Gattex

teduglutide (rDNA origin)

Gattex

Indications

Action

Pharmacokinetics

Time/action profile (↓ in parenteral nutrition/IV volume need)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• headache (most frequent)
• sleep disturbances

Respiratory

• cough

Gastrointestinal

• accelerated intestinal malignancy (life-threatening)
• intestinal obstruction (life-threatening)
• abdominal distention (most frequent)
• abdominal pain (most frequent)
• nausea (most frequent)
• stoma complications (most frequent)
• appetite disorders
• cholangitis
• cholecystitis
• cholelithiasis
• flatulence
• pancreatitis

Fluid and Electrolyte

• fluid overload (most frequent)

Local

• injection site reactions (most frequent)

Metabolic

• hypersensitivity reactions

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Obtain a colonoscopy of entire colon with removal of polyps within 6 mo prior to starting teduglutide. Follow-up colonoscopy is recommended at end of 1 yr on teduglutide. If no polyps found, repeat at least every 5 yrs. If polyps found follow recommended guidelines.
• Monitor for fluid overload, especially in patients with underlying cardiovascular disease; may require adjustment in parenteral support.
• Lab Test Considerations: Monitor bilirubin, alkaline phosphatase, lipase, and amylase within 6 mo of starting and every 6 mo after starting therapy. If clinically meaningful ↑ occurs further diagnostic work-up is recommended.

Potential Nursing Diagnoses

Implementation

• Reconstitute each vial with 0.5 mL of preservative-free Sterile Water for Injection slowly injected from pre-filled syringe. Allow vial to stand for 30 seconds, then gently roll between palms for 15 seconds; do not shake. Allow mixed contents to stand for 2 min. Inspect for undissolved powder and gently roll again until dissolved. If product remains undissolved after second attempt, do not use. Solution should be clear and colorless to light straw; do not administer solutions that are discolored or contain a precipitate. Vial contains 0.38 mL of reconstituted solution with up to 3.8 mg of teduglutide. Administer within 3 hrs of reconstitution. Store in refrigerator; do not freeze. Discard unused solution.
• Subcutaneous: Inject subcut once daily in thighs, arms, and quadrants of the abdomen. Rotate sites daily. Do not inject IM or IV.
• Discontinuation may result in fluid and electrolyte imbalance; monitor closely.

Patient/Family Teaching

• Instruct patient in correct technique for injection and disposal of equipment. Take missed doses as soon as remembered in same day; do not take 2 doses in one day. Advise patient to read Medication Guide before starting and with each Rx refill in case of changes.
• Advise patient that injection site reaction may occur, but if severe reaction or severe rash occurs, notify health care professional.
• Inform patient of risk of accelerated neoplastic growth, colorectal polyps, and small bowel neoplasia. Advise patient to report signs and symptoms.
• Advise patient to notify health care professional if signs and symptoms of intestinal obstruction (abdominal pain, swelling of stoma) occur. May require temporary discontinuation of teduglutide.
• 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. Oral medications may be absorbed more completely and may require dose adjustment.
• Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Emphasize the importance of routine lab tests and colonoscopies to monitor for adverse effects.

Evaluation/Desired Outcomes

• Improved gastrointestinal absorption of fluids and nutrients with a decreased need for parenteral nutrition/IV support.