(loo bi PROS tone)
- RU 0211
- SPI 0211
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Amitiza: 8 mcg
Amitiza: 24 mcg [contains fd&c red #40, fd&c yellow #10 (quinoline yellow)]
Brand Names: U.S.
- Chloride Channel Activator
- Gastrointestinal Agent, Miscellaneous
A chloride channel activator that acts locally on the apical membrane of the gastrointestinal tract to increase intestinal fluid secretion and improve fecal transit. This action bypasses the antisecretory effects of opiates, which suppress secretomotor neuron excitability.
Systemic: Parent drug: Poor (below levels of detection); Active metabolite (M3): Low
Minimal beyond GI tissue
Rapid and extensive within stomach and jejunum by carbonyl reductase to M3 (active metabolite) and others
Parent drug and M3: Feces (trace amounts)
Time to Peak
Plasma: M3: ~1.1 hour
M3: 0.9 to 1.4 hours
Special Populations: Hepatic Function Impairment
Cmax and AUC of active metabolite M3 are increased in patients with moderate-to-severe hepatic impairment.
Use: Labeled Indications
Chronic idiopathic constipation: Treatment of chronic idiopathic constipation in adults
Irritable bowel syndrome with constipation: Treatment of irritable bowel syndrome (IBS) with constipation in women ≥18 years
Opioid-induced constipation: Treatment of opioid-induced constipation in adults with chronic noncancer pain, including patients with chronic pain related to prior cancer or its treatment who do not require frequent (eg, weekly) opioid dosage escalation.
Known or suspected mechanical gastrointestinal (GI) obstruction
Chronic idiopathic constipation: Oral: 24 mcg twice daily
Irritable bowel syndrome with constipation: Females ≥18 years: Oral: 8 mcg twice daily
Opioid-induced constipation: Oral: 24 mcg twice daily
Refer to adult dosing.
Dosing: Renal Impairment
No dosage adjustment necessary.
Dosing: Hepatic Impairment
Mild hepatic impairment (Child-Pugh class A): No dosage adjustment necessary.
Moderate hepatic impairment (Child-Pugh class B):
Chronic idiopathic constipation or opioid-induced constipation: Initial: 16 mcg twice daily; may increase to 24 mcg twice daily if tolerated and an adequate response has not been obtained with lower dosage.
Irritable bowel syndrome with constipation: No dosage adjustment necessary.
Severe hepatic impairment (Child-Pugh class C):
Chronic idiopathic constipation or opioid-induced constipation: Initial: 8 mcg twice daily; may increase to 16 to 24 mcg twice daily if tolerated and an adequate response has not been obtained with lower dosage.
Irritable bowel syndrome with constipation: Initial: 8 mcg once daily; may increase to 8 mcg twice daily if tolerated and an adequate response has not been obtained at lower dosage.
Administer with food and water. Swallow whole; do not break or chew.
Take with food and water to decrease nausea.
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from light and extreme temperatures.
Methadone: May diminish the therapeutic effect of Lubiprostone. Monitor therapy
Central nervous system: Headache (2% to 11%)
Gastrointestinal: Nausea (8% to 29%; dose related; males: 8%; older adults: 19%), diarrhea (7% to 12%)
1% to 10%:
Cardiovascular: Edema (≤3%), chest discomfort (≤2%), chest pain (≤2%), peripheral edema (1%)
Central nervous system: Dizziness (3%), fatigue (≤2%)
Gastrointestinal: Abdominal pain (4% to 8%), flatulence (4% to 6%), abdominal distention (3% to 6%), abdominal distress (3%), loose stools (≤3%), vomiting (≤3%), dyspepsia (≤2%), xerostomia (≤1%)
Respiratory: Dyspnea (≤3%)
<1% (Limited to important or life-threatening): Anorexia, anxiety, arthralgia (Anton 2017), back pain (Anton 2017), bloody diarrhea (Anton 2017), bowel urgency, constipation, cough, decreased appetite, decreased serum potassium, depression, diaphoresis, dysgeusia, eructation, erythema, fecal impaction, fecal incontinence, fibromyalgia syndrome, frequent bowel movements, gastritis, gastroesophageal reflux disease, gastrointestinal disease, hyperhidrosis, hypersensitivity reaction (including skin rash, swelling, throat tightness), hypotension, increased serum ALT, increased serum AST, influenza, ischemic colitis, joint swelling, lethargy, malaise, muscle cramps, muscle spasm, myalgia, neck pain (Anton 2017), pain, palpitations, pharyngolaryngeal pain, pollakiuria, rectal hemorrhage, respiratory tract infection (Anton 2017), syncope, tachycardia, tremor, urinary tract infection, weakness, weight gain
Concerns related to adverse effects:
• Dyspnea: Has been observed with use; often described as chest tightness and difficulty in taking a breath; generally occurs as an acute onset (within 30 to 60 minutes following the first dose) and resolves within a few hours; however, has been frequently reported with subsequent dosing.
• Nausea: Nausea may occur; administer with food to reduce symptoms.
• Syncope/hypotension: May occur (some resulting in hospitalization) and generally resolved following discontinuation or prior to the next dose; reoccurrence has been reported with subsequent doses. Most cases occurred when taking 24 mcg twice daily, within an hour after the first dose or subsequent doses, or during concomitant use of medications known to decrease blood pressure.
• Diarrhea: Avoid use in patients with severe diarrhea.
• Gastrointestinal obstruction: Symptoms of mechanical GI obstruction should be evaluated before prescribing this medicine; use is contraindicated in patients with bowel obstruction.
• Hepatic impairment: Patients with moderate-to-severe hepatic impairment (Child-Pugh class B or C) have higher systemic drug exposure; dosage adjustment may be recommended, depending on the indication and severity of hepatic impairment.
• Males: Not approved for use in males with irritable bowel syndrome with constipation.
• Appropriate use: Efficacy of lubiprostone in the treatment of opioid-induced constipation in patients taking diphenylheptane opioids (eg, methadone) has not been established.
Pregnancy Risk Factor
Adverse events have been observed in animal reproduction studies.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience headache, nausea, abdominal pain, flatulence, or bloating. Have patient report immediately to prescriber angina, severe diarrhea, severe dizziness, passing out, or shortness of breath (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
More about lubiprostone
- Side Effects
- During Pregnancy
- Dosage Information
- Drug Interactions
- Support Group
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- Drug class: chloride channel activators
Other brands: Amitiza