When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to naloxegol, or if you have a history of bowel blockage.

How to Use This Medicine:
Tablet

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you. Stop taking this medicine if you stop taking narcotic pain medicines.
• Take this medicine on an empty stomach at least 1 hour before the first meal of the day or 2 hours after a meal.
• Swallow the tablet whole. Do not crush, break, or chew it.
• If you have trouble swallowing the tablet:
  
  • Mix with water: Crush the tablet and mix it with 120 mL of water and drink it right away. Refill the glass with water, stir, and drink right away to make sure to get full dose of this medicine.
  • Given through a nasogastric tube: Draw up 30 mL of water into a 60 mL syringe and flush the nasogastric tube. Crush the tablet to a powder and mix it with 60 mL of water in a container. Draw up the mixture using 60 mL syringe and give it through the tube. Add 60 mL of water to the container mixture and use the same 60 mL syringe to flush the tube for any remaining medicine.
• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Do not use this medicine together with clarithromycin, itraconazole, or ketoconazole.
• Some foods and medicines can affect how naloxegol works. Tell your doctor if you are using carbamazepine, diltiazem, erythromycin, methadone, rifampin, St John's wort, or verapamil.
• Stop taking other laxatives before you start treatment with this medicine.
• Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, or stomach or bowel problems (including Crohn disease, Ogilvie syndrome, diverticulitis, or stomach or bowel cancer).
• This medicine may cause a tear in your stomach or bowels.
• Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Chills, diarrhea, sweating, stomach pain, anxiety, irritability, yawning
• Severe stomach pain and diarrhea

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088