Trepmac Tablet 90 mg

Trepmac Tablet 90 mg Uses, Dosage, Side Effects, Food Interaction and all others data.

Trepmac Tablet 90 mg is a tyrosine kinase inhibitor with in vitro activity at clinically achievable concentrations against multiple kinases including ALK, ROS1, insulin-like growth factor-1 receptor (IGF-1R), and FLT-3 as well as EGFR deletion and point mutations. Trepmac Tablet 90 mg inhibited autophosphorylation of ALK and ALK-mediated phosphorylation of the downstream signalin proteins STAT3, AKT, ERK1/2, and S6 in in vitro and in vivo assays. Trepmac Tablet 90 mg also inhibited the in vitro proliferation of cell lines expressing EML4-ALK and NPM-ALK fusion proteins and demonstrated dose-dependent inhibition ofEML4-ALK-positive NSCLC xenograft growth in mice.At clinically achievable concentrations (≤500 nM), brigatinib inhibited the in vitro viability of cells expressing EML4-ALK and 17 mutant forms associated with resistance to ALK inhibitors including crizotinib, as well as EGFR-Del (E746-A750), ROS1 L2026M, FLT3-F691L, and FLT3-D835Y. Trepmac Tablet 90 mg exhibited in vivo antitumor activity against 4 mutant forms of EML4-ALK, including G1202R and L1196M mutants identified in NSCLC tumors in patients who have progressed on crizotinib. Trepmac Tablet 90 mg also reduced tumor burden and prolonged survival in mice implanted intracranially with an ALK-driven tumor cell line.

Brigitanib inhibits proliferation and in vitro viability of cells expressing the fusion protein EML4-ALK as well as 17 crizotinib-resistant ALK mutants. Its action is expanded to cells expressing EGFR deletions, ROS1-L2026M, FLT3-F691L and FLT3-D835Y. Brigitanib presents a dose-dependent inhibition of tumor growth, tumor burden and prolonged survival in mice EML4-ALK xenograft models. Time course of Trepmac Tablet 90 mg and exposure-response studies are still unknown.

Trepmac Tablet 90 mg
Uses
Dosage
Side Effect
Precautions
Interactions
Uses during Pregnancy
Uses during Breastfeeding
Accute Overdose
Food Interaction
Half Life
Volume of Distribution
Clearance
Interaction With other Medicine
Contradiction
Storage

Trade Name	Trepmac Tablet 90 mg
Availability	Prescription only
Generic	Brigatinib
Brigatinib Other Names	Brigatinib
Related Drugs	Alunbrig, Xalkori, Zykadia, Opdivo, methotrexate, Keytruda, pembrolizumab, cisplatin, Tagrisso, Avastin
Weight	90 mg
Type	Tablet
Formula	C₂₉H₃₉ClN₇O₂P
Weight	Average: 584.1 Monoisotopic: 583.2591382
Protein binding	66% of brigatinib dose is bound to plasma proteins, which gives a blood-to-plasma concentration ratio of 0.69.
Groups	Approved, Investigational
Therapeutic Class	Cytotoxic Chemotherapy
Manufacturer	Genvio Pharma Ltd.
Available Country	Bangladesh
Last Updated:	October 19, 2023 at 6:27 am

Uses

Trepmac Tablet 90 mg is used for the treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) as detected by an FDA-approved test.
Pediatric Use: The safety and effectiveness of Trepmac Tablet 90 mg in pediatric patients have not been established.

Geriatric Use: Of the 359 patients enrolled in the ALTA 1L Trepmac Tablet 90 mg arm and in ALTA, 26.7% were 65 and older
and 7.5% were 75 and older. No overall differences in safety or effectiveness were observed between patients ≥65 years and younger patients.

Hepatic Impairment: No dose adjustment is recommended for patients with mild hepatic impairment (Child-Pugh A) or
moderate hepatic impairment (Child-Pugh B). Reduce the dose of Trepmac Tablet 90 mg for patients with severe hepatic impairment (Child-Pugh C)

Renal Impairment: No dose adjustment is recommended for patients with mild or moderate renal impairment ClCr 30 to 89 mL/min by Cockcroft-Gault. Reduce the dose of Trepmac Tablet 90 mg for patients with severe renal impairment (ClCr 15 to 29 mL/min)

Trepmac Tablet 90 mg is also used to associated treatment for these conditions: Metastatic Non-Small Cell Lung Cancer

How Trepmac Tablet 90 mg works

Brigitanib acts as a tyrosine kinase inhibitor with activity against multiple kinases including ALK, ROS1, insulin-like growth factor 1 receptor and against EGFR deletions and point mutations. It acts by inhibiting ALK phosphorylation and the activation of downstream signaling proteins.

Dosage

Trepmac Tablet 90 mg dosage

The recommended dosage for Trepmac Tablet 90 mg is 90 mg orally once daily for the first 7 days; then increase the dose to 180 mg orally once daily. Administer Trepmac Tablet 90 mg until disease progression or unacceptable toxicity. If Trepmac Tablet 90 mg is interrupted for 14 days or longer for reasons other than adverse reactions, resume treatment at 90 mg once daily for 7 days before increasing to the previously tolerated dose. Trepmac Tablet 90 mg may be taken with or without food. Instruct patients to swallow tablets whole. Do not crush or chew tablets.

Side Effects

The most common adverse reactions (≥25%) with Trepmac Tablet 90 mg were diarrhea, fatigue, nausea, rash, cough, myalgia, headache, hypertension, vomiting, and dyspnea.

Toxicity

Treatment with brigatinib generated not mutagenic chromosomal damage. Testicular toxicity, reported as lower weight of seminal vesicles and prostate gland, testicular tubular degeneration and lower weight as well as reduced size of testes with evidence of hypoespermatogenesis.

Precaution

Interstitial Lung Disease (ILD)/Pneumonitis: Monitor for new or worsening respiratory symptoms, particularly during the first week of treatment. Withhold Trepmac Tablet 90 mg for new or worsening respiratory symptoms and promptly evaluate for ILD/pneumonitis. Upon recovery, either dose reduce or permanently discontinue Trepmac Tablet 90 mg.
Hypertension: Monitor blood pressure after 2 weeks and then at least monthly during treatment. For severe hypertension, withhold Trepmac Tablet 90 mg, then dose reduce or permanently discontinue.
Bradycardia: Monitor heart rate and blood pressure regularly during treatment. If symptomatic, withhold Trepmac Tablet 90 mg, then dose reduce or permanently discontinue.
Visual Disturbance: Advise patients to report visual symptoms. Withhold Trepmac Tablet 90 mg and obtain ophthalmologic evaluation, then dose reduce or permanently discontinue Trepmac Tablet 90 mg.
Creatine Phosphokinase (CPK) Elevation: Monitor CPK levels regularly during treatment. Based on the severity and with muscle pain or weakness, withhold Trepmac Tablet 90 mg, then resume or reduce dose.
Pancreatic Enzymes Elevation: Monitor lipase and amylase levels regularly during treatment. Based on the severity, withhold Trepmac Tablet 90 mg, then resume or reduce dose.
Hyperglycemia: Assess fasting serum glucose prior to starting Trepmac Tablet 90 mg and regularly during treatment. If not adequately controlled with optimal medical management, withhold Trepmac Tablet 90 mg, then consider dose reduction or permanently discontinue, based on severity.
Embryo-Fetal Toxicity: Can cause fetal harm. Advise females of reproductive potential of the potential risk to a fetus and to use a non-hormonal method of effective contraception.

Interaction

CYP3A Inhibitors: Avoid coadministration of Trepmac Tablet 90 mg with strong or moderate CYP3A inhibitors. If coadministration of a strong or moderate CYP3A inhibitor is unavoidable, reduce the dose of Trepmac Tablet 90 mg.
CYP3A Inducers: Avoid coadministration of Trepmac Tablet 90 mg with strong or moderate CYP3A inducers. If coadministration of a moderate CYP3A inducer is unavoidable, increase the dose of Trepmac Tablet 90 mg.

Food Interaction

Avoid grapefruit products. Grapefruit inhibits CYP3A metabolism, which may increase the serum concentration of brigatinib.
Avoid St. John's Wort. This herb induces the CYP3A metabolism of brigatinib and may reduce its serum concentration.
Take with or without food.

[Moderate] GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of brigatinib.

The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit.

In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands.

Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition.

Itraconazole, a potent CYP450 3A4 inhibitor, has been shown to double brigatinib systemic exposure (AUC) in healthy volunteers.

Increased exposure to brigatinib may increase the risk of adverse effects such as nausea, vomiting, diarrhea, hypertension, bradycardia, hyperglycemia, visual disturbances, lymphopenia, anemia, and elevations in pancreatic enzymes and creatine phosphokinase.

Food does not significantly affect the oral bioavailability of brigatinib.

When brigatinib was administered to healthy volunteers after a high-fat meal (920 calories; 59 g fat, 58 g carbohydrates, 40 g proteins), brigatinib peak plasma concentration (Cmax) decreased by 13% and systemic exposure (AUC) did not change compared to administration after overnight fasting.

MANAGEMENT: Trepmac Tablet 90 mg may be taken with or without food.

Patients should avoid consumption of grapefruit and grapefruit juice during treatment with brigatinib.

Trepmac Tablet 90 mg Drug Interaction

Major: diltiazemModerate: lithiumUnknown: charcoal, sulfamethoxazole / trimethoprim, ubiquinone, copper gluconate, glucose, ethanol, tamsulosin, glycerin, arginine, levocarnitine, cysteine, valproic acid, thiamine, cyanocobalamin, pyridoxine, cholecalciferol, phytonadione, menaquinone

Trepmac Tablet 90 mg Disease Interaction

Moderate: liver dysfunction, pulmonary toxicity, renal impairment

Volume of Distribution

The apparent volume of distribution at steady state is 153 L.

Elimination Route

Administration of brigatinib at a concentration of 90 mg generates a Cmax of 552 ng/ml and AUC of 8165 ng h/ml while the administration of 180 mg presents a Cmax of 1452 ng/ml and AUC of 20276 ng h/ml. It has a dose proportional exposure with an accumulation ratio on the range of 1.9 to 2.4. Following oral administration of brigatinib, the Tmax is presented in a range from 1 to 4 hours. Consumption of a high-fat meal compared to overnight fasting reduces Cmax by 13% without presenting an effect on AUC.

Half Life

The half-life of brigatinib at steady-state was 25 hours.

Clearance

After oral administration of180 mg of brigatinib, the apparent oral clearance at steady-state is 12.7 L/h.

Elimination Route

The elimination of brigatinib is divided in 65% in feces and 25% in urine. From the elimination in both compartments, the unchanged for of brigatinib represented 41% of the total in feces and 86% in urine.

Pregnancy & Breastfeeding use

Based on its mechanism of action and findings in animals, Trepmac Tablet 90 mg can cause fetal harm when administered to a pregnant woman. There are no clinical data on the use of Trepmac Tablet 90 mg in pregnant women. There are no data regarding the secretion of Trepmac Tablet 90 mg in human milk or its effects on the breastfed infant or milk production. Because of the potential for adverse reactions in breastfed infants, advise lactating women not to breastfeed during treatment with Trepmac Tablet 90 mg and for 1 week following the final dose.