Teduglutide (Subcutaneous)

Overview

is a synthetic amino acid that helps the body absorb nutrients, and is used primarily by patients who have short bowel syndrome (SBS). This is a condition that generally occurs when someone has had part of their small intestine removed in a surgical procedure. When part of the small intestine is missing, it is more difficult for the body to absorb nutrients from the intestines, so teduglutide is often used to accelerate and enhance nutrient absorption. It also may have the effect in some patients of making it easier for the body to absorb medications taken orally.

Condition(s) treated

• Short bowel syndrome

Type of medicine

• Synthetic amino acid

Side effects

There are some side effects of teduglutide that do not really require any kind of medical attention, and these will probably fade away during your treatment program as your body becomes adjusted to the medication. If any of the following side effects do persist for a period of time, consult your family doctor about ways that these specific side effects can be mitigated. Mild side effects of teduglutide include:

• sneezing
• sore throat
• headache
• body aches and body pains
• changes in eating habits or appetite
• chills
• nausea and vomiting
• unusual fatigue
• weakness
• difficulty with falling asleep
• nasal congestion
• voice problems
• ear congestion
• coughs

The side effects below are considered more serious than those given above. If any of these side effects should appear while you're taking teduglutide and they remain for longer than a day or two, you should seek medical advice right away:

• bloated or full feeling
• fever
• swelling of the lips, hands, feet, eyelids, face, fingers, lower legs, feet, hands, abdomen or stomach area
• stiffness or pain in the joints
• rashes, itching, or redness of the skin
• persistent abdominal pain
• unusual decrease in urine flow
• regular excess of gas in the stomach
• fast or irregular heartbeat
• breathing which is unusually noisy
• stomach pressure
• unexplained weight gain
• difficulty breathing when at rest
• trouble swallowing
• chest tightness
• persistent indigestion

Dosage

Teduglutide is a medication which must be injected under the skin, which means that you need to be instructed by your doctor on how to self-administer each dosage of teduglutide. If you do not have a thorough understanding of this process, do not start a program of self-injection at home.

Make sure to follow all the directions that have been printed on your prescription label, especially those relating to using only the exact amount of teduglutide prescribed for a specific dosage. You will probably be provided with a Medication Guide when given teduglutide, and you should make sure to read this thoroughly before self-administering the drug at home.

In addition, anytime that you get a prescription refilled by your pharmacist, make sure to reread your Medication Guide, to be sure that nothing has changed since last time. This is especially important if your dosages have changed per your doctor's recommendation.

Teduglutide comes in the form of a powder, which must be mixed with a diluent before usage, making it very important that you understand exactly how much liquid should be mixed in with a specific amount of powder before self-injecting.

You should only prepare a dosage of teduglutide when you are certain that you will be immediately using it at that time. If you mix up a dosage of teduglutide and do not administer it within a three hour window, that dosage must be discarded and not used.

Every time you self-administer teduglutide, it is advisable to use a different injection site - choose somewhere on your thigh, upper arm, or stomach when you actually carry out the injection. You should not administer an injection at the same site for consecutive dosages and you should never inject teduglutide into muscles or veins.

When you are preparing a dosage of teduglutide, remember that every bottle of the medication is intended for single usage, which means that any unused medication must be discarded, even if there is some left over after mixing up your next dosage.

Similarly, every disposable needle and syringe must be used only once, and then it must be thrown away by placing it in a puncture-proof and tamper-proof container. If you don't know where to obtain these kinds of containers, you can consult with your doctor or pharmacist to get a supply.

If you should miss a regularly scheduled dosage of teduglutide, take it as soon as you remember it, unless you remember at a time that is very close to the next scheduled dosage. In that case, you should skip the missed dosage and just wait for the next scheduled one. You should never double up on dosages of teduglutide, even if you think you need more at any given time. If you suspect that you have overdosed on teduglutide, you should immediately call the Poison Control Center and follow any instructions given.

Interactions

The only known interaction that teduglutide has with food or alcohol is that it facilitates absorption by the body for any nutrients ingested. This is a very mild form of interaction, not considered harmful, unless significant amounts of alcohol are being ingested, in which case you should be aware that you will begin feeling the effects of alcohol consumption sooner and probably more intensely than you would have otherwise.

In terms of other drugs interacting with teduglutide, there is only one drug known to have a reaction. When bexarotene is used with teduglutide, there is potential for it to increase the risk of pancreatitis, which is an inflammation of the pancreas gland. If you have any concerns about this potential interaction, you should consult with your doctor about it, and have them fully explain to you what the risks of using teduglutide are. If you are at risk for this kind of interaction, your doctor may want to prescribe some drug other than teduglutide for management of your short bowel syndrome symptoms.

If you become aware of any of the symptoms of pancreatitis, you should immediately contact your doctor and explain exactly what you are experiencing. Some of the specific things to look for with pancreatitis are nausea and vomiting, tenderness in the abdominal area and pain in the upper abdomen that seems to worsen after eating and may even spread throughout the back.

Warnings

There are a few precautions and warnings that you should observe when on a treatment program that includes teduglutide:

• Don't take teduglutide if you are allergic to it, or to any of the ingredients from which it's made.
• Don't use teduglutide if you have stomach cancer or cancers of the pancreas, gallbladder, liver or intestines.
• Prior to using teduglutide, make sure you tell your doctor if you have any family history of kidney disease, intestinal polyps, heart disease, intestinal blockage, stomach blockage, colostomy, ileostomy, or pancreatic problems.
• You should be aware that when using teduglutide, your doctor will likely require frequent blood tests, at least every few months, to monitor its effectiveness in the body. After you've been using teduglutide for at least one year, it is likely that your doctor will recommend a colonoscopy, and if you continue to be treated with teduglutide over a period of time, you will probably need to have a colonoscopy done every five years.
• If you should develop stomach cramps while being treated with teduglutide, or if you experience severe constipation, make sure to contact your doctor immediately and inform them of the issue.
• In some people, treatment with teduglutide increases the risk of developing some forms of cancer, so you should consult with your doctor about your specific risk before agreeing to a program of treatment.
• You should let your doctor know if you are now pregnant, or if you plan to become pregnant while on a program of treatment with teduglutide. There are no known instances of infants being harmed while mothers are being treated with teduglutide, but it's always best to consult with your doctor in such cases.
• No research has been conducted into the area of whether or not teduglutide is passed on to an infant through breast milk, so to be safe, it's best that you do not breast-feed while taking teduglutide.
• This medication should not be administered to any person below the age of 18 without specific recommendation by medical personnel.
• Seniors sometimes have adverse reactions to taking teduglutide, so if you are above the age of 65, be sure to consult with your doctor about the advisability of taking this medication.
• Some negative reactions have been observed in patients in the area of the central nervous system, specifically with manifestations of headaches and interruptions of sleep.
• Respiratory reactions are generally manifested in the form of coughs, sneezes, and occasionally difficult breathing.
• There are several kinds of adverse reactions which may occur in the gastrointestinal tract, including all of following: pancreatitis, accelerated intestinal malignancy, nausea, abdominal pain, appetite disorders, flatulence, abdominal distention, cholecystitis, stoma complications, intestinal obstructions and cholangitis.
• It's possible for users of teduglutide to experience fluid overloads and hypersensitivity reactions, so if any of these appear, you should notify your doctor immediately.
• Since teduglutide is administered by injection, there is always the possibility of reactions on the skin or underneath the skin, somewhere near the injection site. This can be in the form of discoloration, redness, itchiness, and even generalized pain in that area. If injection site reactions occur while you are self-administering teduglutide, you should contact your doctor immediately, and discontinue any further self-injections until receiving medical advice.

Storage

Teduglutide should be stored at room temperature, well away from direct light, heat, and moisture, which means storing it in the bathroom is not a good idea. There is often a good deal of heat and humidity in bathrooms, especially during showering or bathing, which could decrease the effectiveness of the medication.

It should also be stored well out of the reach of pets and children, so that accidental access is not possible. For the same reason, teduglutide should not be kept in any kind of daily reminder container, because these do not have safety lock features that prevent access by the curious.

If teduglutide expires before it can be used, the unused portion should be discarded and not used at all, because the results will be unpredictable. In this case, contact your doctor and explain that you will need a refill.

Summary

The most common reason for teduglutide to be prescribed in a program of treatment is for people who have undergone a surgical procedure on their intestines and had some portion of it removed. Since the body's ability to absorb nutrients is reduced by such a procedure, it sometimes becomes necessary to boost that absorption ability again with the help of medication.

Teduglutide is not normally prescribed for children under the age of 18, and some seniors do have negative reactions to the medication, but generally speaking, there are not many side effects or warnings that accompany usage of teduglutide. Prolonged usage of teduglutide may require that a patient be tested periodically for adverse reactions, and a colonoscopy is usually required after one year of usage. Otherwise, the medication does not have long-term negative effects, although it's always best to consult regularly with the family doctor if anything unusual develops while on a program of treatment.