Vandetanib


Concise Prescribing Info
Indications/Uses
Unresectable locally advanced or metastatic medullary thyroid carcinoma.
Dosage/Direction for Use
Adult : PO 300 mg once daily, adjusted based on toxicity.
Dosage Details
Oral
Metastatic medullary thyroid carcinoma, Unresectable locally advanced medullary thyroid carcinoma
Adult: 300 mg once daily, continue until disease progression or unacceptable toxicity. Dose reduction, dosing interruption, or discontinuation may be required according to individual safety or tolerability (refer to detailed product guideline). Missed dose should not be taken if within 12 hours of next dose.
Renal Impairment
CrCl (mL/min) Dosage
<30
Not recommended.
30-49
200 mg once daily.
Hepatic Impairment
Not recommended.
Administration
May be taken with or without food. Swallow whole, do not chew/crush. For patients w/ difficulty swallowing, disperse tab in ½ glass plain, non-carbonated water & stir for approx 10 min. No other liqd should be used. Swallow immediately after dispersion. Mix remaining residue w/ ½ glass water & swallow. Liqd dispersion may also be administered through nasogastric or gastrotomy tubes.
Contraindications
Patient with QTc interval over 480 milliseconds, congenital long QTc syndrome. Concomitant use with drugs prolonging QTc interval. Pregnancy and lactation.
Special Precautions
Patient with brain metastases, history of torsades de pointes, haemoptysis. Hepatic and renal impairment.
Adverse Reactions
Significant: Diarrhoea, hypothyroidism, hypertension, hypertensive crisis, reversible posterior leukoencephalopathy syndrome (RPLS), rash, photosensitivity reactions, palmar-plantar erythrodysaesthesia, elevated ALT.
Eye disorders: Corneal abnormalities, blurred vision, halo vision, photopsia, glaucoma, conjunctivitis, dry eye, keratopathy.
Gastrointestinal disorders: Colitis, nausea, abdominal pain, vomiting, dyspepsia, dry mouth.
General disorders and admin site conditions: Fatigue, pyrexia, asthenia, pain, oedema.
Hepatobiliary disorders: Cholelithiasis.
Infections and infestations: Sepsis, influenza, furuncle, fungal infection.
Metabolism and nutrition disorders: Decreased appetite, hyperglycaemia, hypocalcaemia, hypokalaemia, dehydration, hyponatremia.
Musculoskeletal and connective tissue disorders: Muscle spasm.
Nervous system disorders: Headache, dysgeusia, paraesthesia, dysaesthesia, dizziness, tremor, lethargy, loss of consciousness, balance disorder.
Psychiatric disorders: Depression, insomnia, anxiety.
Renal and urinary disorders: Proteinuria, UTI, nephrolithiasis, dysuria, haematuria, cystitis, pyelonephritis.
Respiratory, thoracic and mediastinal disorders: Upper respiratory tract infection, nasopharyngitis, bronchitis, pneumonia, sinusitis, laryngitis, epistaxis, haemoptysis.
Skin and subcutaneous tissue disorders: Dermatitis acneiform, acne, dry skin, photosensitivity reactions, pruritus, alopecia, nail abnormalities, folliculitis.
Potentially Fatal: Torsades de pointes, QT prolongation, ventricular tachycardia, heart failure, severe skin reactions (e.g. toxic epidermal necrolysis, Stevens-Johnson syndrome), interstitial lung disease, pneumonitis, ischaemic cerebrovascular events, severe haemorrhage.
Patient Counseling Information
This drug may cause fatigue and blurred vision, if affected, do not drive or operate machinery. Limit exposure to sunlight.
MonitoringParameters
Monitor serum electrolytes (e.g. Ca, Mg, K), TSH, and ECG (QT interval) at baseline, at 2-4 weeks, at 8-12 weeks, and every 3 months thereafter. Monitor renal and hepatic function, blood pressure. Assess for signs and symptoms of heart failure, RPLS, pulmonary and skin toxicities.
Drug Interactions
Decreased plasma concentration with potent CYP3A4 inducers (e.g. dexamethasone, carbamazepine, phenytoin, phenytoin, phenobarbital, rifabutin, rifampicin). Increased plasma concentration of metformin, digoxin.
Potentially Fatal: Increased risk of torsades de pointes with antiarrhythmic drugs (e.g. amiodarone, disopyramide, dofetilide, procainamide, sotalol) and other drugs prolonging QTc interval (e.g. mizolastine, moxifloxacin, cisapride, arsenic, erythromycin IV, toremifene).
Food Interaction
May decrease serum concentration with St John’s wort.
Action
Description: Vandetanib is a tyrosine kinase inhibitor that blocks intracellular signalling, angiogenesis and cellular proliferation through inhibition of epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), rearranged during transfection (RET) tyrosine kinase, protein tyrosine kinase 6 (BRK), TIE, EPH kinase receptor and SRC kinase receptors.
Pharmacokinetics:
Absorption: Slowly absorbed. Time to peak plasma concentration: Approx 6 hours (range: 4-10 hours).
Distribution: Volume of distribution: Approx 7,450 L. Plasma protein binding: Approx 90%, mainly to albumin and α1-acid glycoprotein.
Metabolism: Metabolised in the liver by CYP3A4 enzyme to N-desmethylvandetanib, and by flavin-containing mono-oxygenase enzymes FMO1 and FMO3 to vandetanib-N-oxide.
Excretion: Mainly via faeces (approx 44%); urine (approx 25%). Elimination half-life: Approx 19 days.
Chemical Structure

Chemical Structure Image
Vandetanib

Source: National Center for Biotechnology Information. PubChem Database. Vandetanib, CID=3081361, https://pubchem.ncbi.nlm.nih.gov/compound/Vandetanib (accessed on Jan. 23, 2020)

Storage
Store at 25°C.
This is a cytotoxic drug. Follow applicable procedures for receiving, handling, administration, and disposal.
ATC Classification
L01XE12 - vandetanib ; Belongs to the class of protein kinase inhibitors, other antineoplastic agents. Used in the treatment of cancer.
References
Anon. Vandetanib. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 27/03/2018.

Anon. Vandetanib. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 27/03/2018.

Buckingham R (ed). Vandetanib. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 27/03/2018.

Caprelsa Tablet (AstraZeneca Pharmaceuticals LP). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 27/03/2018.

Joint Formulary Committee. Vandetanib. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 27/03/2018.

Preston CL (ed). Interactions of Vandetanib. Stockley’s Drug Interactions [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 16/04/2018.

Disclaimer: This information is independently developed by MIMS based on Vandetanib from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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