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Eluxadoline

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Eluxadoline, Viberzi

  • See Also
  1. Irritable Bowel Syndrome
  • Indications
  1. Diarrhea Predominant Irritable Bowel Syndrome
  • Contraindications
  1. Prior Cholecystectomy
    1. Pancreatitis risk
  2. Sphincter of Odi dysfunction
  3. Biliary duct obstruction
  4. Alcohol use >3 drinks/day or Alcoholism
  5. Severe Constipation history
  6. Small Bowel Obstruction history
  7. Severe Liver Disease (Child Pugh Class C)
  • Mechanism
  1. DEA Class IV controlled substance in U.S.
  2. Mu-opioid Agonist
    1. Similar activity to Loperamide
  • Dosing
  1. Standard dose
    1. Take 100 mg orally twice daily
  2. Lower dose
    1. Take 75 mg orally twice daily
    2. Indications for lower dose
      1. Intolerant of standard dose
      2. Liver dysfunction
      3. eGFR <60 ml/min
      4. Elderly
      5. OATP1B1 Inhibitor use (see Drug Interactions below)
  • Adverse Effects
  1. Common
    1. Abdominal Pain
    2. Nausea
    3. Constipation
      1. Hold Eluxadoline for severe Constipation
  2. Uncommon but serious (deaths have occurred)
    1. Pancreatitis
    2. Anaphylaxis
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Efficacy
  1. More effective at reducing loose stools than in reducing Abdominal Pain
  2. Marginal efficacy (NNT 11) for decreased Diarrhea and Abdominal Pain at 6 months
  • Drug Interactions
  1. Concurrent medications predisposing to Constipation
    1. Opioids
    2. Anticholinergic Medications
  2. OATP1B1 Inhibitors
    1. Alfentanil
    2. Cyclosporine
    3. Ergotamine
    4. Fentanyl
    5. Sirolimus
    6. Tacrolimus
  3. Rosuvastatin
    1. Eluxadoline may increase Rosuvastatin levels (risk of Statin Myopathy)
  • Resources
  1. Eluxadoline (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7821bd40-4c84-4984-951b-6436ae20421a
  • References
  1. (2016) Presc Lett 23(6):32
  2. (2017) Presc Lett 24(5):27
  3. (2021) Irritable Bowel Syndrome Drug Comparison, Presc Lett, #370305
  4. (2020) Med Lett Drugs Ther 62(1594): 41-58