What Is Symproic?

Symproic is the brand name for Naldemedine, a prescription medication used to treat opioid-induced constipation (OIC) in adults with chronic non-cancer pain. It was approved by the FDA in March 2017 and is manufactured by Shionogi Inc.

Symproic belongs to a class of drugs called peripherally-acting mu-opioid receptor antagonists (PAMORAs). In simple terms, it blocks the effects of opioids in your gut — helping your bowels move normally again — without interfering with the pain relief your opioids provide.

Outside the United States, the same medication is sold under the brand name Rizmoic.

What Does Symproic Treat?

Symproic is specifically approved to treat opioid-induced constipation. OIC is a common side effect of opioid pain medications like Oxycodone, Hydrocodone, Morphine, and Fentanyl. When you take opioids, they don't just block pain signals — they also slow down your digestive system, leading to constipation that can be severe and persistent.

Unlike regular constipation, OIC doesn't always respond to standard treatments like fiber supplements, stool softeners, or over-the-counter laxatives. That's where Symproic comes in.

It's important to note that Symproic is only approved for OIC in patients with chronic non-cancer pain in the U.S. In Europe and Japan, it's also approved for OIC in cancer patients under the Rizmoic brand.

How Does Symproic Work?

Opioid medications activate receptors throughout your body — including in your brain (for pain relief) and in your gut (which causes constipation). Symproic works by blocking the opioid receptors in your gastrointestinal tract without significantly crossing the blood-brain barrier.

This means your gut starts working normally again while your pain medication continues to do its job. For a more detailed explanation, see our article on How Does Symproic Work? Mechanism of Action Explained.

Dosage and How to Take Symproic

Symproic comes as a 0.2 mg oral tablet. The standard dose is:

• One 0.2 mg tablet once daily
• Take it by mouth, with or without food
• Try to take it at the same time each day for consistency
• Swallow the tablet whole

There's only one dose strength available, so there's no dose adjustment needed for most patients. However, you should avoid Symproic if you have severe liver disease (Child-Pugh Class C).

Important: If you stop taking your opioid medication, you should also stop taking Symproic. The medication is only needed while you're on opioid therapy.

Who Can Take Symproic?

Symproic is approved for adults (18 and older) who:

• Take opioid medications for chronic non-cancer pain
• Have constipation caused by their opioid treatment
• Have not gotten enough relief from standard laxatives

You should not take Symproic if you have:

• Known or suspected bowel obstruction
• Severe liver disease
• A history of serious allergic reaction to Naldemedine

Tell your doctor if you have a history of GI conditions like peptic ulcers, diverticulitis, Crohn's disease, or GI cancers, as these may increase the risk of serious complications.

Is Symproic a Controlled Substance?

No. When Symproic was first approved in 2017, it was briefly placed in Schedule II. However, the DEA removed it from all controlled substance schedules in September 2017 after determining it has no abuse potential. This makes it easier to prescribe and refill compared to some other medications.

Common Side Effects

The most common side effects of Symproic include:

• Abdominal pain
• Diarrhea
• Nausea
• Vomiting
• Gastroenteritis

These are usually mild and tend to improve within the first few days. For a complete breakdown, read our guide on Symproic Side Effects: What to Expect.

Drug Interactions

Symproic can interact with other medications. The most important ones to know about:

• Strong CYP3A4 inducers (Rifampin, Carbamazepine, Phenytoin, St. John's Wort) — These significantly decrease Symproic levels and should be avoided.
• Strong CYP3A4 inhibitors (Itraconazole, Ketoconazole, Clarithromycin, Ritonavir) — These can increase Symproic levels and side effects.
• Other opioid antagonists (Naltrexone, Naloxone) — Can increase the risk of opioid withdrawal.
• Grapefruit juice — May increase Naldemedine levels.

For the full list, see Symproic Drug Interactions: What to Avoid.

How Much Does Symproic Cost?

Without insurance, Symproic costs between $484 and $746 for a 30-day supply (30 tablets). There is currently no generic version of Naldemedine available, which keeps the price high.

Ways to save on Symproic:

• Manufacturer savings card — Eligible commercially insured patients may pay as little as $0 per prescription through the Symproic Savings Program at symproic.com.
• Patient assistance programs — Uninsured patients can check NeedyMeds.org and RxAssist.org for financial help.
• Insurance coverage — Many commercial and Medicare Part D plans cover Symproic, often with prior authorization.

For more details, read How to Save Money on Symproic.

How Does Symproic Compare to Other OIC Medications?

Symproic is one of several PAMORAs available for OIC treatment:

• Movantik (Naloxegol) — 25 mg tablet taken once daily. Must be taken on an empty stomach. Similar effectiveness.
• Relistor (Methylnaltrexone) — Available as a subcutaneous injection (12 mg) or oral tablet (450 mg). The injection works faster but requires needles.
• Amitiza (Lubiprostone) — A different drug class (chloride channel activator). Taken as a 24 mcg capsule twice daily. More nausea reported.

Symproic's advantages include once-daily dosing, the ability to take it with or without food, and no controlled substance restrictions. For a deeper comparison, see Alternatives to Symproic.

Finding Symproic at a Pharmacy

Because Symproic is a brand-name specialty medication, not every pharmacy stocks it. Use MedFinder to check which pharmacies near you have it in stock, or read our guide on How to Check If a Pharmacy Has Symproic in Stock.

Key Takeaways

• Symproic (Naldemedine) is a once-daily tablet that treats opioid-induced constipation in adults with chronic non-cancer pain.
• It works by blocking opioid receptors in the gut without affecting pain relief.
• The standard dose is 0.2 mg once daily, taken with or without food.
• Common side effects include diarrhea, abdominal pain, and nausea — usually mild and temporary.
• It is not a controlled substance and has no abuse potential.
• Without insurance, it costs $484 to $746 per month, but savings programs can bring your cost down to $0.