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INTRODUCTION

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collagenase clostridium histolyticum (kol-laj-en-ase kloss-trid-ee-yum his-toe-lit-i-cum)

Xiaflex

Classification

Therapeutic: none assigned

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Indications
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Treatment of Dupuytren's contracture with a palpable cord in adults.

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Action
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Lysis of collagen deposits present in Dupuytren's cord. Therapeutic Effects: Enzymatic disruption of Dupuytren's cord.

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Adverse Reactions/Side Effects
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CV: vasovagal syncope. MS: ligament injury, complex regional pain syndrome (CRPS), sensory abnormality of hand, tendon rupture. Local: contusion, hemorrhage, injection site reaction, pain, pruritus, swelling. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, axillary pain, lymphadenopathy.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Watch for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea), or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

  • Be alert for fainting (vasovagal syncope) that occurs after injection or during treatment of the affected hand. Be ready to protect the patient from falls and trauma that might occur because of syncope during treatment sessions.

  • Assess injection site for pain, swelling, itching, inflammation, or signs of contusion and hemorrhage. Report prolonged or excessive injection site reactions to the physician.

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Interventions
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  • Implement appropriate therapeutic exercises to increase ROM and strength in the affected tendon. Use caution, however, and monitor continually for any increased tendon symptoms, localized pain, or sensory loss in the hand. If symptoms increase, notify the physician and protect the affected area to avoid tendon ruptures. Do not stretch or exercise the affected tendon until the hand has been reexamined.

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Patient/Client-Related Instruction
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  • Instruct patient to report other troublesome side effects such as severe or prolonged axillary pain or swollen lymph nodes.

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Pharmacokinetics
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Absorption: Unknown.

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Distribution: Unknown.

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Metabolism and Excretion: Unknown.

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Half-life: Unknown.

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TIME/ACTION PROFILE (cord disruption)

ROUTE ONSET PEAK DURATION
Intralesional within 24 hr unknown unknown

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Contraindications/Precautions
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Contraindicated in: None known.

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Use Cautiously in: Abnormal coagulation, including concurrent anticoagulants other than low-dose aspirin within 7 days of treatment; OB: Use only if clearly needed; Lactation: Use cautiously; Pedi: Safety and effectiveness not established.

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Interactions
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Drug-Drug: Concurrent use of anticoagulants may ↑ risk of local bleeding.

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Route/Dosage
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IL (Adults): 0.58 mg into a palpable cord with a contracture of a metacarpophalangeal (MP) joint or a proximal interphalangeal (PIP) joint.

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Availability
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Lyophilized powder for injection (requires reconstitution): 0.9 mg/vial (delivers 0.58 mg/dose).

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