Becaplermin

INTRODUCTION

Indications

Treatment of lower extremity diabetic neuropathic ulcers extending to subcutaneous tissue or beyond and having adequate blood supply.

Action

Promotes chemotaxis of cells involved in wound repair and enhances formation of granulation tissue. Therapeutic Effects: Improved healing.

Adverse Reactions/Side Effects

Derm: erythematous rash at application site. Misc: MALIGNANCY (MAY LEAD TO ↑ MORTALITY, ESPECIALLY WITH USE OF ≥3 TUBES).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess the size, depth, color, drainage, and periwound area to help document whether drug therapy is successful in promoting wound healing.

• Monitor any new or increased skin reactions at the site of application, including rash, redness, and irritation. Be especially alert for any abnormal growth of tissues in/around the wound. Report any suspicious skin reactions to the physician.

Interventions

• Implement wound-care procedures (whirlpool, pulsed lavage, gentle débridement) as needed to cleanse ulcers. Make sure the drug is reapplied and dressings are changed according to the recommended procedures.

• When indicated, use appropriate physical agents (ultrasound, electric stimulation, ultraviolet light) to facilitate wound healing and augment drug effects.

• Use assistive devices (walker, crutches) as needed to minimize weight bearing and help protect foot ulcers.

Patient/Client-Related Instruction

• Check that the patient and family or caregivers understand topical application and wound-care procedures, and adhere to the recommended dosing schedule.

• Instruct patient and family/caregivers about proper footwear, hygiene, and visual inspection to prevent recurrence or development of new ulcers.

Pharmacokinetics

Absorption: Minimal absorption (<3%).

Distribution: Action is primarily local.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Known hypersensitivity to becaplermin or parabens; Known neoplasm at site of application; Wounds that close by primary intention.

Use Cautiously in: Known malignancy; OB/Lactation/Pedi: Safety not established.

Interactions

Drug-Drug: None known.

Route/Dosage

Topical (Adults): Length of gel in inches from 15- or 7.5-g tube = length × width of ulcer area × 0.6; from the 2-g tube = length × width of ulcer area × 1.3. Length of gel in centimeters from 15- or 7.5-g tube = length × width of ulcer area ÷ 4; from the 2-g tube = length × width of ulcer area ÷ 2; for 12 ...