How ZELNORM Works   |   IBS-C and Serotonin

SEROTONIN SIGNALING IN THE ENTERIC NERVOUS SYSTEM (ENS) IS KEY TO WELL-REGULATED GI FUNCTION1


5-HT RECEPTORS THROUGHOUT THE ENS REGULATE MULTIPLE ACTIONS, INCLUDING PERISTALTIC REFLEX AND SENSORY SIGNALING1

Neuronal surface showing 5-HT4 receptors & serotonin signaling

It has been established that 5-HT4 receptors are involved in the pathophysiology of IBS-C. These receptors are abundant throughout the gastrointestinal tract and can be bound by serotonin.2,3


ABNORMAL SEROTONIN SIGNALING IN THE ENS COULD BE A CONTRIBUTING CAUSE OF IBS-C4

Alterations in motility, secretion, and visceral sensation in IBS-C are now thought to involve disruption in signaling by 5-HT, which coordinates the activity of the ENS.2

Serotonin is a key transducer of pain Serotonin is a key transducer of pain

and can activate both intrinsic & extrinsic sensory neurons. Patients with IBS-C have been shown to have a significantly lower pain threshold versus controls.3,5

See how ZELNORM stimulates serotonin receptors to relieve IBS-C symptoms    

Indication

ZELNORM (tegaserod) is indicated for the treatment of adult women less than 65 years of age with irritable bowel syndrome with constipation (IBS-C).

Important Safety Information

ZELNORM should be used in females under 65 years of age who do not have a history of ischemic cardiovascular disease and who have no more than one CVD risk factor. CVD risk factors are defined as active smoking, current hypertension/history of antihypertensive treatment, current hyperlipidemia/history of lipid-lowering medication, history of diabetes mellitus, age ≥55 years, or obesity (BMI >30 kg/m2).

Contraindications:

ZELNORM is contraindicated in patients with:

  • History of myocardial infarction (MI), stroke, transient ischemic attack (TIA), or angina
  • History of ischemic colitis or other forms of intestinal ischemia
  • Severe renal impairment (eGFR< 15 mL/min/1.73 m2) or end-stage renal disease
  • Moderate and severe hepatic impairment (Child-Pugh B or C)
  • History of bowel obstruction, symptomatic gallbladder disease, suspected sphincter of Oddi dysfunction, or abdominal adhesions
  • Hypersensitivity to ZELNORM

Warnings and Precautions

Cardiovascular Ischemic Events, Including Major Adverse Cardiovascular Events (MACE): Stroke, MI, and cardiovascular death have been reported in adults taking ZELNORM who had an increased risk of developing an adverse cardiovascular event based on their medical history.

Female patients less than 65 years of age should be assessed for a history of cardiovascular disease and cardiovascular risk factors prior to treatment with ZELNORM.

Discontinue ZELNORM in patients who experience an MI, stroke, TIA, or angina. Evaluate the risks and benefits of continued use of ZELNORM in patients who develop evidence of cardiovascular ischemic heart disease (e.g., coronary artery disease) and/or experience changes in health status that could increase cardiovascular risk during treatment with ZELNORM.

Ischemic Colitis: Ischemic colitis and other forms of intestinal ischemia have been reported postmarketing in patients receiving ZELNORM. Discontinue ZELNORM in patients who develop symptoms of ischemic colitis, such as rectal bleeding, bloody diarrhea, or new or worsening abdominal pain.

Volume Depletion Associated with Diarrhea: In postmarketing experience, serious consequences of diarrhea including hypovolemia, hypotension, and syncope have been reported in patients treated with ZELNORM. Avoid use of ZELNORM in patients who are currently experiencing or frequently experience diarrhea. Instruct patients to discontinue ZELNORM and contact their healthcare provider if severe diarrhea, hypotension, or syncope occur.

Suicidal Ideation and Behavior: Monitor all ZELNORM-treated patients for clinical worsening of depression and emergence of suicidal thoughts and behaviors, especially during the initial few months of treatment. Counsel family members and caregivers of patients to monitor for changes in behavior and to alert the healthcare provider. Instruct patients to immediately discontinue ZELNORM and contact their healthcare provider if their depression is persistently worse or they are experiencing emergent suicidal thoughts or behaviors.

Common Adverse Reactions (incidence >2% and greater than placebo)

The most common adverse reactions in 3 placebo-controlled trials of ZELNORM in female IBS-C patients less than 65 years of age: headache (14% vs 10% placebo), abdominal pain (11% vs 10%), nausea (8% vs 7%), diarrhea (8% vs 3%), flatulence (6% vs 5%), dyspepsia (4% vs 3%), and dizziness (4% vs 3%).

Use in Specific Populations

  • Pregnancy: Safety and effectiveness not established
  • Lactation: Breastfeeding not recommended
  • Pediatric use: Safety and effectiveness not established
  • Geriatric use: Not indicated for patients 65 years of age and older
  • Severe renal conditions: Contraindicated
  • Moderate to severe hepatic conditions: Contraindicated

Please click here for full Prescribing Information.

Indication and Important Safety Information
 
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References: 1. Crowell MD. Role of serotonin in the pathophysiology of the irritable bowel syndrome. Br J Pharmacol. 2004;141(8):1285-1293. 2. Coates MD, Mahoney CR, Linden DR, et al. Molecular defects in mucosal serotonin content and decreased serotonin reuptake transporter in ulcerative colitis and irritable bowel syndrome. Gastroenterology. 2004;126(7):1657-1664. 3. Talley NJ. Serotoninergic neuroenteric modulators. Lancet. 2001;358(9298):2061-2068. 4. Mawe GM, Coates MD, Moses PL. Review article: intestinal serotonin signalling in irritable bowel syndrome. Aliment Pharmacol Ther. 2006;23(8):1067-1076. 5. Stasi C, Bellini M, Bassotti G, et al. Serotonin receptors and their role in the pathophysiology and therapy of irritable bowel syndrome. Tech Coloproctol. 2014;18(7):613-621.