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Alecensa
alectinib
Adult Dosing .
Dosage forms: CAP: 150 mg
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing including toxicity-related dose adjustments
ALK-positive non-small cell lung CA
- [adjuvant tx]
- Dose: 600 mg PO bid x2y; Info: for patients with resected tumor >4cm or node-positive; give with food; do not open/dissolve cap
- [metastatic disease]
- Dose: 600 mg PO bid; Info: give with food; do not open/dissolve cap
renal dosing
- [see below]
- CrCl >30: no adjustment; CrCl <30: not defined
- HD/PD: not defined
hepatic dosing
- [adjust dose amount]
- Child-Pugh Class C: 450 mg bid
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- avoid: breastfeeding during tx and x1wk after D/C
- avoid: sun exposure during tx and for at least 7 days after D/C
- avoid: artificial UV light exposure during tx and for at least 7 days after D/C
- caution: patients of childbearing potential
- caution: male patients of reproductive potential
- caution: patients 65 yo and older
- caution: hepatic impairment, Child-Pugh Class C
- caution: bradycardia
Drug Interactions .
Overview
alectinib
kinase inhibitor
- bradycardia
- nephrotoxicity
- photosensitivity
Contraindicated
- cidofovir
Avoid/Use Alternative
- amikacin
- amikacin inhaled
- aminolevulinic acid topical
- brigatinib
- clofarabine
- crizotinib
- etrasimod
- fexinidazole
- fingolimod
- foscarnet
- ganciclovir
- gentamicin
- landiolol
- lofexidine
- methotrexate
- oxaliplatin
- ozanimod
- pentamidine
- polymyxin B
- ponesimod
- porfimer
- siponimod
- streptomycin
- streptozocin
- tenofovir disoproxil
- tobramycin
- tobramycin inhaled
- valganciclovir
Monitor/Modify Tx
- acebutolol
- acyclovir
- adefovir dipivoxil
- adenosine
- alfentanil
- amiodarone
- amphotericin
- anthrax immune globulin
- apraclonidine ophthalmic
- arsenic trioxide
- articaine
- atazanavir
- atenolol
- auranofin
- axitinib
- balsalazide
- betaxolol
- betaxolol ophthalmic
- bevacizumab
- bisoprolol
- bleomycin
- botulism immune globulin
- bupivacaine
- bupivacaine liposomal
- cabozantinib
- capecitabine
- carbamazepine
- carboplatin
- carfilzomib
- carteolol ophthalmic
- carvedilol
- ceritinib
- chloroprocaine
- cisplatin
- clindamycin
- clonidine
- clozapine
- colistimethate
- copper histidinate
- creatine
- cyclophosphamide
- cyclosporine
- cytomegalovirus immune globulin
- deferasirox
- deferoxamine
- dexmedetomidine
- dexmedetomidine injection
- digoxin
- diltiazem
- disopyramide
- donepezil
- dronedarone
- dulaglutide
- eliglustat
- ensartinib
- esmolol
- etripamil nasal
- everolimus
- fentanyl
- flecainide
- flucytosine
- fosphenytoin
- gadobenate dimeglumine
- galantamine
- guanfacine
- hydroxocobalamin IV
- ifosfamide
- immune globulin
- iodixanol
- iohexol
- iomeprol
- iopamidol
- iopromide
- iothalamate meglumine
- ioversol
- ivabradine
- labetalol
- lacosamide
- lamotrigine
- lanreotide
- lenvatinib
- levobunolol ophthalmic
- lidocaine
- lifileucel
- lithium
- lomustine
- lopinavir/ritonavir
- lorlatinib
- lutetium Lu 177 vipivotide tetraxetan
- mefloquine
- mepivacaine
- mesalamine
- mesalamine rectal
- metoprolol
- midodrine
- mitomycin
- nadolol
- nebivolol
- neomycin
- neostigmine
- nusinersen
- octreotide
- olsalazine
- paltusotine
- pamidronate
- paromomycin
- pasireotide
- pazopanib
- pemetrexed
- penicillamine
- pentostatin
- phenytoin
- pindolol
- plazomicin
- praziquantel
- procainamide
- propafenone
- propofol
- propranolol
- pyridostigmine
- quinidine (antiarrhythmic)
- quinine
- ramucirumab
- regadenoson
- remifentanil
- remimazolam
- Rho(D) immune globulin
- ritonavir
- rituximab
- rivastigmine
- ropeginterferon alfa-2b
- ropivacaine
- sirolimus
- sitagliptin
- sotalol
- sparsentan
- succinylcholine
- sufentanil
- sugammadex
- sunitinib
- tacrolimus
- telavancin
- temsirolimus
- tenofovir alafenamide
- thalidomide
- ticagrelor
- timolol
- timolol ophthalmic
- tiopronin
- tivozanib
- vaccinia immune globulin
- valacyclovir
- vancomycin
- verapamil
- voclosporin
- ziv-aflibercept
- zoledronic acid
Caution Advised
- acitretin
- methoxsalen
- verteporfin
Adverse Reactions .
Serious Reactions
- hepatotoxicity
- renal impairment
- interstitial lung disease
- pneumonitis
- pneumonia
- appendicitis
- pulmonary embolism
- dyspnea
- bradycardia
- cardiac arrest
- MI
- endocarditis
- myalgia, severe
- hemorrhage
- GI perforation
- hemolytic anemia
- visual impairment
- photosensitivity
Common Reactions
- CK elevated
- constipation
- fatigue
- myalgia
- edema
- rash
- hepatotoxicity
- nausea
- diarrhea
- cough
- weight incr.
- dyspnea
- headache
- vomiting
- renal impairment
- vision changes
- photosensitivity
- bradycardia
- back pain
- dysgeusia
- abdominal pain
- hemolytic anemia
- stomatitis
- ALT or AST incr.
- alk phos incr.
- anemia
- Cr incr.
- hyperbilirubinemia
- hypocalcemia
- hyperglycemia
Safety/Monitoring .
Monitoring Parameters
pregnancy test at baseline; LFTs q2wk x3mo, then qmo or more frequently if clinically indicated; CK q2wk x4wk, then as clinically indicated; BP; HR
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; risk of teratogenicity and decr. fetal wt based on animal data at 2.7x systemic exposure and drug's mechanism of action; risk of spontaneous abortion and embryo-fetal toxicity and death at 2.9x or greater systemic exposure and drug's mechanism of action
Individuals of Reproductive Potential
obtain pregnancy test before tx start; avoid pregnancy by using effective contraception during tx and x5wk after D/C in patients of childbearing potential and x3mo after D/C in male patients
Lactation
Clinical Summary
avoid breastfeeding during tx and x1wk after D/C; no human data available to assess risk of infant harm, though possible drug excretion into milk based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for alectinib: liver; CYP450: 3A4 substrate; Info: active metabolite
Excretion: for alectinib: feces 98% (84% unchanged), urine <0.5%; Half-life: 33h
Subclass: Kinase Inhibitors, ALK Inhibitors
Mechanism of Action
for alectinib: inhibits anaplastic lymphoma kinase (ALK), ALK autophosphorylation, and ALK-mediated downstream signaling, leading to inhibition of ALK-dependent tumor cell proliferation
Formulary .
No Formulary Selected
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