Indications for AFINITOR DISPERZ:
Patients ≥1yr with tuberous sclerosis complex (TSC) for the treatment of subependymal giant cell astrocytoma (SEGA) that requires therapeutic intervention but cannot be curatively resected. Adjunct treatment of patients ≥2yrs with TSC-associated partial-onset seizures.
Adults and Children:
Do not combine the 2 dosage forms to achieve the desired total dose. Swallow tabs whole with water or use Disperz tabs administered as a suspension only. Take at the same time each day either consistently with or without food. Prepare suspension using 5mL of water in an oral syringe or 25mL of water in a drinking glass; max 10mg dose per syringe or glass. Use therapeutic drug monitoring to guide subsequent dosing. Adjust dose at 1–2 week intervals as needed to achieve and maintain trough concentrations of 5–15ng/mL; max 5mg increment per titration (see full labeling). Continue until disease progression or unacceptable toxicity. SEGA: <1yr: not established. ≥1yr: initially 4.5mg/m2 once daily. Partial-onset seizures: <2yrs: not established. ≥2yrs: initially 5mg/m2 once daily. Severe hepatic impairment: initiate at 2.5mg/m2 once daily. Concomitant CYP3A4/PgP inhibitors (strong): avoid; (moderate): reduce daily dose by 50% (or change to every other day if reduced dose unavailable in tab strength); if moderate inhibitor is discontinued, after 3 days, resume dose used prior to initiating inhibitor. Concomitant strong CYP3A4/PgP inducers: double daily dose by increments of 5mg or less; if strong inducer is discontinued, after 5 days, resume dose used prior to initiating inducer. Dose modifications for adverse reactions: see full labeling.
Allergy to other rapamycin derivatives.
Monitor for new or worsening respiratory symptoms; discontinue, reduce dose, and/or manage with corticosteroids if non-infectious pneumonitis occurs. Increased risk of infections (may be severe or fatal); monitor and treat promptly if occur. Pre-existing invasive fungal infections: treat before starting. Give PJP prophylaxis with concomitant corticosteroids or other immunosuppressants. Use dexamethasone mouthwash at initiation to reduce the incidence and severity of stomatitis; use alcohol-, peroxide-, iodine-, or thyme-free products if occurs. Monitor for signs of wound-related complications. Peri-surgical period. Hepatic impairment (see Adult). Diabetes. Monitor CBCs, renal function, lipids, and blood glucose prior to starting and annually thereafter (more frequently if clinically indicated). Avoid close contact with those who have received live vaccines. Pediatrics: complete childhood vaccination series according to ACIP guidelines prior to initiation. Elderly. Embryo-fetal toxicity. Advise to use effective contraception during and for 8 weeks (females) or 4 weeks (males w. female partners) after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 2 weeks after the last dose).
mTOR kinase inhibitor.
Avoid live vaccines. Potentiated by strong CYP3A4/PgP inhibitors (eg, ketoconazole), grapefruit or grapefruit juice; avoid. Caution with moderate CYP3A4/PgP inhibitors (eg, erythromycin, verapamil); see Adult. Antagonized by strong CYP3A4/PgP inducers (eg, rifampin); see Adult. Avoid St. John's Wort. Increased risk of angioedema with concomitant ACEI; avoid.
Stomatitis, infections, rash, fatigue, diarrhea, edema, abdominal pain, nausea, fever, asthenia, cough, headache, decreased appetite, RTI; non-infectious pneumonitis, impaired wound healing, hyperglycemia, hypercholesterolemia, hypertriglyceridemia, myelosuppression, renal failure, angioedema or severe hypersensitivity reactions (discontinue if occur).
Fecal, renal (minor). Half-life: approximately 30 hours.
Tabs, Disperz—28 (4 blister cards x 7 tabs)