Zelnorm Tegaserod
ZELNORM
Zelnorm [tegaserod] marketed by Novartis, is a 5 HT4 receptor partial agonist that binds with a high affinity at human 5-HT4 receptors. By acting as an agonist at neuronal 5-HT receptors, it triggers the release of further neuro transmitters such as calcitonin gene-related peptide from sensory neurons. The activation of 5-HT4 receptors in the gastro intestinal tract stimulates the peristaltic reflux and intestinal secretions, as well as inhibits visceral sensitivity.
INDICATIONS:
- Short term treatment of irritable bowel syndrome [IBS] whole primary bowel symptoms is constipation, bloating, and abdominal pain.
DOSAGE:
6 mg Zelnorm taken twice daily before meals for 4-6 week orally. If patients respond to the therapy, an additional 4-6 weeks course can be considered.
CONTRAINDICATIONS:
- In severe renal impairment
- Moderate to severe hepatic impairment
- A history of bowel obstruction
- Symptomatic gall bladder disease
- Suspected sphincter of oddi dysfunction or abdominal adhesions
- A known hypersensitivity to the drug or any of its excipients.
SPECIAL PRECAUTIONS:
In patients currently experiencing or who frequently experience diarrhea, to be discontinued immediately in patients with new or sudden worsening of abdominal pain.
PREGNANCY and LACTATION:
Pregnancy: to be used only if clearly indicated
Lactation: not known whether the drug excreted is human milk
SIDE EFFECTS:
- Abdominal pain
- Diarrhea
- Nausea
- Flatulence
- Headache
- Dizziness
- Blood in your stools
- Migraine
- Back pain
DRUG INTERACTIONS: clinically no significant drug-drug interactions have been observed.
CONTROVERSIES:
On 30 March 2007, the FDA notified healthcare professionals and patients that Novartis has agreed to discontinue marketing Zelnorm. Following is the FDA Public Health Advisory
FDA Public Health Advisory
FDA is issuing this public health advisory to inform patients and health care professionals that the sponsor of Zelnorm (tegaserod maleate), Novartis Pharmaceuticals Corporation, has agreed to stop selling Zelnorm. Zelnorm is being taken off the market because a new safety analysis has found a higher chance of heart attack, stroke, and worsening heart chest pain that can become a heart attack in patients treated with Zelnorm compared to those treated with a sugar pill they thought was Zelnorm.
FDA announces the following, effective immediately:
At FDA's request, Novartis Pharmaceuticals Corporation has agreed to stop selling Zelnorm.
Patients being treated with Zelnorm should contact their physician to discuss alternative treatments for their condition.
Patients who are taking Zelnorm should seek emergency medical care right away if they experience severe chest pain, shortness of breath, dizziness, sudden onset of weakness or difficulty walking or talking or other symptoms of a heart attack or stroke.
Physicians who prescribe Zelnorm should work with their patients and transition them to other therapies as appropriate to their symptoms and need.
Zelnorm is a prescription medication approved for short term treatment of women with irritable bowel syndrome with constipation and for patients younger than 65 years with chronic constipation. In late February and early March 2007, Novartis Pharmaceuticals gave FDA the results of new analyses of 29 clinical studies of Zelnorm for treatment of a variety of gastrointestinal tract conditions; the data from all the studies were combined to assess the chance of side effects on the heart and blood vessels. In each study, patients were assigned at random to either Zelnorm or a sugar pill they thought was Zelnorm. These 29 studies included 11,614 patients treated with Zelnorm and 7,031 treated with a sugar pill. The average age of patients in these studies was 43 years and most patients—88%--were women.
The number of patients who suffered a heart attack, stroke or severe heart chest pain that can turn into a heart attack was small. However, patients treated with Zelnorm had a higher chance of having any of these serious and life-threatening side effects than did those who were treated with a sugar pill. Thirteen patients treated with Zelnorm (0.1%) had serious and life-threatening cardiovascular side effects; among these, four patients had a heart attack (one died), six had a type of severe heart chest pain which can quickly turn into a heart attack, and three had a stroke. Among the patients taking the sugar pill, only one (or 0.01%) had symptoms suggesting the beginning of a stroke that went away without complication.
There may be patients for whom no other treatment options are available and in whom the benefits of Zelnorm treatment outweigh the chance of serious side effects. FDA will work with Novartis to allow access to Zelnorm for those patients through a special program.
FDA has also indicated to Novartis a willingness to consider limited re-introduction of Zelnorm at a later date if a population of patients can be identified in whom the benefits of the drug outweigh the risks. However, before FDA makes a decision about limited re-introduction, any proposed plan would be discussed at a public advisory committee meeting.
Samir is the author of
Zelnorm, Tegaserod Maleate
information located at
Genericsmed.com
site
REFERENCES:
- Drug Today, July-September 2005 Edition, pg 485
- http://www.zelnorm.com/index.jsp
- http://www.fda.gov/cder/drug/infopage/zelnorm/
- http://www.rxlist.com/cgi/generic/zelnorm.htm
- http://www.rxwiki.com/index.php?title=Zelnorm
- http://www.drugs.com/zelnorm.html
- http://www.fda.gov/cder/drug/advisory/tegaserod.htm
