as 150 mg/m2 or as low as 50 mg/m2. **(THREE-WEEK REGIMEN):** 350 mg/m2 q3wks. Dosage may be adjusted to as low as 200 mg/m2.

**_(In Combination with Leucovorin and 5-Fluorouracil):_** **REGIMEN ONE:** 125 mg/m2 on days 1, 8, 15, 22. **REGIMEN TWO:** 180 mg/m2 on days 1, 15, 29.

Dosage in Renal Impairment

No dose adjustment.

Dosage in Hepatic Impairment

**Bilirubin**|  **Dose**  
---|---  
More than upper limit of normal to 2 mg/dL or less:| Reduce dose one level  
More than 2 mg/dL:| Not recommended

#####  SIDE EFFECTS

**Expected (64%–32%):** Nausea, alopecia, vomiting, diarrhea. **Frequent (29%–22%):** Constipation, fatigue, fever, asthenia, skeletal pain, abdominal pain, dyspnea. **Occasional (19%–16%):** Anorexia, headache, stomatitis, rash.

#####  ADVERSE EFFECTS/TOXIC REACTIONS

Hematologic toxicity characterized by anemia, leukopenia, thrombocytopenia, and neutropenia, sepsis occur frequently.

#####  NURSING CONSIDERATIONS

BASELINE ASSESSMENT

Offer emotionalcyclase-C (cGMP) agonist. **CLINICAL:** Anti-constipation agent.

#####  USES

Treatment of irritable bowel syndrome with constipation, chronic idiopathic constipation.

#####  PRECAUTIONS

**Contraindications:** Hypersensitivity to linaclotide. Pediatric patients 6 yrs and younger, known or suspected mechanical GI obstruction. **Cautions:** Diarrhea.

#####  ACTION

Binds on the luminal surface of GI epithelium. Increase cGMP which stimulates chloride and bicarbonate into intestinal lumen. **Therapeutic Effect:** Increase intestinal fluid, accelerates transit.

#####  PHARMACOKINETICS

Metabolized within GI tract. Minimal distribution beyond GI tissue. Minimal systemic absorption. **Half-life:** N/A.

#####    ​LIFESPAN CONSIDERATIONS

**Pregnancy/Lactation:** Unknown if distributed in breast milk. **Pregnancy Category C. Children:** Avoid use in pediatric pts 7 yrs through 17 yrs. Contraindicated in pediatric pts 6 yrs of age and younger. **Elderly:** No age-related precautions noted.

#####  INTERACTIONS

**DRUG:** None significant. **HERBAL:** None significant. **FOOD:** None known. **LAB