crofelemer

General

Pronunciation:
kro-fel-e-mer

Trade Name(s)

• Fulyzaq

Ther. Class.
antidiarrheals

Pharm. Class.
catechins

Indications

Symptomatic relief of non-infectious diarrhea in HIV-infected patients currently receiving antiretroviral therapy.

Action

• A natural product derived from  Croton lechleri , a species of flowering plant.
• Inhibits cyclic adenosine monophosphate (cAMP)-stimulated cystic fibrosis transmembrane conductance regulator (CTFR) chloride ion channels and the calcium-activated chloride channels on luminal membranes of enterocytes. Blocks chloride secretion and water loss by inhibiting chloride channels on the membranes of enterocytes.

Therapeutic Effect(s):

Decreased incidence and severity of diarrhea.

Pharmacokinetics

Absorption: Minimal absorption following oral administration.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

TIME/ACTION PROFILE

Contraindication/Precautions

Contraindicated in:

• None noted.

Use Cautiously in:

• Infectious causes of diarrhea (evaluate and treat prior to use);
• OB:  Use during pregnancy only if clearly needed;
• Lactation: Breast feeding should be avoided by HIV-infected patients;
• Pedi:  Safe and effective use in children <18 yr has not been established.

Adverse Reactions/Side Effects

CNS: anxiety

EENT: nasopharyngitis

Resp: bronchitis, cough, upper respiratory tract infection

GI: abdominal distention, flatulence, hemorrhoids, nausea, ↑ liver function tests

GU: urinary tract infection

MS: arthralgia, back pain, muscuoloskeletal pain

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Due to minimal systemic absorption, interactions are unlikely.

Route/Dosage

PO  (Adults)  125 mg twice daily.

Availability

Delayed-release tablets: 125 mg

Assessment

• Assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function.
• Assess color, consistency, and amount of stool produced.

Potential Diagnoses

• Diarrhea (Indications) 

Implementation

• PO  Administer tablets twice daily with or without food. Swallow tablets whole; do not crush, break, or chew.

Patient/Family Teaching

• Instruct patient to take crofelemer as directed.
• Advise female patients to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

Decreased incidence and severity of diarrhea.