Names and pronunciation
(bih′-nee-meh′-tih-nib) Mektovi
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Drug reference
(bih′-nee-meh′-tih-nib) Mektovi
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Func. class.: Antineoplastic Func. class.: Laxative, stimulant
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USES: Treatment of unresectable/met- astatic melanoma (BRAF V600E or V600K mutations) with encorafenib USES: Short-term treatment of consti- pation; bowel or rectal preparation for surgery, examination
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Chem. class.: Diphenylmethane
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Do not confuse: Dulcolax (bisacodyl)/Dulcolax (docusate)
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ACTION: Acts directly on intestine by increasing peristalsis; thought to irritate colonic intramural plexus
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CONTRAINDICATIONS: Hyper- sensitivity CONTRAINDICATIONS: Hyper- sensitivity, abdominal pain, nausea, vom- iting, appendicitis, acute surgical abdo- men, ulcerated hemorrhoids, acute hepatitis, fecal impaction, intestinal/ biliary tract obstruction Precautions: Pregnancy, breastfeeding, rectal fissures, severe CV disease
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SIDE EFFECTS CNS: Muscle weakness GI: Nausea, anorexia, cramps, diarrhea, rectal burning (suppositories) META: Protein-losing enteropathy (extended use), hypokalemia (extended use), tetany
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INTERACTIONS Increase: gastric irritation—antacids, milk, H2 blockers, gastric acid pump inhibitors Decrease: absorption with antacids, H2 blockers, gastric acid pump inhibitors Drug/Food • Increase irritation—dairy products, separate by 2 hr Drug/Lab Increase: sodium phosphate Decrease: calcium, magnesium Drug/Herb Increase: laxative action—flexibility of the valley, pheasant’s eye, senna, squill
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DOSAGE AND ROUTES • Adult: PO 45 mg bid with encorafenib PO 450 mg daily until disease progres sion DOSAGE AND ROUTES • Adult and child ≥12 yr: PO 5-15 mg in PM or AM; may use up to 30 mg for bowel or rectal preparation; RECT 10 mg as a single dose; 30-mL enema • Child 3-11 yr: PO 5-10 mg as a single dose; RECT 5-10 mg as a single dose Available forms: Tablets delayed release 5, 10 mg; enteric-coated tablets 5 mg; suppository 5, 10 mg; rectal solution 10 mg/30 mL
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Available forms: Tablets 15 mg (bis-a-koe′dill) Peglyte , Bisacolax, Bisacolax, Correctol, Carter’s Little Pills , Codulax , Dacodyl, Doxidan, Dulcolax, Ex-Lax Ultra, Femilax, Fleet, Laxative for Women , Silver Bullet Suppository , The Magic Bullet Soflax-Ex
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Administer: PO route • Use lowest dose • Swallow tablets whole with full glass of water; do not break, crush, chew tablets • Take alone only with water for better absorption; do not take within 1 hr of other products or within 1 hr of antacids, milk, H2 antagonists; do not take enteric product with proton-pump inhibitors • In AM or PM Rectal route • Insert high in rectum end first, effect in 15 min-1 hr
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Assess: • Blood, urine electrolytes if product is used often by patient • I&O ratio to identify fluid loss • Cause of constipation; identify whether fluids, bulk, exercise missing from lifestyle; determine use of constipating products • GI symptoms: cramping, rectal bleed- ing, nausea, if these symptoms occur, product should be discontinued • Multiple products/routes may be used for bowel prep
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Evaluate: • Therapeutic response: decrease in constipation, removal of stool from B colon
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to use laxatives for long-term ther- apy because bowel tone will be lost; 1-wk use is usually sufficient • That normal bowel movements do not always occur daily • Not to use in presence of abdominal pain, nausea, vomiting • To notify prescriber if constipation is unrelieved or if symptoms of electrolyte imbalance occur: muscle cramps, pain, weakness, dizziness • To take with a full glass of water; if using with dairy products separate by 2 hr; to separate from other foods by 1 hr • Identify bulk, water, constipating prod- ucts, exercise in patient’s life
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PHARMACOKINETICS Small amounts absorbed/metabolized by liver; excreted in urine, bile, feces, breast milk PO: Onset 6-10 hr RECT: Onset 15-60 min
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• Adult: PO 45 mg bid with encorafenib PO 450 mg daily until disease progres sion DOSAGE AND ROUTES
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• Adult and child ≥12 yr: PO 5-15 mg in PM or AM; may use up to 30 mg for bowel or rectal preparation; RECT 10 mg as a single dose; 30-mL enema
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• Child 3-11 yr: PO 5-10 mg as a single dose; RECT 5-10 mg as a single dose Available forms: Tablets delayed release 5, 10 mg; enteric-coated tablets 5 mg; suppository 5, 10 mg; rectal solution 10 mg/30 mL
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