Medical term:
lubiprostone
lubiprostone
Pharmacologic class: Chloride channel activator
Therapeutic class: GI motility enhancer
Pregnancy risk category C
Action
Enhances chloride-rich intestinal fluid secretion without altering sodium and potassium serum concentrations; increases intestinal fluid secretion and intestinal motility, which promotes stool passage and relieves symptoms of chronic idiopathic constipation
Availability
Soft gelatin capsules: 8 mcg, 24 mcg
Indications and dosages
➣ Chronic idiopathic constipation
Adults: 24 mcg P.O. twice daily
➣ Treatment of irritable bowel syndrome with constipation in women
Adults ages 18 and older: 8 mcg P.O. b.i.d.
Dosage adjustment
• Moderate to severe hepatic impairment
Contraindications
• Hypersensitivity to drug or its components
• History of mechanical GI obstruction
Precautions
Use cautiously in:
• severe diarrhea, hepatic or renal dysfunction
• pregnant or breastfeeding patients.
Administration
• Administer with food and water.
Adverse reactions
CNS: headache, dizziness, hypoesthesia, fatigue, depression, anxiety, insomnia
CV: chest discomfort or pain, hypertension
EENT: sinusitis, nasopharyngitis, pharyngolaryngeal pain
GI: nausea, vomiting, diarrhea, constipation, abdominal distention, abdominal pain or discomfort, flatulence, dyspepsia, gastroesophageal reflux disease, gastroenteritis, dry mouth
GU: urinary tract infection
Musculoskeletal: arthralgia, back pain, extremity pain, muscle cramp
Respiratory: upper respiratory tract infection, influenza, bronchitis, dyspnea, cough
Other: weight gain, peripheral edema, fever, viral infection
Interactions
None
Patient monitoring
• Evaluate patient for signs and symptoms of mechanical obstruction before therapy begins.
• Assess patient periodically for continuing need for therapy.
Patient teaching
• Instruct patient not to break or chew capsule.
• Instruct patient not to take drug during episodes of severe diarrhea.
• Advise patient to report side effects, such as severe nausea, diarrhea, and dyspnea, to prescriber.
• Caution female patient with child-bearing potential that drug may pose hazard to fetus.
• Advise breastfeeding patient that she should decide whether to discontinue breastfeeding or stop taking drug.
• As appropriate, review all other significant adverse reactions.
lubiprostone
(loo-bi-pross-tone) ,Amitiza
(trade name)Classification
Therapeutic: laxativesPharmacologic: chloride channel activators
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (reduction in symptoms)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | within 1 wk | 1 wk | unknown |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness
- headache
Cardiovascular
- peripheral edema
Respiratory
- dyspnea
Gastrointestinal
- diarrhea (most frequent)
- nausea (most frequent)
- abdominal pain
- abdominal distention
- dyspepsia
- dry mouth
- reflux
Musculoskeletal
- arthralgia
Interactions
Drug-Drug interaction
None noted.Route/Dosage
Chronic Idiopathic Constipation and Opioid-Induced Constipation
Hepatic Impairment
Oral (Adults) Moderate hepatic impairment (Child-Pugh Class B)-16 mcg twice daily; if patient tolerates, can titrate to 24 mcg twice daily, if needed; Severe hepatic impairment (Child-Pugh Class C)-8 mcg twice daily; if patient tolerates, can titrate to 24 mcg twice daily, if needed.IBS with Constipation
Hepatic Impairment
Oral (Adults) Severe hepatic impairment (Child-Pugh Class C)-8 mcg once daily; if patient tolerates, can titrate to 8 mcg twice daily, if needed.Availability
Nursing implications
Nursing assessment
- Assess for abdominal distention, presence of bowel sounds, and usual bowel patterns prior to and periodically during therapy.
- Assess color, consistency, and amount of stool produced.
- Lab Test Considerations: Assess women of childbearing age for pregnancy. Begin therapy following a negative pregnancy test.
Potential Nursing Diagnoses
Constipation (Indications)Diarrhea (Adverse Reactions)
Implementation
- Patients with symptoms suggestive of mechanical GI obstruction should be evaluated prior to initiating therapy.
- Oral: Administer with food and water to decrease nausea. Swallow capsules whole; do not crush, break or chew.
- Do not administer to patients severe diarrhea.
Patient/Family Teaching
- Instruct patient to take lubiprostone as directed.
- Inform patient that dyspnea may occur within 1 hr of first dose; usually resolves within 3 hrs, but may return with repeat doses.
- Advise patients that lubiprostone may cause diarrhea. Advise patient to notify health care professional if diarrhea becomes severe.
- May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Advise female patients that a negative pregnancy test should be determined prior to taking lubiprostone and to use effective contraception during therapy. Notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Evaluation/Desired Outcomes
- Decrease in symptoms of chronic constipation. Need for continued therapy should be assessed periodically.
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