General: PREVYMIS Tablets: Administer with or without food.
Swallow tablets whole. Do not divide, crush or chew.
PREVYMIS Concentrate for Solution for Infusion: PREVYMIS injection must be administered through a sterile 0.2 micron or 0.22 micron polyethersulfone (PES) in-line filter.
Administer by intravenous infusion via a peripheral catheter or central venous line over approximately 60 minutes.
Do not administer as an intravenous bolus injection.
PREVYMIS tablet and concentrate for solution for infusion may be used interchangeably at the discretion of the physician, and no dose adjustment is necessary.
Missed Dose: Instruct patients that if they miss a dose of PREVYMIS, they should take it as soon as they remember. If they do not remember until it is time for the next dose, instruct them to skip the missed dose and go back to the regular schedule. Instruct patients not to double their next dose or take more than the prescribed dose.
Recommended Dosage in Adults: The recommended dosage of PREVYMIS is 480 mg administered once daily.
PREVYMIS should be started after HSCT. PREVYMIS may be started on the day of transplant and no later than 28 days post-transplant. PREVYMIS may be started before or after engraftment. Continue PREVYMIS through 100 days post-transplant.
The safety and efficacy of letermovir use for more than 100 days has not been studied in clinical trials.
Dosage Adjustment in Adults: If PREVYMIS is co-administered with cyclosporine, the dosage of PREVYMIS should be decreased to 240 mg once daily [see Table 6 in Established and Other Potential Drug Interactions under INTERACTIONS].
If cyclosporine is initiated after starting PREVYMIS, the next dose of PREVYMIS should be decreased to 240 mg once daily.
If cyclosporine is discontinued after starting PREVYMIS, the next dose of PREVYMIS should be increased to 480 mg once daily.
If cyclosporine dosing is temporarily interrupted due to high cyclosporine levels, no dose adjustment of PREVYMIS is needed.
Pediatric Patients: Safety and efficacy of PREVYMIS have not been established in pediatric patients less than 18 years of age.
Geriatric Patients: No dose adjustment of PREVYMIS is required based on age [see Use in Elderly under PRECAUTIONS].
Renal Impairment: No dose adjustment of PREVYMIS is required based on renal impairment [see Hepatic Impairment as follows, Renal Impairment under PRECAUTIONS].
Hepatic Impairment: No dose adjustment of PREVYMIS is required based on mild (Child-Pugh Class A) to moderate (Child-Pugh Class B) hepatic impairment. PREVYMIS is not recommended for patients with severe (Child-Pugh Class C) hepatic impairment.
PREVYMIS is not recommended in patients with moderate hepatic impairment combined with moderate or severe renal impairment [see Hepatic Impairment under PRECAUTIONS].
Preparation and Administration of Intravenous Solution: PREVYMIS concentrate for solution for infusion is supplied in 30 mL single-dose vials containing either 240 mg (12 mL per vial) or 480 mg (24 mL per vial). The preparation and administration instructions are the same for either dose.
PREVYMIS vials are for single use only. Discard any unused portion.
Preparation: PREVYMIS must be diluted prior to intravenous (IV) use.
Inspect vial contents for discoloration and particulate matter prior to dilution. PREVYMIS concentrate for solution for infusion is a clear, colorless solution and may contain a few product-related small translucent or white particles.
Do not use the vial if the solution is cloudy, discolored, or contains matter other than a few small translucent or white particles.
Do not use PREVYMIS injection with IV bags and infusion set materials containing polyurethane or the plasticizer diethylhexyl phthalate (DEHP). Materials that are phthalate-free are also DEHP-free.
Do not shake PREVYMIS vial.
Add one single-dose vial of PREVYMIS concentrate for solution for infusion to a 250 mL pre-filled IV bag containing either 0.9% sodium chloride or 5% dextrose and mix bag gently. Do not shake.
Once diluted, the solution of PREVYMIS is clear, and ranges from colorless to yellow. Variations of color within this range do not affect the quality of the product. The diluted solution should be inspected visually for particulate matter and discoloration prior to administration.
Discard if the diluted solution is cloudy, discolored, or contains matter other than a few small translucent or white particles.
Storage of Diluted Solution: The diluted solution can be stored for up to 24 hours at room temperature or up to 48 hours under refrigeration at 2°C to 8°C (36°F to 46°F).
This time includes storage of the diluted solution in the intravenous bag through the duration of infusion.
Administration: The diluted solution must be administered through a sterile 0.2 micron or 0.22 micron PES in-line filter.
Do not administer the diluted solution through a filter other than a sterile 0.2 micron or 0.22 micron PES in-line filter.
Administer as an intravenous infusion only. Do not administer as an intravenous push or bolus.
After dilution, administer PREVYMIS via intravenous infusion via peripheral or central venous catheter using a total time of approximately 60 minutes. Administer the entire contents of the IV bag.
Compatible Diluents, Drug Products, and Other Materials Used for Intravenous Administration: Compatible Diluents: PREVYMIS concentrate for solution for infusion is compatible with 0.9% sodium chloride and 5% dextrose solutions.
Compatible Drug Products: A study was conducted to evaluate physical compatibility of PREVYMIS concentrate for solution for infusion with injectable drug products. Compatibility was determined through visual observations, turbidity, and measurement of particulate matter. Compatible drug products are listed as follows.
PREVYMIS should not be co-administered through the same intravenous line (or cannula) with other drug products and diluent combinations except those listed as follows.
The following compatible drug products may be co-administered with PREVYMIS for injection when both drug products are in 0.9% Sodium Chloride via Y tubing only, as per the approved instructions of the respective drug products: Ampicillin sodium, Ampicillin sodium/Sulbactam sodium, Anti-thymocyte globulin, Caspofungin, Daptomycin, Fentanyl citrate, Fluconazole, Furosemide, Human insulin, Magnesium sulfate, Methotrexate, Micafungin.
The following compatible drug products may be co-administered with PREVYMIS for injection when both drug products are in 5% Dextrose via Y tubing only, as per the approved instructions of the respective drug products: Amphotericin B (lipid complex)*, Anidulafungin, Cefazolin sodium, Ceftaroline, Ceftriaxone sodium, Doripenem, Famotidine, Folic acid, Ganciclovir sodium, Hydrocortisone sodium succinate, Morphine sulfate, Norepinephrine bitartrate, Pantoprazole sodium, Potassium chloride, Potassium phosphate, Tacrolimus, Telavancin, Tigecycline.
* Amphotericin B (lipid complex) is compatible with PREVYMIS. However, Amphotericin B (liposomal) is incompatible [see Incompatible Diluents, Drug Products, and Other Materials Used for Intravenous Administration as follows].
Compatible IV Bags and Infusion Set Materials: PREVYMIS is compatible with the following IV bags and infusion set materials. Any IV bags or infusion set materials not listed as follows should not be used.
IV Bag Materials: Polyvinyl chloride (PVC), ethylene vinyl acetate (EVA) and polyolefin (polypropylene and polyethylene).
Infusion Set Materials: PVC, polyethylene (PE), polybutadiene (PBD), silicone rubber (SR), styrene-butadiene copolymer (SBC), styrene-butadiene-styrene copolymer (SBS), polystyrene (PS).
Plasticizers: Tris (2-Ethylhexyl) trimellitate (TOTM), butyl benzyl phthalate (BBP).
Catheters: Radiopaque polyurethane.
Incompatible Diluents, Drug Products, and Other Materials Used for Intravenous Administration: Incompatible Drug Products: PREVYMIS concentrate for solution for infusion is physically incompatible with amiodarone hydrochloride, amphotericin B (liposomal), aztreonam, cefepime hydrochloride, ciprofloxacin, cyclosporine, diltiazem hydrochloride, filgrastim, gentamicin sulfate, levofloxacin, linezolid, lorazepam, midazolam HCl, mycophenolate mofetil hydrochloride, ondansetron, palonosetron.
Incompatible IV Bags and Infusion Set Materials: PREVYMIS concentrate for solution for infusion is incompatible with diethylhexyl phthalate (DEHP) plasticizers and polyurethane-containing IV administration set tubing.