STRONG CYP3A4 INHIBITORS (E.G., KETOCONAZOLE, ITRACONAZOLE, CLARITHROMYCIN INCREASE PLASMA NALOXEGOL CONCENTRATIONS AND MAY INCREASE THE RISK OF ADVERSE REACTIONS.
AVOID USE WITH MODERATE CYP3A4 INHIBITORS LIKE DILTIAZEM, ERYTHROMYCIN, VERAPAMILLIKE ; IF UNAVOIDABLE, DECREASE THE DOSAGE OF MOVANTIK TO 12.5 MG ONCE DAILY AND MONITOR FOR ADVERSE REACTIONS.
NO DOSAGE ADJUSTMENTS ARE NECESSARY WITH WEAK CYP3A4 INHIBITORS E.G., QUINIDINE, CIMETIDINE.
GRAPEFRUIT OR GRAPEFRUIT JUICE CAN INCREASE PLASMA NALOXEGOL CONCENTRATION.
STRONG CYP3A4 INDUCERS (E.G., RIFAMPIN, CARBAMAZEPINE, ST. JOHN'S WORT) SIGNIFICANTLY DECREASE PLASMA NALOXEGOL CONCENTRATIONS AND MAY DECREASE ITS EFFICACY.
OTHER OPIOID ANTAGONISTS: POTENTIAL FOR ADDITIVE EFFECT OF OPIOID RECEPTOR ANTAGONISM AND INCREASED RISK OF OPIOID WITHDRAWAL.