Ziatir
Ziatir Uses, Dosage, Side Effects, Food Interaction and all others data.
Ziatir, is a tyrosine kinase inhibitor that inhibits the BCR-ABL tyrosine kinase created by the Philadelphia chromosome abnormality in chronic myeloid leukaemia (CML). It blocks proliferation and induces apoptosis in BCR-ABL positive cell lines, as well as fresh leukaemic cells from Philadelphia chromosome positive CML. Ziatir also inhibits receptor kinases for platelet-derived growth factor (PDGF) and stem cell factor (SCF), c-kit, PDGF- and SCF-mediated cellular events.
Ziatir is an antineoplastic agent and a 2-phenylaminopyrimidine derivative that is used to treat chronic myelogenous leukemia. It works as a specific inhibitor of a number of tyrosine kinase enzymes. Chronic myelogenous leukemia is associated with the Philadelphia chromosome promoting the generation of BCR-ABL mutation, which results from the combination of two genes, known as BCR and ABL. BCR-ABL generates a fusion protein that acts as a constitutively active tyrosine kinase and imatinib works to inhibit this constitutive enzymatic activity.
Trade Name | Ziatir |
Availability | Prescription only |
Generic | Imatinib |
Imatinib Other Names | Imatinib, Imatinibum |
Related Drugs | omeprazole, methotrexate, Prilosec, lansoprazole, Prevacid, hydroxyurea, doxorubicin, Revlimid, cyclophosphamide, Gleevec |
Type | |
Formula | C29H31N7O |
Weight | Average: 493.6027 Monoisotopic: 493.259008649 |
Protein binding | 95% protein bound, mostly to albumin and alpha-1-acid glycoprotein. |
Groups | Approved |
Therapeutic Class | Targeted Cancer Therapy |
Manufacturer | |
Available Country | Argentina |
Last Updated: | September 19, 2023 at 7:00 am |
![Ziatir Ziatir](https://www.medicinesfaq.com/media/png/ziatir.png)
Uses
Newly diagnosed adult and pediatric patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in chronic phase.
Patients with Philadelphia chromosome positive chronic myeloid leukemia in blast crisis, accelerated phase, or in chronic phase after failure of interferon-alpha therapy.
Adult patients with relapsed or refractory Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL).
Pediatric patients with newly diagnosed Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) in combination with chemotherapy.
Adult patients with myelodysplastic or myeloproliferative diseases associated with PDGFR (platelet-derived growth factor receptor) gene re-arrangements as determined with an FDA-approved test
Adult patients with aggressive systemic mastocytosis without the D816V c-Kit mutation as determined with an FDA approved test
Adult patients with hypereosinophilic syndrome and/or chronic eosinophilic leukemia who have the FIP1L1-PDGFRα fusion kinase (mutational analysis or FISHdemonstration of CHIC2 allele deletion) and for patients with HES and/or CEL who are FIP1L1-PDGFRα fusion kinase negative or unknown.
Adult patients with unresectable, recurrent and/or metastatic dermatofibrosarcoma protuberans.
Patients with Kit (CD117) positive unresectable and/or metastatic malignant gastrointestinal stromal tumors.
Adjuvant treatment of adult patients following complete gross resection of Kit (CD117) positive GIST.
Ziatir is also used to associated treatment for these conditions: Chordomas, Chronic Eosinophilic Leukemia (CEL), Chronic Myeloid Leukemia (CML), Desmoid Tumors, FIP1L1-PDGFRα fusion kinase status unknown Chronic eosinophilic leukemia, FIP1L1-PDGFRα fusion kinase status unknown Hypereosinophilic syndrome, Hypereosinophilic Syndromes, Metastatic Gastrointestinal Stromal Tumor, Metastatic Melanoma, Myelodysplastic Syndromes (MDS), Myeloproliferative Disorders, Refractory Acute Lymphoblastic Leukemia, CKit mutational status unknown Aggressive systemic mastocytosis, Metastatic Dermatofibrosarcoma protuberans, Newly diagnosed Acute Lymphoblastic Leukaemia, Newly diagnosed, chronic phase Chronic myeloid leukemia, Recurrent Dermatofibrosarcoma protuberans, Refractory, accelerated phase Chronic myeloid leukemia, Refractory, blast crisis Chronic myeloid leukemia, Refractory, chronic phase Chronic myeloid leukemia, Systemic mastocytosis with associated hematological neoplasm, Unresectable Gastrointestinal stromal tumor
How Ziatir works
Ziatir mesylate is a protein-tyrosine kinase inhibitor that inhibits the Bcr-Abl tyrosine kinase, the constitutive abnormal tyrosine kinase created by the Philadelphia chromosome abnormality in chronic myeloid leukemia (CML). It inhibits proliferation and induces apoptosis in Bcr-Abl positive cell lines as well as fresh leukemic cells from Philadelphia chromosome positive chronic myeloid leukemia. Ziatir also inhibits the receptor tyrosine kinases for platelet derived growth factor (PDGF) and stem cell factor (SCF) - called c-kit. Ziatir was identified in the late 1990s by Dr Brian J. Druker. Its development is an excellent example of rational drug design. Soon after identification of the bcr-abl target, the search for an inhibitor began. Chemists used a high-throughput screen of chemical libraries to identify the molecule 2-phenylaminopyrimidine. This lead compound was then tested and modified by the introduction of methyl and benzamide groups to give it enhanced binding properties, resulting in imatinib.
Dosage
Ziatir dosage
Oral (Adult)-
- Dermatofibrosarcoma protuberans: 400 mg bid.
- Chronic myeloid leukaemia: Chronic phase: 400 mg daily, increased to 600 mg daily or 400 mg bid. Blast crisis or accelerated phase: 600 mg daily, increased to 400 mg bid as required.
- Mastocytosis: 400 mg daily. Start with 100 mg daily if there is associated eosinophilia, may increase to 400 mg if response is insufficient.
- Unresectable, metastatic malignant gastrointestinal stromal tumours: 400 mg daily, may increase up to 400 mg bid.
- Myelodysplastic disease: 400 mg daily.
- Acute lymphoblastic leukaemia, Monotherapy in relapsed or refractory acute lymphoblastic leukaemia: 600 mg daily with induction, consolidation or maintenance chemotherapy.
- Hypereosinophilic syndrome: 400 mg daily. Start with 100 mg daily in patients with FIP1L1-PDGF receptor-α fusion kinase, may increase to 400 mg if response is inadequate.
Oral (Child)-
- Chronic myeloid leukaemia: 340 mg/m2 daily. Max: 800 mg. May be given once daily or divided into morning and evening doses. May be increased to 570 mg/m2 daily in childn w/ disease progression, unsatisfactory haematological response at least 3 mth of treatment, failed to achieve cytogenic response after 12 mth of treatment or loss a previously achieved haematological or cytogenic response.
- Acute lymphoblastic leukaemia, Monotherapy in relapsed or refractory acute lymphoblastic leukaemia:340 mg/m2 daily. Max: 600 mg.
Should be taken with food.
Side Effects
GI disturbances and bleeding, myelosuppression, superficial oedema, myalgia, arthralgia, muscle cramps, fatigue, rhabdomyolysis, rashes, pruritus, headache, dizziness, taste disturbances, anorexia, paraesthesia, insomnia, eye disorders or visual disturbances, epistaxis, cough, dyspnoea, dry skin, alopecia, night sweats, pyrexia, weakness, rigors, haemorrhages, growth retardation in childn, CHF, palpitations, tachycardia, arrhythmias, angina pectoris and MI. Rarely, serious and severe skin disorders (e.g. erythema multiforme, Stevens-Johnson syndrome, acute generalised exanthematous pustulosis, exfoliative dermatitis and bullous eruptions); aseptic necrosis of bone, ulceration.
Toxicity
The most frequently reported adverse reactions (>30%) were edema, nausea, vomiting, muscle cramps, musculoskeletal pain, diarrhea, rash, fatigue and abdominal pain.
Precaution
Patient with cardiac disease or increased risk for CHF. Renal and hepatic impairment. Pregnancy.
Interaction
Increased serum levels with CYP3A4 inhibitors (e.g. azole antifungals, macrolide antibiotics). Reduced serum levels with CYP3A4 inducers (e.g. carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampicin). May increase serum levels of substrates of CYP3A4 (e.g. ciclosporin, pimozide, triazolo-benzodiazepines, dihydropyridine Ca channel blockers, certain statins), CYP2C9 (e.g. warfarin) and CYP2D6.
Food Interaction
- Avoid grapefruit products. Grapefruit inhibits CYP3A4 metabolism, which can increase serum levels of imatinib.
- Exercise caution with St. John's Wort. This herb induces CYP3A4 metabolism, which may reduce the serum concentration of imatinib.
- Take with a full glass of water. Taking imatinib with water may reduce gastric irritation.
- Take with food. Food reduces gastric irritation.
[Moderate] GENERALLY AVOID: Coadministration of imatinib with strong CYP450 3A4 inhibitors such as grapefruit juice, may significantly increase the plasma concentrations of imatinib, a known substrate of CYP450 3A4.
The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of imatinib by certain compounds present in grapefruits.
Because grapefruit juice inhibits primarily intestinal rather than hepatic CYP450 3A4, the magnitude of interaction is greatest for those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability).
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.
Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.
In a single-dose study, coadministration of imatinib with ketoconazole (a strong CYP450 3A4 inhibitor) increased imatinib peak plasma concentration (Cmax) and systemic exposure (AUC) by 26% and 40%, respectively.
MANAGEMENT: Patients treated with imatinib should preferably avoid the consumption of grapefruit or grapefruit juice.
If coadministration is unavoidable, monitor for prolonged and
Ziatir Drug Interaction
Moderate: metoprolol, metoprolol, metoprolol, metoprolol, acetaminophen, acetaminophen, levothyroxine, levothyroxine, ondansetron, ondansetronUnknown: aspirin, aspirin, diphenhydramine, diphenhydramine, sulfamethoxazole / trimethoprim, sulfamethoxazole / trimethoprim, cyanocobalamin, cyanocobalamin, cholecalciferol, cholecalciferol
Ziatir Disease Interaction
Moderate: cardiovascular disease, fluid retention, bone marrow suppression, gastrointestinal disorders, hepatic impairment, hypothyroidism, renal impairment
Elimination Route
The pharmacokinetics in CML and GIST patients are similar. Ziatir is well absorbed with mean absolute bioavailability is 98% and maximum plasma levels achieved within 2-4 hours of dosing
Half Life
Following oral administration in healthy volunteers, the elimination half-lives of imatinib and its major active metabolite, the N-demethyl derivative (CGP74588) are approximately 18 and 40 hours, respectively.
Clearance
- 8 L/h [50-year-old CML and GIST patient weighing 50 kg]
- 14 L/h [50-year-old CML and GIST patient weighing 100 kg]
Elimination Route
Ziatir elimination is predominately in the feces, mostly as metabolites. 81% of the dose is eliminated within 7 days, in feces (68% of the dose) and urine (13% of the dose). Unchanged imatinib accounted for 25% of the dose (5% urine, 20% faces), the remainder being metabolites.
Pregnancy & Breastfeeding use
Category D: There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
Contraindication
Hypersensitivity. Lactation.
Special Warning
Patients on potent CYP3A4 inducers: Increase dose by 50% and carefully monitor clinical response.
Severe Hepatic Impairment: Reduce dose by 25%.
Acute Overdose
Symptoms: Nausea, vomiting, diarrhoea, rash, erythema, oedema, swelling, fatigue, muscle spasms, thrombocytopenia, pancytopenia, headache, pyrexia, decreased appetite, weakness, myalgia, GI pain, decreased neutrophil count, increased creatine phosphokinase, bilirubin and transaminases.
Management: Supportive and symptomatic treatment.
Storage Condition
Store below 30° C. Protect from moisture.
Innovators Monograph
You find simplified version here Ziatir
Ziatir contains Imatinib see full prescribing information from innovator Ziatir Monograph, Ziatir MSDS, Ziatir FDA label
FAQ
What is Ziatir used for?
Ziatir is used to treat certain types of leukemia (cancer that begins in the white blood cells) and other cancers and disorders of the blood cells.
How safe is Ziatir?
The selective kinase inhibitor imatinib mesylate has been found to be safe and effective following almost 11 years of follow-up in patients with chronic myeloid leukemia.
How does Ziatir work?
Ziatir works by blocking the action of the abnormal protein that signals cancer cells to multiply.
What are the common side effects of Ziatir?
Coimmon side effects of Ziatir are upset stomach, nausea/vomiting, diarrhea, headache, muscle/joint pain, muscle cramps, dizziness, blurred vision, or drowsiness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. People using this medication may have serious side effects.
Is Ziatir safe in pregnancy?
Exposure to Ziatir during pregnancy might result in an increased risk of serious fetal abnormalities or spontaneous abortion. Women of childbearing potential should use adequate contraception while taking Ziatir.
Is Ziatir safe during breastfeeding?
Ziatir should be used only with careful monitoring during breastfeeding.
Can I drink alcohol with Ziatir?
The drinking of alcohol does not appear to affect the safety or usefulness of Ziatir.
Can I drive after taking Ziatir ?
You should be careful when driving or operating machinery if your vision has changed.
How long does it take for Ziatir to start working?
Using Ziatir time to response is approximately 3 months, and median time to disease progression on Ziatir is about 2 years.
How long does Ziatir stay in my system?
Ziatir has a half-life of around 18 hours. A drug's half-life is the time it takes for your body to clear half of a dose of the drug.
Should Ziatir be taken with food?
Take Ziatir with a meal and a large glass of water. Do not take Ziatir on an empty stomach.
When should be taken of Ziatir?
Ziatir is usually taken with a meal and a large glass of water once or twice a day. Take Ziatir at around the same time every day.
Can Ziatir be taken at night?
The dose may be taken once a day or the dose may be divided into two small doses, once in the morning and once in the evening.
How long can I take Ziatir?
Optimal duration of therapy is unknown but generally Ziatir should be continued for 6–9 months, after which additional tumor shrinkage is usually minor.
How long can I stay on Ziatir?
Ziatir is generally given for at least 3 years if the patient is tolerating it well. Clinical trials are ongoing to determine if longer durations are beneficial.
Can you stop taking Ziatir?
Ziatir can safely be discontinued in patients with a sustained deep molecular response with no late molecular recurrence.
Can Ziatir cure cancer?
It does not cure patients of their cancers; it keeps the cancers from growing. Patients taking Ziatir are recommended to maintain treatment for life to help avoid relapse of the disease.
What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What happen if I take too much Ziatir?
If you take too much Ziatir, call your local Poison Control Center or seek emergency medical attention right away. Symptoms of overdose may include muscle cramps, and swollen or bloated stomach.
Does Ziatir affect immune system?
Ziatir can push the immune system to combat a variety of bacteria.
Does Ziatir affect my kidney?
Researchers found that a reversible decline in kidney function was linked with long-term Ziatir use in these patients.