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Choosing her appropriate LOTRONEX dose.

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Starting dose: 0.5 mg BID 4 weeks Maintain if… -> Well controlled at 0.5 mg BID
Increase if...-> Inadequate relief, but well tolerated: Increase dose to 1 mg BID.

A dose-response relationship has not been established for serious complications of constipation.1

IMPORTANT SAFETY INFORMATION

If constipation occurs at 0.5 mg BID, discontinue until resolved.

  • Once resolved, resume at 0.5 mg QD
  • If constipation occurs at the lower dose, discontinue use

If 1 mg BID does not provide adequate control of IBS symptoms after 4 weeks, discontinue use.

In clinical studies1:

  • Occurrences of constipation, a frequent and dose-related side effect of LOTRONEX, were generally mild to moderate, transient in nature, and resolved spontaneously with continued treatment or an interruption of treatment
  • Following treatment interruption, 78% of affected patients resumed bowel movements within 2 days and were able to re-initiate LOTRONEX treatment
  • Approximately 75% of patients who experienced constipation with 1 mg BID reported only 1 episode

If a patient experiences constipation, discontinue LOTRONEX immediately and wait until it subsides

Once resolved: resume at 0.5 mg QD -> If constipation recurs at this lower dose, STOP PERMANENTLY

Reference: 1. LOTRONEX [package insert]. Roswell, GA: Sebela Pharmaceuticals Inc; 2019.

INDICATIONS AND USAGE

LOTRONEX is indicated only for women with severe diarrhea-predominant irritable bowel syndrome (IBS) who have: chronic IBS symptoms (generally lasting 6 months or longer), had anatomic or biochemical abnormalities of the gastrointestinal tract excluded, and not responded adequately to conventional therapy. Diarrhea-predominant IBS is severe if it includes diarrhea and one or more of the following: frequent and severe abdominal pain/discomfort, frequent bowel urgency or fecal incontinence, disability or restriction of daily activities due to IBS. Because of infrequent but serious gastrointestinal adverse reactions associated with LOTRONEX, the indication is restricted to those patients for whom the benefit-to-risk balance is most favorable. Clinical studies have not been performed to adequately confirm the benefits of LOTRONEX in men.

IMPORTANT SAFETY INFORMATION

WARNING: SERIOUS GASTROINTESTINAL ADVERSE REACTIONS

Infrequent but serious gastrointestinal adverse reactions have been reported with the use of LOTRONEX. These events, including ischemic colitis and serious complications of constipation, have resulted in hospitalization, and rarely, blood transfusion, surgery, and death.

  • LOTRONEX is indicated only for women with severe diarrhea-predominant irritable bowel syndrome (IBS) who have not responded adequately to conventional therapy.
  • LOTRONEX should be discontinued immediately in patients who develop constipation or symptoms of ischemic colitis. Patients should immediately report constipation or symptoms of ischemic colitis to their prescriber. LOTRONEX should not be resumed in patients who develop ischemic colitis. Patients who have constipation should immediately contact their prescriber if the constipation does not resolve after LOTRONEX is discontinued. Patients with resolved constipation should resume LOTRONEX only on the advice of their treating prescriber.

CONTRAINDICATIONS

  • Do not initiate in patients with constipation
  • History of chronic or severe constipation or sequelae from constipation; intestinal obstruction, stricture, toxic megacolon, gastrointestinal perforation, and/or adhesions; ischemic colitis; impaired intestinal circulation, thrombophlebitis, or hypercoagulable state; Crohn’s disease or ulcerative colitis; diverticulitis; severe hepatic impairment
  • Concomitant use of fluvoxamine

WARNINGS AND PRECAUTIONS

  • Serious Complications of Constipation: May occur in some patients without warning. Include obstruction, ileus, impaction, toxic megacolon, and secondary bowel ischemia and in rare cases perforation and death have been reported. Risk is increased in patients who are elderly, debilitated, or taking medications that decrease bowel motility. The incidence of serious complications of constipation was approximately 0.1% (1 per 1,000 patients) in women receiving either LOTRONEX or placebo.
  • Discontinue LOTRONEX immediately if constipation occurs.
  • Ischemic colitis: May occur in some patients without warning. Promptly evaluate patients with signs of ischemic colitis (e.g., rectal bleeding, bloody diarrhea, new or worsening abdominal pain). In IBS clinical trials, the cumulative incidence of ischemic colitis in women receiving LOTRONEX was 0.2% (2 per 1,000 patients, 95% confidence interval 1 to 3) through 3 months and was 0.3% (3 per 1,000 patients, 95% confidence interval 1 to 4) through 6 months.
  • Discontinue LOTRONEX immediately if signs of ischemic colitis occur, such as rectal bleeding, bloody diarrhea, or new or worsening abdominal pain.

ADVERSE REACTIONS

Most common adverse reactions (incidence >2% and >placebo) in clinical studies were constipation, abdominal discomfort and pain, nausea, and gastrointestinal discomfort and pain.

Please see the accompanying complete prescribing information for LOTRONEX, including Boxed Warning and Medication Guide.