Edaravone
Jeneng merek: Radicava; Radicava ORS
Kelas obat:
Agen Antineoplastik
Panganggone Edaravone
Amyotrophic Lateral Sclerosis
Pengobatan amyotrophic lateral sclerosis (ALS; Lou Gehrig disease, Charcot's sclerosis); ditetepake minangka obat yatim piatu dening FDA kanggo panggunaan iki.
Wis ditampilake alon-alon nyuda fungsi (umpamane, motorik halus, motorik kasar, bulbar, lan fungsi ambegan) sing ditaksir kanthi skala rating standar (ALSFRS- R) digunakake ing pasien karo ALS.
Ora ana tamba kanggo ALS lan pilihan perawatan winates kasedhiya sing mung nuduhake keuntungan cilik ing wektu tundha penyakit lan pati.
Akademi Neurologi Amerika nerbitake pedoman adhedhasar bukti kanggo ALS ing taun 2009; Nanging, mung obat sing bisa ngowahi penyakit sing kasedhiya ing wektu iku yaiku riluzole. Kasedhiyan edaravone nawakake pilihan liyane; Nanging, loro obat kasebut nyedhiyakake perbaikan sing winates ing urip.
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Carane nggunakake Edaravone
Umum
Pengawasan Pasien
Administrasi
Administrasi oral (minangka suspensi oral) utawa infus IV .
Administrasi IV
Administrasi kanthi infus IV.
Kasedhiya sacara komersial ing tas infus polypropylene sing dilapisi kemasan sekunder sing ngemot penyerap oksigen, dirancang kanggo nglindhungi obat kasebut saka oksidasi, lan indikator oksigen. Indikator kudu jambon nalika tingkat oksigen sing bisa ditampa; Aja nggunakake yen indikator wis dadi biru utawa ungu sadurunge mbukak paket.
Aja nyampur karo obat liya.
Tingkat AdministrasiKanggo saben dosis 60 mg minangka 2 kantong infus IV 30 mg berturut-turut sajrone total 60 menit (tingkat infus kira-kira 1 mg saben menit [3,33 mL saben menit]).
Administrasi Oral
Administrasi liwat tutuk utawa liwat tabung pakan.
Atur ing wayah esuk kanthi weteng kosong sawise pasa sewengi. (Deleng Tabel 1 kanggo kondisi pasa tartamtu.) Aja mangan panganan sajrone 1 jam sawise administrasi kajaba banyu.
Tabel 1: Administrasi Suspensi Oral Edaravone Relatif karo Jinis Konsumsi Pangan1Jinis panganan / suplemen kalori sing dikonsumsi
Waktu pasa sadurunge lan sawise administrasi dosis suspensi oral edaravone babagan jinis panganan
Panganan dhuwur lemak (800–1000 kalori, 50% lemak)
8 jam sadurunge administrasi lan 1 jam sawise administrasi
Panganan rendah lemak (400-500 kalori, 25% lemak)
4 jam sadurunge administrasi lan 1 jam sawise administrasi
Suplemen kalori (250 kalori; contone, minuman protein)
2 jam sadurunge administrasi lan 1 jam sawise administrasi
Sadurunge saben nggunakake, wadhah wadhah lan goyangake kanthi kuat ≥30 detik. Nyedhiyakake suspensi oral nggunakake jarum suntik oral 5-mL sing diwenehake; sendok teh kluwarga ora minangka alat ukur sing cukup.
Administrasi liwat Feeding TubeSuspensi lisan bisa ditindakake liwat tabung nasogastrik utawa tabung gastrostomi endoskopik (PEG) perkutan sing digawe saka silikon, polivinil klorida (PVC), utawa poliuretan. Gunakake jarum suntik tip kateter kanggo siram tabung kanthi paling sethithik 1 ons (30 mL) banyu sadurunge lan sawise administrasi obat.
Dosis
Dewasa
ALS IV60 mg (diwenehake minangka 2 infus 30-mg berturut-turut sajrone total 60 menit) ing siklus perawatan 28 dina miturut jadwal ing ngisor iki:
Siklus perawatan awal: Administrasi ing dina 1- 14, disusul periode bebas narkoba 14 dina.
Siklus perawatan sakteruse: Atur kanggo 10 saka 14 dina pisanan, banjur 14 dina periode bebas obat.
Oral105 mg (5 mL) liwat tutuk utawa liwat tabung pakan nggunakake suspensi oral ing siklus perawatan 28 dina miturut jadwal ing ngisor iki:
Siklus perawatan awal: Kelola ing dina 1–14, disusul periode bebas obat 14 dina.
Siklus perawatan sakteruse: Diwenehi 10 saka 14 dina pisanan, disusul periode bebas obat 14 dina.
Ngalih saka IV menyang OralPasien sing nampa IV edaravone 60 mg bisa diowahi menyang oral edaravone 105 mg (5 ml suspensi oral) nggunakake frekuensi dosis sing padha.
Sawise ngalih menyang terapi oral, tindakake rekomendasi dosis kanggo suspensi oral babagan konsumsi panganan.
Populasi Khusus
Gangguan Hepatik
Panyesuaian dosis ora dibutuhake.
Gangguan Ginjal
Gangguan ginjel entheng utawa moderat: Ora perlu pangaturan dosis. Ora ana data babagan gangguan ginjel sing abot.
Panganggone Geriatri
Panyesuaian dosis ora dibutuhake; sawetara wong sing luwih tuwa bisa nuduhake sensitivitas sing luwih gedhe.
Pènget
Kontraindikasi
Pènget/PanandhapReaksi Sensitivitas
Reaksi Hipersensitivitas
Reaksi hipersensitivitas (contone, abang, wheals, eritema multiforme), kalebu kasus anafilaksis (contone, urtikaria, hipotensi, dyspnea), sing dilapurake sajrone pengalaman pasca pemasaran.
Ngawasi pasien kanthi teliti. Yen ana reaksi hipersensitivitas, mandhegake obat kasebut lan miwiti perawatan sing cocog; ngawasi pasien nganti kondisi pulih.
Sensitivitas SulfitNgandhut sodium bisulfit; bisa nyebabake reaksi alergi (contone, gejala anafilaksis, episode asma sing ngancam nyawa utawa kurang abot) ing individu sing rentan.
Prevalensi sakabèhé sensitivitas sulfit ing populasi umum ora dingerteni. Sensitivitas sulfit luwih kerep ana ing wong sing nandhang asma.
Populasi Tertentu
KandhutanOra ana data sing nyukupi babagan risiko pangembangan nalika digunakake ing wanita ngandhut. Ing studi kewan, efek pangembangan sing ora becik (contone, tambah kematian, wutah sing suda, perkembangan seksual sing telat, prilaku sing diowahi) lan keracunan ibu sing diamati ing dosis sing cocog sacara klinis.
LaktasiOra dingerteni manawa edaravone disebarake menyang susu manungsa utawa yen obat kasebut duweni efek marang bayi sing disusui utawa produksi susu. Disebarake menyang susu ing tikus.
Pirsani keuntungan sing wis dingerteni saka nyusoni bebarengan karo kabutuhan klinis wanita kanggo edaravone lan efek samping obat utawa penyakit sing potensial kanggo bayi.
Panggunaan PediatrikEfikasi lan safety ora ditetepake.
Panggunaan GeriatrikOra ana bedane sakabèhé ing khasiat utawa safety dibandhingake karo wong diwasa enom. Nanging, sensitivitas tambah ora bisa ditolak.
Gangguan HepatikOwah-owahan ing eksposur sing diamati ing pasien kanthi gangguan hepatik entheng, moderat, utawa abot sing ora dianggep signifikan sacara klinis; mula, panyesuaian dosis ora perlu kanggo pasien sing duwe gangguan hepatik.
Gagal GinjalOwah-owahan sing diamati ing konsentrasi plasma puncak rata-rata lan AUC ing pasien kanthi gangguan ginjel entheng nganti moderat ora dianggep penting sacara klinis; pangaturan dosis mulane ora perlu ing pasien kasebut. Efek gagal ginjel abot ora diteliti.
Efek Samsaya Awon
Reaksi salabetipun ingkang paling umum (≥10%): kontusio, gangguan mlaku, sirah.
Apa obatan liyane bakal mengaruhi Edaravone
Dimetabolisme dening macem-macem enzim uridine diphosphate-glucuronosyltransferase (UGT) (yaiku, UGT 1A1, 1A6, 1A7, 1A8, 1A9, 1A10, 2B7, lan 2B17). Ora SAMesthine bakal nyandhet UGT 1A1 utawa 2B7.
Ora samesthine bisa nyandhet isoenzim CYP utama (yaiku, isoenzim CYP 1A2, 2B6, 2C8, 2C9, 2C19, 2D6, utawa 3A4) utawa ngindhuksi isoenzim CYP 1A2, 3A4, utawa konsentrasi klinis sing relevan.
Ora samesthine bakal nyandhet transporter utama (yaiku, P-glikoprotein [P-gp], protein tahan kanker payudara [BCRP], polipeptida pengangkut anion organik [OATP] 1B1, OATP1B3, transporter anion organik [OAT ] 1, OAT3, transporter kation organik [OCT] 2, MATE1, MATE2-K).
Obat sing Ngaruhi utawa Dimetabolisme dening Enzim Mikrosomal Hepatik
Interaksi farmakokinetik ora mungkin.
Obat sing Ngaruhi utawa Dimetabolisme dening Enzim UGT
Interaksi farmakokinetik ora mungkin.
Obat sing kena pengaruh utawa kena pengaruh dening transporter membran
Interaksi farmakokinetik ora mungkin.
Obat Spesifik
Obat
Interaksi
Komentar
Furosemide
Ora ana owah-owahan ing konsentrasi plasma puncak utawa AUC saka furosemide (substrat OAT3)
Riluzole
Interaksi farmakokinetik ora samesthine; Diwenehake bebarengan karo edaravone ing umume pasien ing studi klinis
Rosuvastatin
Ora ana owah-owahan ing konsentrasi plasma puncak utawa AUC saka rosuvastatin (substrat BCRP)
Sildenafil
Ora ana owah-owahan ing konsentrasi plasma puncak utawa AUC sildenafil (substrat CYP3A4)
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