Midostaurin


Thông tin thuốc gốc
Chỉ định và Liều dùng
Oral
Acute myeloid leukaemia with FTL3 mutation
Adult: In combination with standard cytarabine and daunorubicin induction and high dose cytarabine consolidation chemotherapy: 50 mg bid on days 8-21 of chemotherapy cycles. Maintenance: As monotherapy for patient in complete response: 50 mg once daily until relapsed for up to 12 cycles of 28 days cycles. Dose reduction, dosing interruption, or discontinuation may be required according to individual safety and tolerability (refer to detailed product guideline).

Oral
Aggressive systemic mastocytosis, Mast cell leukaemia, Systemic mastocytosis with associated haematological neoplasm
Adult: 100 mg bid continued until disease progression or unacceptable toxicity occurs. Dose reduction, dosing interruption, or discontinuation may be required according to individual safety and tolerability (refer to detailed product guideline).
Cách dùng
Liquid Filled Cap: Should be taken with food. Take approx 12 hr intervals. Swallow whole, do not open/crush.
Chống chỉ định
Concomitant administration with potent CYP3A4 inducers.
Thận trọng
Patient with cardiac dysfunction, risk of QTc prolongation. Severe renal and hepatic impairment. Pregnancy and lactation.
Phản ứng phụ
Significant: Bone marrow suppression (e.g. neutropenia, leukopenia); gastrointestinal toxicity (e.g. nausea, vomiting, diarrhoea, abdominal pain, constipation, mucositis); decreased LVEF, QTc prolongation; hypersensitivity reaction (e.g. analphylactic shock, angioedema).
Blood and lymphatic system disorders: Hyperbilirubinaemia.
Cardiac disorders: Dyspnoea.
Gastrointestinal disorders: Increased serum lipase/amylase, gastrointestinal haemorrhage.
General disorders and administration site conditions: Fatigue, pyrexia.
Infections and infestations: Localised infection.
Investigations: Increased serum creatinine, increased gamma-glutamyl transferase, increased serum alkaline phosphatase, increased ALT/AST.
Metabolism and nutrition disorders: Peripheral oedema, hypokalaemia, hyperkalaemia, hyperglycaemia, hyponatraemia, hypernatraemia, hypocalcaemia, hyperuricaemia, hypoalbuminemia, hypophosphataemia, hypomagnasemia.
Musculoskeletal and connective tissue disorders: Musculoskeletal pain, arthralgia.
Nervous system disorders: Headache, dizziness.
Psychiatric disorders: Insomnia.
Renal and urinary disorders: UTI, renal insufficiency.
Respiratory, thoracic and mediastinal disorders: Upper respiratory tract infection, pleural effusion.
Skin and subcutaneous tissue disorders: Hyperhidrosis, rash.
Vascular disorders: Haemorrhoids, epistaxis, hypotension, hypertension.
Potentially Fatal: CHF, interstitial lung disease (ILD), pneumonitis.
Thông tin tư vấn bệnh nhân
This drug may cause dizziness and vertigo, if affected do not drive or operate machinery.
MonitoringParameters
Perform confirmatory test of FLT3 mutation (internal tandem duplication or tyrosine kinase domain) prior to initiation of therapy for acute myeloid leukaemia. Monitor WBC at treatment initiation and regularly thereafter. Assess LVEF at baseline and during treatment or when clinically indicated. Monitor CBC with differential in systemic mastocytosis at least weekly for 4 weeks, then every other week for next 8 weeks, then monthly thereafter or when clinically indicated. Monitor for pulmonary symptoms indicative of ILD or pneumonitis; signs and symptoms of infection. Perform pregnancy test within 7 days of therapy.
Tương tác
Increased plasma concentration with strong CYP3A4 inhibitors (e.g. ketoconazole, ritonavir, clarithromycin, nefazodone). Increased risk of QT prolongation with QT prolonging drugs (e.g. chloroquine).
Potentially Fatal: Decreased plasma concentration with strong CYP3A4 inducers (e.g. carbamazepine, rifampicin, enzalutamide, phenytoin).
Food Interaction
Increased absorption with food. Decreased serum concentrations with St. John’s wort.
Tác dụng
Description: Midostaurin is a multikinase inhibitor effective against tyrosine kinase, protein kinase C family, and multiple receptors including growth factors (e.g. vascular endothelial growth factor, platelet-derived growth factor). It inhibits FLT3 receptor signaling and cell proliferation, inducing apoptosis in mutant expressing leukemic cells and in cells overexpressing wild type FLT3 and PDGFR. It may also inhibit KIT signaling, cell proliferation, and histamine release and induces apoptosis in mast cells.
Pharmacokinetics:
Absorption: Rapidly absorb from the gastrointestinal tract. Food, particularly high fat meal, increases absorption. Time to peak plasma concentration: 1-3 hours.
Distribution: Distributed mainly in plasma. Volume of distribution: 95.2 L. Plasma protein-binding: >99.8% mainly to α1-acid glycoprotein.
Metabolism: Metabolised mainly in the liver by CYP3A4 via oxidative pathways to active metabolites, CGP62221 and CGP52421.
Excretion: Via urine (5%); faeces (95%, 91% as metabolites, 4% as unchanged drug). Elimination half-life: 19 hours.
Đặc tính

Chemical Structure Image
Midostaurin

Source: National Center for Biotechnology Information. PubChem Database. Midostaurin, CID=9829523, https://pubchem.ncbi.nlm.nih.gov/compound/Midostaurin (accessed on Jan. 22, 2020)

Bảo quản
Store at 25°C.
Phân loại MIMS
Phân loại ATC
L01EX10 - midostaurin ; Belongs to the class of other protein kinase inhibitors. Used in the treatment of cancer.
References
Anon. Midostaurin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 20/03/2019.

Buckingham R (ed). Midostaurin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/03/2019.

Rydapt (Novartis Pharmaceuticals Corporation). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 20/03/2019.

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