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INTRODUCTION

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becaplermin (be-kap-ler-min)

Regranex

Classification

Therapeutic: wound/ulcer/decubiti healing agent

Pharmacologic: platelet-derived growth factors

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

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

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Adverse Reactions/Side Effects
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Derm: erythematous rash at application site. Misc: MALIGNANCY (MAY LEAD TOMORTALITY, ESPECIALLY WITH USE OF ≥3 TUBES).

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • 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.

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Interventions
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  • 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.

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Patient/Client-Related Instruction
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  • 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.

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Pharmacokinetics
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Absorption: Minimal absorption (<3%).

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Distribution: Action is primarily local.

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Metabolism and Excretion: Unknown.

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Half-life: Unknown.

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TIME/ACTION PROFILE (improvement in ulcer healing)

ROUTE ONSET PEAK DURATION
topical within 10 wk unknown unknown

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

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

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Interactions
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Drug-Drug: None known.

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Route/Dosage
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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 hr each day.

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Availability
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