• Sennosides (Senokot) — a stimulant laxative
• Bisacodyl (Dulcolax) — another stimulant laxative

These are much more affordable and widely available but may not provide adequate relief for true OIC, which is why prescription medications like Symproic exist.

How to Choose the Right Alternative

The best alternative depends on several factors:

• Insurance coverage: Which medication does your plan prefer? Check your formulary or call your insurance company.
• How you prefer to take it: Oral tablet once daily? Twice daily? Injection?
• Other medications you take: Drug interactions vary between these options. See our guide on Symproic drug interactions.
• Your medical history: Some alternatives may be better suited depending on other conditions you have.
• Cost: Prices vary significantly. Your doctor and pharmacist can help you find the most affordable option.

Always talk to your doctor before switching medications. They can evaluate your full medical picture and help you make the best choice.

Final Thoughts

Not being able to fill your Symproic prescription is frustrating, but it doesn't mean you have to suffer from opioid-induced constipation. There are several effective alternatives, from other PAMORAs like Movantik and Relistor to different drug classes like Amitiza.

If you're still hoping to find Symproic, try using Medfinder to check pharmacy availability near you, or read our tips on how to find Symproic in stock.

The most important thing is to keep the conversation going with your doctor so you can find a treatment that works for you.