Drug Guide
Lubiprostone
Classification
Therapeutic: Laxative, Chloride Channel Activator
Pharmacological: Prostaglandin derivative, Chloride channel activator
FDA Approved Indications
- Chronic idiopathic constipation in adults
- Irritable bowel syndrome with constipation (IBS-C) in women aged 18 and older
- Opioid-induced constipation in adults
Mechanism of Action
Lubiprostone activates type 2 chloride channels (ClC-2) on the apical aspect of intestinal epithelial cells, leading to increased chloride-rich fluid secretion into the intestinal lumen, which helps facilitate bowel movements.
Dosage and Administration
Adult: Initially 24 mcg twice daily with food and water. Dosage may be adjusted based on response and tolerability.
Pediatric: Not approved for pediatric use.
Geriatric: Same as adult; monitor renal and hepatic function as appropriate.
Renal Impairment: Use with caution; no specific dose adjustment recommended but assessment is advised.
Hepatic Impairment: Use with caution; no specific dose adjustment recommended but assessment is advised.
Pharmacokinetics
Absorption: Rapid absorption, bioavailability approximately 12%, unaffected by food.
Distribution: Low plasma protein binding (~8%).
Metabolism: Primarily hepatic via hydrolysis; minimal formation of active metabolites.
Excretion: Fecal (main), minimal urinary excretion.
Half Life: Approximately 3-6 hours.
Contraindications
- Mechanical gastrointestinal obstruction
- Severe diarrhea
Precautions
- Use cautiously in patients with electrolyte abnormalities, history of bowel obstruction or with worsening abdominal symptoms, and in those taking medications affecting fluid/electrolyte balance.
Adverse Reactions - Common
- Nausea (Common)
- Diarrhea (Common)
- Headache (Uncommon)
Adverse Reactions - Serious
- Dehydration (Rare)
- Serious diarrhea leading to dehydration or electrolyte imbalance (Rare)
Drug-Drug Interactions
- CYP2C8 inhibitors (e.g., gemfibrozil) may increase lubiprostone levels—monitor and consider dose adjustments.
Drug-Food Interactions
- No significant interactions reported.
Drug-Herb Interactions
- No specific data available.
Nursing Implications
Assessment: Assess bowel function, electrolyte levels, hydration status, and abdominal status prior to initiation.
Diagnoses:
- Constipation
- Risk for electrolyte imbalance
- Dehydration
Implementation: Administer with food and water as prescribed, monitor for effectiveness and adverse effects, especially diarrhea and dehydration.
Evaluation: Assess for increase in bowel movements, relief of constipation, and monitor for adverse effects.
Patient/Family Teaching
- Take as directed with food and water.
- Report severe or prolonged diarrhea, dehydration, or abdominal pain.
- Maintain adequate fluid intake.
Special Considerations
Black Box Warnings:
- None specific, but caution in patients with mechanical GI obstruction.
Genetic Factors: No known genetic considerations affecting use.
Lab Test Interference: No significant laboratory interferences reported.
Overdose Management
Signs/Symptoms: Severe diarrhea, dehydration, electrolyte imbalance, abdominal pain.
Treatment: Supportive care, restore hydration and electrolytes, monitor vital signs and laboratory parameters.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable under recommended storage conditions; discard after expiration.