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(MAHN-ahk-tuh-NO-in)
Moctanin
Class: Gallstone solubilizer

 Action Dissolves cholesterol gallstones via perfusion of common bile duct.

 Indications Solubilizing agent for cholesterol (radiolucent) gallstones retained in biliary tract after cholecystectomy, via perfusion of common bile duct, when other means of removing them have failed or cannot be undertaken.

 Contraindications Impaired hepatic function, significant biliary tract infection or history of recent duodenal ulcer or jejunitis; portosystemic shunting, so that there is saturation of hepatic uptake and metabolism of material absorbed from gut lumen; acute pancreatitis; any active life-threatening problems that would be complicated by perfusion into biliary tract.

 Route/Dosage

ADULTS: Biliary/nasobiliary: 3–5 ml/hr continuous perfusion for 2–10 days.

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Fatigue; lethargy; depression; headache. DERM: Pruritus. GI: Abdominal pain or discomfort; nausea; vomiting; diarrhea; loose stools; norexia; indigestion; burning; increased fistula drainage; irritation of duodenal mucosa. HEMA: Leukopenia. HEPA: Increased serum amylase; bile shock. META: Hypokalemia. OTHER: Fever; chills; diaphoresis; allergic reaction.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Hepatic impairment: Patients with impaired hepatic function may experience metabolic acidosis during drug perfusion.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Use caution in patients with obstructive jaundice due to stones.
  • Not for parenteral (IM/IV) use.
  • Prepare vials by adding 13 ml of Sterile Water for Injection.
  • Continuously perfuse on a 24-hour basis at a rate of 3 to 5 ml/hr. Continuous perfusion usually requires 2 to 10 days for elimination or size reduction of stones. If, after 10 days, cholangiography shows neither elimination nor reduction in size or density of stones, an endoscopy should be performed to determine advisability of additional perfusion based on friability, softness or reduction of stone density.
  • Maximize benefits of therapy by administering drug at 37°C 98.6°F).
  • Perfuse into biliary tract either directly via catheter inserted through T-tube or via catheter inserted through mature sinus tract through nasobiliary tube placed endoscopically.
  • Place tip of catheter as close to stone as possible. Drug is effective only when in direct contact with stone.
  • Store at room temperature. If stored below 59°F (15°C), drug may form semisolid, which will reliquefy on rewarming.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note impaired hepatic function, significant biliary tract infection, acute pancreatitis, recent duodenal ulcer, recent jejunitis, portosystemic shunting or active life-threatening problems that would be complicated by perfusion into biliary tract.
  • Ensure that liver function tests are performed routinely in patients with impaired liver function.
  • Monitor flow rate and pressure carefully. Irritation to GI and biliary tracts is related to perfusion pressure and rate of administration.
  • Monitor for intolerable abdominal pain, nausea, diarrhea or emesis. If symptoms occur, stop perfusion for 1 hr, aspirate duct, then restart. If symptoms persist, stop perfusion for 1 hr, aspirate duct, then restart at reduced rate of 3 ml/hr. If symptoms still persist, temporarily discontinue perfusion during mealtimes.
  • Observe for fever, anorexia, chills, severe right upper quadrant abdominal pain or jaundice. If these symptoms occur, discontinue drug and notify physician.
OVERDOSAGE: SIGNS & SYMPTOMS
  Abdominal pain

 Patient/Family Education

  • Instruct patient to report these symptoms to physician: fever, chills, anorexia, severe right upper quadrant abdominal pain, jaundice, fatigue, lethargy, abdominal pain or discomfort, nausea, vomiting, diarrhea, anorexia, depression or any other problem.

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