teduglutide: clinical use

Prescribing considerations

• Initiate and supervise through an experienced short-bowel or intestinal-failure service.
• Ensure intestinal adaptation has stabilised and parenteral fluid and nutritional support are optimised before treatment.
• Assess malignancy history and complete appropriate gastrointestinal polyp or neoplasia screening.
• Monitor patients with cardiovascular disease closely for fluid overload.
• Renal impairment can increase exposure; severe hepatic impairment has not been studied.
• Manage changes to parenteral support and treatment discontinuation cautiously because dehydration and acute kidney injury can occur.

Contraindications and cautions

• Hypersensitivity to teduglutide, an excipient or trace tetracycline residues
• Active or suspected malignancy
• Gastrointestinal, hepatobiliary or pancreatic malignancy within the previous five years

Monitoring

• Weight, hydration, urine or stoma output, electrolytes and requirements for parenteral support
• Small-bowel function and symptoms of intestinal obstruction
• Colorectal and upper gastrointestinal surveillance for polyps or neoplasia
• Gallbladder, biliary and pancreatic symptoms, with laboratory testing or imaging when indicated
• Response and toxicity of important oral concomitant medicines
• Product name and batch number for traceability

Clinical pharmacology

Teduglutide is a DPP-IV-resistant GLP-2 analogue that increases villus height and crypt depth. It is highly bioavailable after subcutaneous administration, is probably metabolised through peptide pathways and is substantially cleared through the kidneys.

Formulation and product differences

• Do not freeze, mix with other medicines, or use reconstituted solution that is cloudy or contains particles.

Injection

Route: Parenteral

Strengths: 1.25 mg, 5 mg