Names and pronunciation
(or-it′a-van′sin) Orbactiv, Kimyrsa
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Drug reference
(or-it′a-van′sin) Orbactiv, Kimyrsa
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Func. class.: Antibiotic agents Func. class.: Weight-control agent
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Chem. class.: Glycopeptide Chem. class.: Lipase inhibitor
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ACTION: Inhibits bacterial cell wall biosynthesis, disrupts bacterial cell membrane ACTION: Inhibits the absorption of dietary fats
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USES: Enterococcus faecalis, Enterococcus faecium, Staphylococcus aureus (MRSA), Staphylococcus aureus (MSSA), Streptococcus agalactiae (group B streptococci), Streptococcus anginosus, Streptococcus constellatus, Streptococcus dysgalactiae, Strepto- coccus intermedius, Streptococcus pyogenes (group A β-hemolytic strepto- cocci); treatment of acute bacterial skin and skin structure infections due to gram-positive organisms, including cel- lulitis/erysipelas, major cutaneous abscesses, and wound infections USES: Obesity management
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Anticoagulant therapy, anti- microbial resistance, breastfeeding, coli- tis, diarrhea, inflammatory bowel disease, infusion reactions, pregnancy, CDAD, van- comycin hypersensitivity, viral infection
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SIDE EFFECTS CNS: Dizziness, flushing, headache CV: Sinus tachycardia, phlebitis O GI: Nausea, vomiting, diarrhea, CDAD HEMA: Anemia, eosinophilia MS: Myalgia, osteomyelitis INTEG: Rash, vasculitis, pruritus, angio- edema, infusion-related reaction MISC: Wheezing, bronchospasm
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INTERACTIONS Increase: toxicity—products metabo- lized by CYP2D6, CYP3A4 Increase: bleeding risk—warfarin; avoid concurrent use Drug/Lab Test Increase: LFTs, uric acid, INR, aPTT
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DOSAGE AND ROUTES • Adult: IV 1200 mg as a single dose DOSAGE AND ROUTES • Adult/children ≥12 yr: PO (Alli) 60 mg, (Xenical) 120 mg tid with each main meal containing fat, max 360 mg/ day
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Available forms: Powder for injection: 400-mg vial Available forms: Capsules 60, 120 mg
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Administer: • Draw C&S prior to using • Visually inspect for particulate matter and discoloration beforehand; the recon- stituted solution is clear, colorless to pale yellow • Reconstitution: Reconstitute each 400-mg vial with 40 mL sterile water for injection. Three vials are necessary for a single dose; gently swirl until dis- solved • Dilution: Withdraw and discard 120 mL from a 1000-mL intravenous bag of D5W; transfer 40 mL solution from each of the 3 reconstituted vials to the D5W IV bag (1.2 mg/mL) • Storage: Refrigerate or store at room temperature. The combined storage time (from reconstitution to dilution) and 3-hour infusion time should not exceed 6 hr at room temperature or 12 hr if refrigerated Intermittent IV INFUSION • Infuse over 3 hr; do not infuse with other medications or electrolytes; do not use with saline-based solutions • Avoid heparin for 5 days after use of this product; false elevated aPTT and co- agulation studies may occur
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Assess: • Infection: wounds, fever, sputum, urine, monitor WBC baseline and peri- odically report changes • CBC and differential • Infusion-related reactions: symptoms of red man syndrome (flushing, urticaria, pruritus); slow or stop infusion • Bowel function: for diarrhea, bloody stools, cramping; assess for fever; report to health care professional, may be Clostridium difficile–associated diarrhea (CDAD), may start up to 8 wk after completion of treatment • Anticoagulant use: may increase ef- fects of warfarin; monitor closely, avoid use with heparin; heparin effects may be reduced and lab results altered • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; cautious use in breastfeeding, excreted in breast milk
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Evaluate: • Therapeutic response: resolution of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Reason for product, expected result • Used only once to resolve infection • Hypersensitivity reactions: to notify prescriber of rash, facial swelling, dyspnea • To avoid use of other prescription products, OTC products, or herbal prod- ucts unless approved by prescriber • Bowel function: to notify health care professional of diarrhea, bloody stools, cramping, fever; do not self-treat • To notify prescriber if pregnancy is planned or suspected (or′lih-stat) Alli, Xenical
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PHARMACOKINETICS 85% protein binding, half-life 245 hr, excre- tion urine, unchanged, peak infusion’s end
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• Adult/children ≥12 yr: PO (Alli) 60 mg, (Xenical) 120 mg tid with each main meal containing fat, max 360 mg/ day
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