Zavesca (Oral)
Zavesca (Oral) Uses, Dosage, Side Effects, Food Interaction and all others data.
Zavesca (Oral), commonly marketed under the trade name Zavesca, is a drug used to treat Gaucher disease. It inhibits the enzyme glucosylceramide synthase, an essential enzyme for the synthesis of most glycosphingolipids. It is only used for patients who cannot be treated with enzyme replacement therapy with imiglucerase. Zavesca (Oral) is now the first and only approved therapy for patients with Niemann-Pick disease type C (NP-C). It has recently been approved for treatment of progressive neurological symptoms in adult and pediatric patients in the European Union, Brazil, and South Korea. Zavesca (Oral) was first developed as an anti-HIV agent in the 1990s. However, clinical experience with miglustat showed that therapeutic levels of the drug could not be achieved in patients without a high incidence of adverse effect.
Zavesca (Oral), an N-alkylated imino sugar, is a synthetic analogue of D-glucose. Zavesca (Oral) is an inhibitor of the enzyme glucosylceramide synthase, which is a glucosyl transferase enzyme responsible for catalyzing the formation of glucosylceramide (glucocerebroside). Glucosylceramide is a substrate for the endogenous glucocerebrosidase, an enzyme that is deficient in Gaucher's disease. The accumulation of glucosylceramide due to the absence of glucocerebrosidase results in the storage of this material in the lysosomes of tissue macrophages, leading to widespread pathology due to infiltration of lipid-engorged macrophages in the viscera, lymph nodes, and bone marrow. This results in secondary hematologic consequences including sever anemia and thrombocytopenia, in addition to the characteristic progressive hepatosplenomegaly, as well as skeletal complications including osteonecrosis and osteopenia with secondary pathological fractures.
Trade Name | Zavesca (Oral) |
Availability | Prescription only |
Generic | Miglustat |
Miglustat Other Names | BuDNJ, Butyldeoxynojirimycin, Miglustat, Miglustatum, n-Butyl deoxynojirimycin, N-Butylmoranoline, NB-DNJ |
Related Drugs | VPRIV, eliglustat, Cerezyme, Elelyso, imiglucerase, velaglucerase alfa |
Type | |
Formula | C10H21NO4 |
Weight | Average: 219.278 Monoisotopic: 219.147058165 |
Protein binding | Miglustat does not bind to plasma proteins. |
Groups | Approved |
Therapeutic Class | |
Manufacturer | |
Available Country | USA |
Last Updated: | September 19, 2023 at 7:00 am |
![Zavesca (Oral) Zavesca (Oral)](https://www.medicinesfaq.com/media/png/zavesca-oral.png)
Uses
Zavesca (Oral) is a glucosylceramide synthase inhibitor used for the management of mild to moderate type I Gaucher disease for patients who are not candidates for whole enzyme replacement.
For the treatment of adult patients with mild to moderate type 1 (nonneuropathic) Gaucher's disease for whom enzyme replacement therapy is not a therapeutic option (e.g. due to constraints such as allergy, hypersensitivity, or poor venous access). Now approved in some countries for the treatment of progressive neurological symptoms in adult and pediatric patients with Niemann-Pick disease type C (NP-C).
Zavesca (Oral) is also used to associated treatment for these conditions: Gaucher Disease, Type 1
How Zavesca (Oral) works
Zavesca (Oral) functions as a competitive and reversible inhibitor of the enzyme glucosylceramide synthase, the initial enzyme in a series of reactions which results in the synthesis of most glycosphingolipids. The goal of treatment with miglustat is to reduce the rate of glycosphingolipid biosynthesis so that the amount of glycosphingolipid substrate is reduced to a level which allows the residual activity of the deficient glucocerebrosidase enzyme to be more effective (substrate reduction therapy), reducing the accumulation of glucocerebroside in macrophages. In vitro and in vivo studies have shown that miglustat can reduce the synthesis of glucosylceramide-based glycosphingolipids. In clinical trials, miglustat improved liver and spleen volume, as well as hemoglobin concentration and platelet count. Inhibition of glycosphingolipid synthesis has also shown to reduce intracellular lipid storage, improve fluid-phase endosomal uptake and normalize lipid transport in peripheral blood B lymphocytes of NP-C patients, which results in a decrease in the potentially neurotoxic accumulation of gnagliosides GM2 and GM3, lactosylceramide and glucosylceramide, possibly preventing further neuronal damage. Other studies have also suggested that miglustat may indirectly modulate intracellular calcium homeostasis through its effects on glucosylceramide levels, and evidence has shown that an initiating factor in the pathogenesis of NP-C may be impaired calcium homeostasis related to sphingosine storage. Therefore, the effect that miglustat exerts on intracellular calcium levels may influence an important underlying pathogenic mechanism of NP-C.
Toxicity
Zavesca (Oral) has been administered at doses of up to 3000 mg/day (approximately 10 times the recommended starting dose administered to Gaucher patients) for up to six months in Human Immunodeficiency Virus (HIV)-positive patients. Adverse events observed in the HIV studies included granulocytopenia, dizziness, and paresthesia. Leukopenia and neutropenia have also been observed in a similar group of patients receiving 800 mg/day or above.
Food Interaction
- Take at the same time every day.
- Take with or without food.
Zavesca (Oral) Disease Interaction
Moderate: inflammatory bowel disease, peripheral neuropathy, renal impairment, thrombocytopenia
Elimination Route
Mean oral bioavailability is 97%.
Half Life
The effective half-life of miglustat is approximately 6 to 7 hours.
Innovators Monograph
You find simplified version here Zavesca (Oral)