Lubiprostone

Lubiprostone (rINN, marketed under the trade name Amitiza among others) is a medication used in the management of chronic idiopathic constipation, predominantly irritable bowel syndrome-associated constipation in women and opioid-induced constipation. The drug is owned by Mallinckrodt and is marketed by Takeda Pharmaceutical Company.

Lubiprostone
Clinical data
Trade namesAmitiza
Other namesAmitiza
RU-0211
SPI-0211
AHFS/Drugs.comMonograph
MedlinePlusa607034
License data
Routes of
administration		Oral
ATC code
Legal status
Legal status
Pharmacokinetic data
BioavailabilityNegligible
Protein binding94%
MetabolismExtensive, CYP not involved
Elimination half-lifeUnknown (lubiprostone)
0.9–1.4 hours (main metabolite)
ExcretionRenal (60%) and fecal (30%)
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.107.168
Chemical and physical data
FormulaC20H32F2O5
Molar mass390.468 g·mol−1
3D model (JSmol)
 NY (what is this?)  (verify)

The drug was developed by Sucampo Pharmaceuticals and approved by the Food and Drug Administration (FDA) in 2006.[1] It was recommended for use in the UK by the National Institute for Health and Care Excellence (NICE) in July 2014.[2] Health Canada approved the drug in 2015.[3]

The cost to the NHS was £29.68 per 24 mg 28-cap pack as of April 2017.

Lubiprostone received approval from the Food and Drug Administration in 2008 to treat irritable bowel syndrome with constipation (IBS-C) and is available through prescription only.

The drug is available in the United States, Japan, Switzerland, India, United Kingdom; and Canada.

In Bangladesh and India, lubiprostone is marketed under the trade name Lubilax by Beacon Pharmaceuticals, and under the trade name Lubowel by Sun Pharmaceutical.

Medical uses

Lubiprostone is used for the treatment of chronic constipation of unknown cause in adults, as well as irritable bowel syndrome associated with constipation in women.[4]

Lubiprostone is approved to treat chronic idiopathic constipation (CIC) in adults.

Lubiprostone is also approved to treat opioid-induced constipation, in adults with chronic non-cancer pain. The effectiveness of lubiprostone has not been established in patients who are taking a diphenylheptane opioid (e.g., methadone).

Lubiprostone is approved to treat irritable bowel syndrome with constipation (IBS-C) in women 18 years of age and older.[5]

Lubiprostone has not been studied in children. There is current research under way to determine the safety and efficacy in postoperative bowel dysfunction.

Adverse effects

In clinical trials, the most common adverse event was nausea (31%). Other adverse events (≥5% of patients) included diarrhea (13%), headache (13%), abdominal distension (5%), abdominal pain (5%), flatulence (6%), sinusitis (5%), vomiting (5%), and fecal incontinence (1%).

Contraindications

There is no current data on use in people with liver or kidney complications. The effects on pregnancy have not been studied in humans but testing in guinea pigs resulted in fetal loss.

Amitiza is not approved for use in children. Lubiprostone is contraindicated in patients exhibiting chronic diarrhea, bowel obstruction, or diarrhea-predominant irritable bowel syndrome.

Mechanism of action

Lubiprostone is a bicyclic fatty acid derived from prostaglandin E1 that acts by specifically activating ClC-2 chloride channels on the apical aspect of gastrointestinal epithelial cells, producing a chloride-rich fluid secretion. These secretions soften the stool, increase motility, and promote spontaneous bowel movements (SBM).

Symptoms of constipation such as pain and bloating are usually improved within one week, and SBM may occur within one day.

Pharmacokinetics

Unlike many laxative products, lubiprostone does not show signs of drug tolerance, chemical dependency, or altered serum electrolyte concentration.[6] There was no rebound effect following withdrawal of treatment, but a gradual return to pre-treatment bowel movement frequency should be expected.

Minimal distribution of the drug occurs beyond the immediate gastrointestinal tissues. Lubiprostone is rapidly metabolized by reduction/oxidation, mediated by carbonyl reductase. There is no metabolic involvement of the hepatic cytochrome P450 system. The measurable metabolite, M3, exists in very low levels in plasma and makes up less than 10% of the total administered dose.

Data indicate that metabolism occurs locally in the stomach and jejunum.

References
  1. "FDA Approves New Type of Drug To Treat Constipation in Adults". The Wall Street Journal. February 1, 2006.
  2. "Final appraisal determination: Lubiprostone for treating chronic idiopathic constipation". National Institute for Health and Care Excellence. June 2014.
  3. "Health Canada New Drug Authorizations: 2015 Highlights". Health Canada. 2016-05-04.
  4. "Amitiza". The American Society of Health-System Pharmacists.
  5. "AMITIZA® (lubiprostone) 8 mcg Now Available to Treat Irritable Bowel Syndrome with Constipation in Adult Women" (Press release). Takeda Pharmaceutical Company. May 26, 2008.
  6. Lacy BE, Levy LC (June 2008). "Lubiprostone: a novel treatment for chronic constipation". Clinical Interventions in Aging. 3 (2): 357–64. doi:10.2147/cia.s2938. PMC 2546479. PMID 18686757.
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