Drug Guide
Teduglutide
Classification
Therapeutic: Hemodynamic support in short bowel syndrome, growth hormone analogs
Pharmacological: Glucagon-like peptide-2 (GLP-2) receptor agonist
FDA Approved Indications
- Short bowel syndrome (SBS) in adult patients to reduce dependence on parenteral support
Mechanism of Action
Teduglutide mimics endogenous GLP-2, promoting intestinal growth and enhancing nutrient absorption by increasing intestinal villus height and crypt depth, thereby improving intestinal absorption capacity.
Dosage and Administration
Adult: 0.05 mg/kg subcutaneously once daily, administered at the same time each day; dosage adjustments are not typically required beyond initial dosing.
Pediatric: Not approved for pediatric use.
Geriatric: No specific dose adjustments necessary based on age, but caution in renal or hepatic impairment.
Renal Impairment: No adjustment needed for mild to moderate impairment; limited data on severe impairment.
Hepatic Impairment: No specific adjustments are required.
Pharmacokinetics
Absorption: Subcutaneous administration; bioavailability approaches 100%.
Distribution: Primarily binds to plasma proteins.
Metabolism: Degraded primarily by proteolytic enzymes; no significant CYP450 involvement.
Excretion: Metabolized to small peptides and amino acids; renal clearance of metabolites.
Half Life: Approximately 2 hours.
Contraindications
- Hypersensitivity to teduglutide or excipients.
Precautions
- History of gastrointestinal obstruction, active or suspected neoplasia, or intestinal amebiasis. Caution in patients with a history of malignancies; monitor for signs of abnormal tissue growth.
Adverse Reactions - Common
- Gastrointestinal symptoms such as nausea, abdominal pain, bloating (Common)
- Increased absorption leading to fluid overload, edema (Common)
Adverse Reactions - Serious
- Potential for neoplastic growth, including gastrointestinal malignancies (Rare)
- Infections due to immune modulation (Rare)
Drug-Drug Interactions
- None specifically identified; caution with other agents affecting gastrointestinal motility or fluid status.
Drug-Food Interactions
- No known significant interactions.
Drug-Herb Interactions
- Limited data; consult with healthcare provider before use of herbal supplements.
Nursing Implications
Assessment: Monitor for signs of neoplasia, gastrointestinal symptoms, fluid overload, and response to therapy.
Diagnoses:
- Risk for infection related to immune modulation.
- Impaired gastrointestinal function.
Implementation: Administer subcutaneously at scheduled times, assist with site rotation, monitor for adverse reactions, and assess efficacy regularly.
Evaluation: Assess for reduction in parenteral support requirements, improvement in gastrointestinal symptoms, and absence of adverse events.
Patient/Family Teaching
- Inject medication at the same time daily.
- Report any new or worsening symptoms, such as abdominal pain, bleeding, or unusual lumps.
- Maintain follow-up appointments for ongoing monitoring.
- Understand the importance of adherence to therapy and follow instructions.
Special Considerations
Black Box Warnings:
- Potential risk of gastrointestinal malignancies; patients should be monitored closely.
Genetic Factors: No specific genetic markers identified for response or risk.
Lab Test Interference: May increase serum levels of various biomarkers; interpret laboratory results with clinical context.
Overdose Management
Signs/Symptoms: Excessive fluid retention, edema, abdominal pain, or signs of gastrointestinal hyperactivity.
Treatment: Discontinue medication; provide supportive care; monitor fluid status; seek emergency care if severe.
Storage and Handling
Storage: Store refrigerated at 2°C to 8°C (36°F to 46°F). Do not freeze.
Stability: Stable for up to 24 hours at room temperature (up to 25°C); discard if not used within specified time.