plecanatide

Therapeutic Classification: laxatives

Pharmacologic Classification: guanylate cyclase-C agonists

Indications ⬆ ⬇

REMS

Chronic idiopathic constipation.
Irritable bowel syndrome with constipation.

Action ⬆ ⬇

Locally ↑ cyclic guanosine monophosphate concentrations, which ↑ intestinal fluid and accelerates transit time.

Therapeutic effects:

Increased frequency of complete spontaneous bowel movements.

Pharmacokinetics ⬆ ⬇

Absorption: Minimally absorbed, action is primarily local.

Distribution: Stays within the GI tract with minimal distribution.

Metabolism/Excretion: Converted to its principal active metabolite within the GI tract. Plecanatide and active metabolite then degrade in intestinal lumen to smaller peptides and amino acids. Excretion information unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(improvement in symptoms)

ROUTE	ONSET	PEAK	DURATION
PO	1 wk	2–12 wk	2 wk‡

‡Following discontinuation.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Known/suspected mechanical GI obstruction;
Pedi: Children 6 yr ( risk of dehydration).

Use Cautiously in:

OB: Safety not established in pregnancy; fetal exposure to plecanatide or its active metabolite unlikely;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children 6–18 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

GI: ↑liver enzymes, abdominal distention, diarrhea, flatulence

Interactions ⬆ ⬇

Drug-drug:

None reported.

Route/Dosage ⬆ ⬇

PO (Adults ): 3 mg once daily.

Availability ⬆ ⬇

Assessment ⬆ ⬇

Monitor bowel function (frequency, consistency) periodically during therapy. If severe diarrhea occurs, withhold plecanatide and rehydrate patient.

Lab Test Considerations:

May cause ↑ ALT, and AST.

Implementation ⬆ ⬇

PO: Administer once daily without regard to food. Swallow tablet whole. Tablets can be crushed and mixed in applesauce or water and administered orally or with water in a nasogastric or gastric feeding tube. Do not mix with other foods or liquids.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take plecanatide as directed. If a dose is missed, omit and take next dose at regular time; do not double doses.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇