Iclusig Generic Name & Formulations
Legal Class
General Description
Pharmacological Class
How Supplied
Manufacturer
Generic Availability
Mechanism of Action
Iclusig Indications
Indications
In combination with chemotherapy for adults with newly diagnosed Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL). As monotherapy for adults with Ph+ ALL for whome no other kinase inhibitors are indicated or T315I-positive Ph+ ALL. In adults with chronic phase (CP) chronic myeloid leukemia (CML) with resistance or intolerance to at least 2 prior kinase inhibitors. In adults with accelerated phase (AP) or blast phase (BP) CML for whom no other kinase inhibitors are indicated. In adults with T315I-positive CML (chronic, accelerated, or blast phase).
Limitations of Use
Iclusig Dosage and Administration
Adult
Swallow whole. ≥18yrs: (Newly diagnosed Ph+ ALL): initially 30mg once daily with a reduction to 15mg upon achieving MRD-negative (≤0.01% BCR::ABL1/ABL1) CR at the end of induction; continue in combination with chemotherapy for up to 20 cycles. (Monotherapy Ph+ ALL): initially 45mg once daily; consider discontinuing if no response occurred by 3 months. (CP-CML): initially 45mg once daily with a reduction to 15mg upon achieving ≤1% BCR-ABL1IS; if loss of response occurs, may re-escalate to previously tolerated dosage of 30mg or 45mg. (AP-CML, BP-CML): initially 45mg once daily; consider reducing dose in AP-CML if major cytogenetic response achieved; consider discontinuing if no response occurred by 3 months. For all: continue until loss of response or unacceptable toxicity. Concomitant strong CYP3A inhibitors (if unavoidable): reduce Iclusig dose (see full labeling). Concomitant hepatic impairment: reduce to 30mg once daily. Moderate to severe hepatic impairment (newly diagnosed Ph+ ALL): monitor closely and modify dose. Dose modifications for adverse reactions: see full labeling.
Children
Administration
Nursing Considerations
Iclusig Contraindications
Not Applicable
Iclusig Boxed Warnings
Boxed Warning
Iclusig Warnings/Precautions
Warnings/Precautions
Risk of venous thromboembolic and arterial occlusive events (including fatal MI, stroke, stenosis of arterial vessels of the brain, severe peripheral vascular disease, and the need for urgent revascularization procedures) in patients with or without CV risk factors (including ≤50yrs old, or increasing age, history of ischemia, HTN, diabetes, hypercholesterolemia); monitor and interrupt or discontinue based on recurrence/severity. Monitor for heart failure; interrupt or discontinue if new or worsening condition occurs. Monitor LFTs at baseline, then at least monthly or as needed; interrupt or discontinue based on recurrence/severity. Monitor BP at baseline, as clinically needed and manage appropriately; interrupt, reduce dose or discontinue if not controlled. Evaluate for renal artery stenosis if significant worsening, labile or treatment-resistant hypertension occurs. Risk of pancreatitis; check serum lipase every 2 weeks for the first 2 months and then monthly thereafter or as clinically indicated; interrupt, resume, or discontinue based on severity. Increased toxicity in newly diagnosed chronic phase CML: not recommended. Conduct eye exams at baseline and periodically during treatment. Monitor for symptoms of neuropathy, hemorrhage, cardiac arrhythmias, or fluid retention and manage as clinically indicated; interrupt, resume at same or reduced dose, or discontinue based on recurrence/severity. Obtain CBCs every 2 weeks for the first 3 months, then monthly or as indicated; if ANC <1×109/L or platelets <50×109/L, interrupt until ANC ≥1.5×109/L and platelets ≥75×109/L, then resume at same or reduced dose. Tumor lysis syndrome: ensure adequate hydration and treat uric levels prior to therapy. Impaired wound healing: withhold for ≥1 week prior to elective surgery; do not give for ≥2 weeks after major surgery and until adequate healing. Permanently discontinue if GI perforation occurs. Interrupt therapy if reversible posterior leukoencephalopathy syndrome occurs. Hepatic impairment. Elderly. Embryo-fetal toxicity. Advise females of reproductive potential to use effective contraception during and for 3 weeks after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 1 week after the last dose).
Iclusig Pharmacokinetics
Absorption
Peak concentration observed within 6 hours.
Distribution
Steady-state volume of distribution: 1223 L. >99% protein bound.
Elimination
Iclusig Interactions
Interactions
Iclusig Adverse Reactions
Adverse Reactions
Iclusig Clinical Trials
See Literature
Iclusig Note
Not Applicable
Iclusig Patient Counseling
See Literature
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