Tafenoquine (Arakoda)
Jeneng merek: Arakoda
Kelas obat:
Agen Antineoplastik
Panganggone Tafenoquine (Arakoda)
Tafenoquine succinate nduweni kegunaan ing ngisor iki:
Tafenoquine succinate (Arakoda) minangka antimalaria sing dituduhake kanggo profilaksis malaria ing pasien umur 18 taun lan luwih.
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Carane nggunakake Tafenoquine (Arakoda)
Umum
Tafenoquine succinate (Arakoda) kasedhiya ing wangun dosis lan kekuatan ing ngisor iki:
Tablet: 100 mg tafenoquine.
Para dokter kudu ngerti manawa ana 2 formulasi oral tafenoquine succinate kanthi indikasi lan regimen dosis sing beda. Tablet 100-mg (contone, Arakoda) diwenehi label kanggo digunakake kanggo profilaksis malaria ing wong diwasa; tablet 150-mg (contone, Krintafel) diwenehi label kanggo nggunakake obat radikal (nyegah kambuh) malaria Plasmodium vivax ing wong diwasa lan bocah-bocah umur 16 taun lan luwih lawas. Ati-ati kanggo mesthekake yen dosis sing cocog digunakake kanggo indikasi spesifik.
Kabeh pasien kudu dites kanggo kekurangan glukosa-6-fosfat dehidrogenase (G6PD) sadurunge menehi resep tafenoquine succinate.
Tes meteng dianjurake kanggo wanita sing duwe potensi reproduksi sadurunge miwiti perawatan karo tafenoquine succinate.
Dosis
Iku penting sing labeling pabrikan takon kanggo informasi sing luwih rinci babagan dosis lan administrasi obat iki. Ringkesan dosis:
Dewasa
Dosis lan AdministrasiJeneng Regimen
Wektu
Dosis
Rejimen Loading
Kanggo saben 3 dina sadurunge lelungan menyang wilayah malaria
200 mg (2 saka tablet 100 mg) sapisan saben dina suwene 3 dina
Rejimen pangopènan
Nalika ing wilayah malaria
200 mg (2 saka tablet 100 mg) sapisan saben minggu; diwiwiti 7 dina sawise dosis regimen loading pungkasan
Rejimen profilaksis terminal
Ing minggu sawise metu saka wilayah malaria
200 mg (2 saka tablet 100 mg) dijupuk sepisan 7 dina sawise dosis pangopènan pungkasan
Pènget
Kontraindikasi
Pènget/PanandhapAnemia Hemolitik
Amarga ana risiko anemia hemolitik ing pasien sing kurang G6PD, tes G6PD kudu ditindakake sadurunge menehi resep tafenoquine succinate. Amarga watesan karo tes G6PD, dokter kudu ngerti risiko sisa hemolisis, lan dhukungan medis lan tindak lanjut sing nyukupi kanggo ngatur risiko hemolitik kudu kasedhiya. Perawatan karo tafenoquine succinate dikontraindikasi ing pasien kanthi kekurangan G6PD utawa status G6PD sing ora dingerteni. Ing uji klinis, penurunan tingkat hemoglobin kacarita ing sawetara pasien G6PD-normal. Ngawasi pasien kanggo tandha-tandha klinis utawa gejala hemolisis. Anjurake pasien supaya mandhegake tafenoquine succinate lan golek perawatan medis yen ana tandha-tandha hemolisis.
Kekurangan G6PD sajrone Kandhutan lan Laktasi
Potensi Cilaka kanggo Janin: Panganggone tafenoquine succinate sajrone meteng bisa nyebabake anemia hemolitik ing janin sing kurang G6PD. Sanajan wanita ngandhut duwe tingkat G6PD normal, janin bisa kekurangan G6PD. Rekomendasi wanita sing duwe potensi reproduksi yen perawatan karo tafenoquine succinate sajrone meteng ora dianjurake lan supaya ora meteng utawa nggunakake kontrasepsi sing efektif sajrone perawatan lan 3 wulan sawise dosis tafenoquine succinate pungkasan. Yen meteng dideteksi nalika nggunakake tafenoquine succinate, mateni tafenoquine succinate sanalika bisa lan ngalih menyang obat profilaksis alternatif kanggo malaria nalika meteng.
Potensi cilaka kanggo Bayi Nyusoni: Bayi sing kurang G6PD bisa uga beresiko anemia hemolitik saka paparan tafenoquine succinate liwat susu ibu. Status G6PD bayi kudu dipriksa sadurunge nyusoni diwiwiti. Tafenoquine succinate dikontraindikasi ing wanita sing nyusoni nalika bayi ditemokake kurang G6PD utawa status G6PD bayi ora dingerteni. Wenehi pitutur marang wong wadon sing duwe bayi kurang G6PD utawa yen status G6PD bayi ora dingerteni supaya ora nyusoni sajrone perawatan karo tafenoquine succinate lan suwene 3 sasi sawise dosis pungkasan.
Methemoglobinemia
Peningkatan asimtomatik ing methemoglobin wis diamati ing uji klinis tafenoquine succinate. Nggawe terapi sing cocog yen ana tandha-tandha utawa gejala methemoglobinemia. Ngawasi kanthi ati-ati individu kanthi kekurangan methemoglobin reduktase gumantung saka nikotinamida adenine dinukleotida (NADH). Anjurake pasien supaya mandhegake tafenoquine succinate lan golek perawatan medis yen ana tandha-tandha methemoglobinemia.
Efek Psikiatri
Ing pasien sing nampa tafenoquine succinate (Arakoda) ing uji klinis, reaksi salabetipun kejiwaan kalebu gangguan turu (2,5%), depresi / swasana ati depresi (0,3%), lan kuatir (0,2%). . Tafenoquine succinate dihentikan ing subyek kanthi reaksi ala saka upaya bunuh diri (0,1%). Subyek sing duwe riwayat gangguan psikiatri ora kalebu saka telung saka limang uji coba tafenoquine succinate ing ngendi Mefloquine kalebu minangka pembanding.
Psikosis dilapurake ing telung pasien kanthi riwayat psikosis utawa skizofrenia sing nampa dosis tafenoquine ( 350 mg nganti 500 mg dosis tunggal, utawa 400 mg saben dina suwene 3 dina) beda karo regimen succinate tafenoquine sing disetujoni. Safety lan efektifitas tafenoquine succinate durung ditetepake ing dosis utawa regimen liyane saka regimen disetujoni; nggunakake tafenoquine succinate (Arakoda) ing dosis utawa regimen liyane saka dosis mingguan 200-mg ora disetujoni dening FDA.
Tafenoquine succinate (Arakoda) wis contraindicated ing patients karo riwayat kelainan psikotik utawa psikotik saiki. gejala. Yen gejala psikotik (halusinasi, khayalan, utawa pikiran utawa prilaku sing ora terorganisir banget), coba mandhegake tafenoquine succinate lan evaluasi cepet dening profesional kesehatan mental sanalika bisa. Gejala psikiatri liyane, kayata owah-owahan swasana ati, kuatir, insomnia, lan ngipi elek, kudu dievaluasi kanthi cepet dening profesional medis yen gejala kasebut moderat lan tahan luwih saka telung dina utawa abot.
Reaksi Hipersensitivitas
Reaksi hipersensitivitas serius (contone, angioedema lan urtikaria) wis diamati nalika administrasi tafenoquine. Reaksi hipersensitivitas wis dilaporake ing uji klinis tafenoquine succinate. Mungkasi profilaksis karo tafenoquine succinate lan instal terapi sing cocok yen reaksi hipersensitivitas kedadeyan. Tafenoquine succinate dikontraindikasi ing pasien sing ngalami hipersensitifitas marang tafenoquine utawa komponen saka formulasi tafenoquine succinate utawa 8-aminoquinoline liyane.
Reaksi Saleh Tertunda
Reaksi salabetipun kalebu anemia hemolitik, methemoglobinemia, efek psikiatri, lan reaksi hipersensitivitas dilapurake kanthi nggunakake tafenoquine succinate utawa tafenoquine ing uji klinis. Amarga suwene setengah umur tafenoquine succinate (kira-kira 17 dina), efek psikiatri, anemia hemolitik, methemoglobinemia, lan pratandha utawa gejala reaksi hipersensitivitas sing bisa kedadeyan bisa ditundha ing wiwitan lan / utawa durasi. Anjurake pasien supaya golek perawatan medis yen ana tandha hipersensitivitas.
Populasi Spesifik
KandhutanRingkesan Resiko: Panganggone tafenoquine succinate sajrone meteng bisa nyebabake anemia hemolitik ing janin sing kurang G6PD. Perawatan karo tafenoquine succinate sajrone meteng ora dianjurake. Yen meteng dideteksi nalika nggunakake tafenoquine succinate, mateni tafenoquine succinate sanalika bisa lan pindhah menyang obat profilaksis alternatif kanggo malaria nalika meteng. Data sing kasedhiya kanthi nggunakake tafenoquine succinate ing wanita ngandhut ora cukup kanggo netepake risiko sing ana gandhengane karo obat-obatan kanggo cacat lair utama, keguguran utawa asil ibu utawa janin sing ala. Ing pasinaon kewan, ana tambah abortions, karo lan tanpa keracunan ibu nalika tafenoquine diwenehi cublak kanggo terwelu ngandhut ing lan ndhuwur dosis padha karo bab 0,4 kaping paparan Clinical adhedhasar comparison area lumahing awak. Ora ana fetotoksisitas sing diamati ing dosis kira-kira 1,5 kaping paparan klinis (adhedhasar perbandingan area lumahing awak) ing studi sing padha ing tikus.
Risiko latar mburi sing kira-kira cacat lair utama lan keguguran kanggo populasi sing dituduhake ora dingerteni. . Kabeh meteng duwe risiko latar mburi cacat lair, mundhut, utawa asil salabetipun liyane. Ing populasi umum AS, kira-kira risiko latar mburi cacat lair utama lan keguguran ing kandhutan sing diakoni sacara klinis yaiku 2% nganti 4% lan 15% nganti 20%, masing-masing.
Maternal lan/utawa Embrio sing Gegandhengan karo Penyakit. /Risiko Fetal: Malaria nalika meteng nambah risiko asil meteng sing ora becik, kalebu anemia ibu, prematuritas, aborsi spontan lan lair mati.
Data Kewan: Tafenoquine nyebabake aborsi sing gegandhengan karo dosis nalika diwenehi oral marang terwelu sing ngandhut nalika ngandhut. organogenesis (Dina Gestation 6 nganti 18), kanthi dosis 7 mg / kg (kira-kira 0,4 kali paparan klinis adhedhasar perbandingan area permukaan awak) lan ndhuwur. Dosis sing luwih dhuwur tinimbang 7 mg / kg uga digandhengake karo keracunan ibu (kematian lan nyuda bobot awak). Ing studi sing padha ing tikus, dosis 3, 10, utawa 30 mg / kg / dina nyebabake keracunan ibu (limpa nggedhekake, bobot awak suda lan asupan panganan sing suda) nanging ora ana fetotoksisitas ing dosis dhuwur (kira-kira 1,5 kali paparan klinis). adhedhasar perbandingan area permukaan awak). Ora ana bukti malformasi ing salah siji spesies. Ing studi pangembangan sadurunge lan postnatal ing tikus, tafenoquine sing diwenehake sajrone meteng lan laktasi ngasilake keracunan ibu lan nyuda bobot awak anak lan nyuda aktivitas motor ing 18 mg / kg / dina, sing padha karo 0,6 kali lipat. dosis klinis adhedhasar perbandingan area lumahing awak.
LaktasiRingkesan Resiko: Bayi sing disusui kanthi kekurangan G6PD beresiko ngalami anemia hemolitik saka paparan tafenoquine succinate. Status G6PD bayi kudu dipriksa sadurunge nyusoni diwiwiti. Tafenoquine succinate contraindicated ing wanita sing nyusoni nalika bayi ditemokake kurang G6PD utawa status G6PD bayi ora dingerteni.
Ora ana informasi babagan anane tafenoquine succinate ing susu manungsa, efek saka tamba ing bayi nyusoni, utawa efek saka tamba ing produksi susu. Ing bayi sing disusui kanthi G6PD normal, keuntungan pangembangan lan kesehatan saka nyusoni kudu dianggep bebarengan karo kabutuhan klinis ibu kanggo tafenoquine succinate lan efek potensial ing bayi sing disusui saka tafenoquine succinate utawa saka kondisi ibu sing ndasari.
Pertimbangan Klinis: Priksa status G6PD bayi sadurunge nyusoni ibu diwiwiti. Yen bayi kurang G6PD, paparan tafenoquine succinate nalika nyusoni bisa nyebabake anemia hemolitik ing bayi; Mulane, menehi saran marang wong wadon sing duwe bayi sing kurang G6PD utawa sing status G6PD ora dingerteni, supaya ora nyusoni nalika perawatan karo tafenoquine succinate lan 3 sasi sawise dosis pungkasan tafenoquine succinate.
Wanita lan Lanang Potensi ReproduksiVerifikasi status meteng ing wanita potensial reproduksi sadurunge miwiti perawatan karo tafenoquine succinate.
Tafenoquine succinate bisa nyebabake anemia hemolitik ing janin sing kurang G6PD. Rekomendasi wanita sing duwe potensi reproduksi yen perawatan karo tafenoquine succinate sajrone meteng ora dianjurake lan supaya ora meteng utawa nggunakake kontrasepsi efektif kanggo 3 sasi sawise dosis pungkasan tafenoquine succinate.
Pediatric UseAman lan efektifitas tafenoquine succinate ( Arakoda) ing pasien pediatrik durung ditetepake.
Panggunaan GeriatrikUji klinis tafenoquine succinate (Arakoda) ora kalebu jumlah pasien sing umure luwih saka 65 taun sing cukup kanggo nemtokake manawa reaksi kasebut beda karo pasien sing luwih enom. Pengalaman klinis liyane sing dilapurake ora nemtokake bedane respon antarane pasien tuwa lan luwih enom.
Gagal GinjalFarmakokinetik tafenoquine succinate durung diteliti ing pasien sing duwe gangguan ginjel. Yen tafenoquine succinate diwenehake marang pasien kasebut, pemantauan reaksi salabetipun sing ana gandhengane karo tafenoquine succinate dibutuhake.
Gangguan HepatikFarmakokinetik tafenoquine succinate durung diteliti ing pasien kanthi gangguan hepatik. Yen tafenoquine succinate diwenehake marang pasien kasebut, pemantauan reaksi salabetipun sing ana gandhengane karo tafenoquine succinate dibutuhake.
Efek Samsaya Awon
Reaksi salabetipun sing paling umum (insiden ≥1%) yaiku: sirah, pusing, nyeri punggung, diare, mual, muntah, tambah alanine aminotransferase (ALT), mabuk. , insomnia, depresi, impen abnormal, kuatir.
Apa obatan liyane bakal mengaruhi Tafenoquine (Arakoda)
Obat Spesifik
Iku penting panyedhiya label pabrikan dikonsultasi kanggo informasi sing luwih rinci babagan interaksi karo obat iki, kalebu kemungkinan pangaturan dosis. Sorotan interaksi:
Singkirake administrasi bebarengan karo obat sing dadi substrat transporter kation organik-2 (OCT2) utawa transporter multidrug and toxin extrusion (MATE).
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