Provider Briefing: Symproic Availability in 2026

Symproic (Naldemedine) 0.2 mg tablets remain a valuable treatment option for opioid-induced constipation (OIC) in adults with chronic non-cancer pain. However, clinicians should be aware that patients are increasingly reporting difficulty filling Symproic prescriptions — not due to a formal supply disruption, but due to limited pharmacy-level stocking.

This briefing covers the current state of Symproic availability, prescribing implications, cost considerations, and tools that can help your patients access this medication.

Current Supply Status: No FDA Shortage, But Limited Access

As of February 2026, Symproic is not listed on the FDA Drug Shortage database. Manufacturing by Shionogi continues, and the U.S. commercial partner (BioDelivery Sciences International, a Collegium Pharmaceutical subsidiary) maintains distribution.

However, real-world pharmacy availability tells a different story. Because Symproic is:

• A brand-only product with no approved generic
• Indicated for a niche patient population (OIC in chronic non-cancer pain)
• Priced at approximately $484–$746 per month at retail

...many retail pharmacies — particularly large chains — do not routinely stock it. Patients may be told the medication is "unavailable" or "on backorder" when in reality the pharmacy simply hasn't ordered it.

Timeline and Background

Understanding the history helps contextualize the current access challenges:

• March 2017: FDA approves Naldemedine 0.2 mg tablets (Symproic) for OIC in adults with chronic non-cancer pain
• September 2017: DEA removes Naldemedine from Schedule II, determining it has no abuse potential — an important milestone that eliminated controlled substance prescribing barriers
• April 2019: BioDelivery Sciences International acquires exclusive U.S. commercial rights from Shionogi
• 2019–2020: Insurance coverage expands significantly, with major PBMs adding preferred formulary status
• 2021–present: Collegium Pharmaceutical acquires BDSI; commercialization continues but as a niche product

Notably, Naldemedine was initially placed in Schedule II as a precautionary measure due to its structural relationship to opioid compounds. The DEA's decision to remove it entirely from scheduling in 2017 was a significant regulatory development that should simplify prescribing workflows — Symproic does not require DEA-number prescriptions, tamper-proof pads, or controlled substance monitoring.

Prescribing Implications

Dosing and Administration

Symproic is straightforward to prescribe:

• Dose: 0.2 mg once daily
• Administration: Oral tablet, with or without food
• No dose adjustment needed for mild-to-moderate hepatic impairment or renal impairment
• Avoid in severe hepatic impairment (Child-Pugh Class C)
• Discontinue if the patient stops opioid therapy

Key Drug Interactions

Clinicians should be aware of the following interactions:

• Strong CYP3A4 inducers (Rifampin, Carbamazepine, Phenytoin, St. John's Wort): Avoid coadministration — significantly reduces Naldemedine plasma levels
• Strong CYP3A4 inhibitors (Ketoconazole, Itraconazole, Clarithromycin, Ritonavir): Monitor for increased adverse effects
• P-glycoprotein inhibitors (Cyclosporine): May increase Naldemedine exposure — monitor accordingly
• Other opioid antagonists (Naltrexone, Naloxone): Avoid coadministration — increased risk of opioid withdrawal

For a comprehensive review of interactions, see our Symproic drug interactions guide.

Safety Considerations

• GI perforation: Cases have been reported. Use with caution in patients with conditions that may compromise GI tract wall integrity (peptic ulcer disease, diverticulitis, GI malignancies, Crohn's disease)
• Opioid withdrawal: Monitor for symptoms, particularly in patients on lower opioid doses or those with disrupted blood-brain barrier integrity
• No boxed warning

The Availability Picture: Why Patients Can't Fill

When patients report they "can't find" Symproic, the issue typically falls into one of these categories:

1. Pharmacy doesn't stock it: Low-volume, high-cost brand medications are often not kept on shelf at chain pharmacies
2. Insurance barriers: Prior authorization denials or step therapy requirements delay or prevent access
3. Cost: Patients without adequate coverage face $484–$746/month out of pocket
4. Patient abandonment: Patients give up after initial difficulty finding it

Cost and Access Landscape

Insurance Coverage

Symproic has gained improved formulary coverage over recent years. Many commercial plans and some Medicare Part D plans cover it, though typically with:

• Prior authorization: Documentation of OIC diagnosis, current opioid therapy, and inadequate response to laxatives
• Step therapy: Trial and failure of at least one laxative (e.g., MiraLAX, Senokot)
• Tier 3 or specialty tier placement on most formularies

Patient Savings Programs

• Symproic Savings Card: Eligible commercially insured patients may pay as little as $0 per prescription (available at symproic.com)
• Patient assistance programs: Patients without insurance can explore options through NeedyMeds.org and RxAssist.org

Tools and Resources for Your Practice

To help your patients navigate Symproic access challenges, consider these resources:

• Medfinder for Providers: Direct patients to Medfinder to check real-time pharmacy availability. This reduces phone calls to your office from frustrated patients who can't find their medication.
• Specialty pharmacy referral: If chain pharmacies in your area don't stock Symproic, identify one or two specialty or independent pharmacies that can reliably fill prescriptions
• Prior authorization templates: Prepare documentation in advance to streamline PA submissions — include OIC diagnosis, current opioid regimen, laxative trial documentation, and clinical rationale

Alternative Therapies to Consider

When Symproic is not accessible or not covered, the following alternatives may be appropriate:

• Movantik (Naloxegol) 25 mg: Another PAMORA; once daily on empty stomach; similar efficacy profile
• Relistor (Methylnaltrexone): PAMORA available as SC injection (12 mg) or oral tablet (450 mg); injection form may be preferred for patients in palliative settings
• Amitiza (Lubiprostone) 24 mcg: Chloride channel activator; different MOA; twice daily with food

Each has distinct formulary positioning, and switching may improve access depending on the patient's insurance plan. For a patient-facing comparison, see our alternatives to Symproic guide.

Looking Ahead

Several developments may impact Symproic access in the coming years:

• Generic Naldemedine: No generic is currently approved, but patent expirations could eventually open the door to generic competition, which would improve availability and reduce cost
• Formulary shifts: As PBM negotiations continue, formulary placement for OIC medications may change annually — stay current with your patients' insurance changes
• Expanded indications: Naldemedine is approved in Europe and Japan (as Rizmoic) for a broader OIC indication including cancer patients. Potential U.S. label expansion could increase demand and distribution

Final Thoughts

Symproic remains a well-tolerated, effective, once-daily oral treatment for opioid-induced constipation. The primary barrier to patient access in 2026 is not supply — it's distribution, cost, and insurance navigation.

Providers can make a meaningful difference by proactively addressing these barriers: directing patients to Medfinder, preparing prior authorizations efficiently, identifying reliable local pharmacies, and being ready to pivot to alternative therapies when needed.

For a practical guide on helping patients fill their prescriptions, see how to help your patients find Symproic in stock.