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 and 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, hold plecanatide and rehydrate patient.

Lab Test Considerations:

May ↑ ALT, and AST.

Implementation ⬆ ⬇

PO: Administer once daily without regard to food. Swallow tablet whole. Tablets can be crushed and mixed in room temperature applesauce or water. Do not mix with other foods or liquids. For administration with water, mix 30 mL of water into a cup with the tablet, swirl for ≥10 sec, and swallow entire amount immediately. Add an additional 30 mL of water if any part of the tablet remains; swirl again and swallow immediately.
- Administration through a gastric or nasogastric feeding tube: Mix about 30 mL of room temperature water into a cup with the crushed tablet and swirl for ≥15 sec. Flush the feeding tube with 30 mL water, draw up the mixture with a syringe, and administer mixture via the feeding tube immediately. Add an additional 30 mL of water to the cup if any part of the tablet remains, swirl for ≥15 sec, and use the same syringe to administer via the feeding tube. Flush the feeding tube with ≥10 mL of water after administration.

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of plecanatide. Instruct patient to take as directed. If a dose is missed, omit and take next dose at regular time; do not double doses. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.
Instruct patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care provider before taking any new medications.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇