Drug Guide
Prucalopride Succinate
Classification
Therapeutic: Laxative, Prokinetic agent
Pharmacological: Serotonin 5-HT4 receptor agonist
FDA Approved Indications
- Chronic idiopathic constipation in adults
Mechanism of Action
Prucalopride selectively stimulates 5-HT4 receptors in the gastrointestinal tract, enhancing peristalsis and facilitating bowel movements.
Dosage and Administration
Adult: Typically 2 mg once daily with or without food. Dose may be reduced to 1 mg in cases of renal impairment.
Pediatric: Not approved for pediatric use.
Geriatric: No specific dose adjustment; monitor renal function.
Renal Impairment: Adjust dose based on renal function; generally, 1 mg once daily for moderate impairment, avoid in severe impairment.
Hepatic Impairment: Not specifically studied; use with caution.
Pharmacokinetics
Absorption: Rapidly absorbed after oral administration.
Distribution: Widely distributed; specific volume not well defined.
Metabolism: Primarily metabolized via hepatic pathways; not a significant substrate for CYP450 enzymes.
Excretion: Excreted mainly via urine and feces.
Half Life: Approximately 20–30 hours.
Contraindications
- Hypersensitivity to prucalopride or any component of the formulation.
Precautions
- Use cautiously in patients with renal impairment, cardiovascular disease, and history of seizures. Monitor for cardiovascular adverse effects.
Adverse Reactions - Common
- Nausea (Common)
- Abdominal pain (Common)
Adverse Reactions - Serious
- Heart rate increase, arrhythmias (Rare)
- Seizures (Very rare)
Drug-Drug Interactions
- Caution with other medications that prolong QT interval.
Drug-Food Interactions
- No significant interactions reported.
Drug-Herb Interactions
- Limited data; consult healthcare provider.
Nursing Implications
Assessment: Monitor bowel movement frequency and consistency. Assess for cardiovascular symptoms.
Diagnoses:
- Risk for constipation or bowel obstruction.
- Risk for cardiac arrhythmias.
Implementation: Administer as prescribed. Educate patient on response and side effects.
Evaluation: Effectiveness in relieving constipation; monitor for adverse cardiac and neurological events.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report any palpitations, dizziness, or seizures to healthcare provider.
- Maintain hydration and diet high in fiber.
- Do not crush or split tablets.
Special Considerations
Black Box Warnings:
- Potential increased risk of cardiovascular events, especially in patients with pre-existing heart conditions.
Genetic Factors: Limited pharmacogenetic data.
Lab Test Interference: No known interference.
Overdose Management
Signs/Symptoms: Nausea, vomiting, dizziness, arrhythmias, seizures.
Treatment: Supportive care; activated charcoal if within hour of ingestion; cardiovascular monitoring; seizure management as needed.
Storage and Handling
Storage: Store at room temperature away from moisture and heat.
Stability: Stable up to the expiration date on the package.