Names and pronunciation
Zynlonta
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Drug reference
Zynlonta
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Func. class.: Antineoplastic-alkylating agent Func. class.: Antidiarrheal
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USES: Relapsed or refractory large B-cell lymphoma USES: Diarrhea (cause undeter- mined), travelers’ diarrhea, chronic diarrhea, to decrease amount of ileos- tomy discharge
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Chem. class.: Piperidine derivative
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Do not confuse: Loperamide/furosemide
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ACTION: Direct action on intestinal muscles to decrease GI peristalsis; reduces volume, increases bulk; electrolytes not lost
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CONTRAINDICATIONS: Hyper- sensitivity, CDAD, constipation, dysentery, GI bleeding/obstruction/perforation, ileus, vomiting
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Black Box Warning: Children, cardiac arrest, torsade de pointes Precautions: Pregnancy, breastfeeding, children <2 yr, hepatic disease, dehydration, gastroenteritis, toxic megacolon, geriatric patients, severe ulcerative colitis
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SIDE EFFECTS CNS: Dizziness, drowsiness, fatigue GI: Nausea, dry mouth, vomiting, con- stipation, abdominal pain, anorexia, toxic megacolon, bacterial enterocolitis, flatulence INTEG: Rash MISC: Hyperglycemia SYST: Anaphylaxis, angioedema, toxic epidermal necrolysis
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INTERACTIONS Increase: CNS depression—alcohol, antihistamines, analgesics, opioids, seda- tive/hypnotics Drug/Herb Increase: CNS depression—chamomile, hops, kava, valerian
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DOSAGE AND ROUTES • Adult: IV 0.15 mg/kg over 30 min on day 1 of each cycle (q3wk) × 2 cycles, then 0.075 mg/kg over 30 min q3wk for subsequent cycles DOSAGE AND ROUTES • Adult: PO 4 mg, then 2 mg after each loose stool, max 16 mg/day • Child 9-11 yr: PO 2 mg, then 1 mg af- ter each loose stool, max 6 mg/24 hr • Child 6-8 yr: PO 2 mg, then 0.1 mg/kg after each loose stool, max 4 mg/day • Child 2-5 yr: PO 1 mg, then 0.1 mg/kg after each loose stool, max 4 mg/24 hr
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Available forms: Lyophilized powder for injection; for IV use 10 mgl (loe-per′a-mide) Diamode, Imodium , Imodium A-D Available forms: Caps 2 mg; oral solution 1 mg/5 mL; tabs 2 mg
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Administer: • Do not break, crush, or chew caps • For 48 hr only • Do not mix oral sol with other sol
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Assess: • Stools: volume, color, characteristics, frequency; bowel pattern before product; rebound constipation • Electrolytes (potassium, sodium, chlo- L rine) if receiving long-term therapy • Response after 48 hr; if no response, product should be discontinued • Abdominal distention, toxic megaco- lon in those with ulcerative colitis • Dehydration, CNS change in children, hepatic disease • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; breastfeed- ing is not recommended
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Evaluate: • Therapeutic response: decreased diar- rhea (48 hr); decreased chronic diar- rhea (10 days)
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid OTC products unless directed by prescriber • That ileostomy patient may take prod- uct for extended time • Not to operate machinery if drowsiness occurs • To use hard candy, sips of water for dry mouth • To notify health care professional if diarrhea continues over 48 hr or 10 days if distention, fever, or abdominal pain occurs
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PHARMACOKINETICS PO: Duration 24 hr, protein binding 97%, half-life 9-14 hr, metabolized in liver, excreted in feces as unchanged product, small amount in urine
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• Adult: IV 0.15 mg/kg over 30 min on day 1 of each cycle (q3wk) × 2 cycles, then 0.075 mg/kg over 30 min q3wk for subsequent cycles DOSAGE AND ROUTES
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• Adult: PO 4 mg, then 2 mg after each loose stool, max 16 mg/day
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• Child 9-11 yr: PO 2 mg, then 1 mg af- ter each loose stool, max 6 mg/24 hr
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• Child 6-8 yr: PO 2 mg, then 0.1 mg/kg after each loose stool, max 4 mg/day
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• Child 2-5 yr: PO 1 mg, then 0.1 mg/kg after each loose stool, max 4 mg/24 hr
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