Table 11.

Dosage and administration of peripherally acting mu (μ) opioid receptor antagonists (PAMORAs) [60, 139, 147]

Drug	Administration route	Initial dose	Maintenance dose
Methylnaltrexone	Subcutaneous	In adult patients with chronic pain (except palliative care patients with advanced illness):a 12 mg (0.6 mL) as needed, given as at least 4 doses weekly, up to once daily (7 doses weekly) In adult patients with advanced illness (palliative care patients):b 8 mg (0.4 mL) for patients weighing 38–61 kg 12 mg (0.6 mL) for patients weighing 62–114 kg
	Oralc	450 mg	450 mg/day
Naloxegol	Oral	25 mgd	25 mg/dayd
Naldemedine	Oral	0.2 mg/day	0.2 mg/day

^aIn these patients, treatment with usual laxatives should be stopped when commencing treatment with methylnaltrexone

^bThe usual administration schedule is one single dose every other day. Doses may also be given with longer intervals, as per clinical need. Patients may receive two consecutive doses 24 h apart, only when there has been no response (bowel movement) to the dose on the preceding day. Methylnaltrexone is added to usual laxative treatment

^cNot approved for use in the European Union

^dIn patients with moderate or severe renal failure, the initial dose is 12.5 mg/day. This dose can be increased to 25 mg if 12.5 mg/day is well tolerated by the patient