Drug Guide
Plecanatide
Classification
Therapeutic: Gastrointestinal agent, laxative
Pharmacological: Guanylate cyclase-C agonist
FDA Approved Indications
- Chronic idiopathic constipation (CIC) in adults
- Irritable bowel syndrome with constipation (IBS-C) in adults
Mechanism of Action
Plecanatide activates guanylate cyclase-C on the intestinal epithelium, increasing intracellular cyclic GMP levels, leading to increased chloride and bicarbonate secretion into the intestinal lumen. This action softens stool and accelerates intestinal transit.
Dosage and Administration
Adult: 3 mg orally once daily, taken on an empty stomach at least 30 minutes before the first meal of the day
Pediatric: Not approved for pediatric use
Geriatric: Use with caution; adjust dose if necessary due to age-related changes in renal function
Renal Impairment: Adjust dose in severe renal impairment (creatinine clearance <30 mL/min) — 3 mg once daily; in moderate impairment, use caution
Hepatic Impairment: No specific dose adjustment required
Pharmacokinetics
Absorption: Poor oral absorption; primarily local action in the GI tract
Distribution: Minimal systemic absorption, highly localized activity
Metabolism: Not extensively metabolized; acts locally in the gut
Excretion: Primarily excreted unchanged in feces
Half Life: Approximate half-life not specified; intended for once-daily dosing
Contraindications
- Hypersensitivity to plecanatide or any component of the formulation
Precautions
- Use with caution in patients with known or suspected bowel obstruction or symptoms of bowel obstruction. Pregnancy Category B—use only if clearly needed; lactation not recommended.
Adverse Reactions - Common
- Diarrhea (Most common adverse event, occurs in a small percentage of patients)
- Abdominal pain (Less common)
Adverse Reactions - Serious
- Dehydration due to diarrhea (Rare)
- Severe diarrhea leading to electrolyte imbalance or dehydration (Rare)
Drug-Drug Interactions
- None specifically identified, but caution with other drugs affecting electrolyte balance or GI motility
Drug-Food Interactions
- No known significant interactions
Drug-Herb Interactions
- No known significant interactions
Nursing Implications
Assessment: Monitor for signs of diarrhea, dehydration, and electrolyte imbalances.
Diagnoses:
- Risk for fluid volume deficit related to diarrhea
- Altered bowel elimination related to medication adverse effects.
Implementation: Administer 3 mg orally once daily, ideally in the morning. Educate patients about potential diarrhea and fluid intake.
Evaluation: Assess bowel movement regularity and stool consistency; monitor for adverse reactions.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report new or worsening diarrhea, dehydration, or abdominal pain.
- Maintain adequate hydration.
- Inform healthcare provider if pregnant or planning to become pregnant.
Special Considerations
Black Box Warnings: N/A
Genetic Factors: N/A
Lab Test Interference: None reported.
Overdose Management
Signs/Symptoms: Severe diarrhea, dehydration, electrolyte disturbances
Treatment: Discontinue plecanatide; provide supportive care, rehydration, and electrolyte management as needed.
Storage and Handling
Storage: Store at room temperature (20°C to 25°C, 68°F to 77°F); protect from moisture.
Stability: Stable up to the expiration date listed on the package.