Names and pronunciation
[al-ek′ti-nib] Alecensa, Alecensaro
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Drug reference
[al-ek′ti-nib] Alecensa, Alecensaro
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Func. class.: Antineoplastics
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Chem. class.: Tyrosine kinase inhibitor
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ACTION: Targets ALK, RET genes, decreasing proliferation of cancer cells
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USES: For the treatment of metastatic, ALK-positive, non–small-cell lung cancer (NSCLC), pregnancy, breastfeeding
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CONTRAINDICATIONS: Hyper- sensitivity, pregnancy, breastfeeding PRECAUTIONS: Child: Liver dis- ease, pulmonary disease
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SIDE EFFECTS CV: Bradycardia, edema CNS: Headache, fatigue HEMA: Anemia, neutropenia, lymphopenia GI: Vomiting, nausea, anorexia, constipa- tion, diarrhea, hepatotoxicity, increased weight META: Hypocalcemia, hyperglycemia, hypokalemia, hyponatremia MS: Myalgia RESP: Dyspnea, cough INTEG: Rash, photosensitivity
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INTERACTIONS Increased: bradycardia, other products causing bradycardia, monitor carefully NURSING CONSIDERATIONS
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DOSAGE AND ROUTES • Adult: PO 600 mg bid, with food, until disease progression or unacceptable toxicity Hepatic Dose A Adult: Child-Pugh Class C 450 mg bid
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Available forms: Capsules 150 mg Administer • Use cytotoxic handling procedures • Give capsule whole; do not open, cut, or break • Use with food • Do not double doses; if dose is missed, give at next regularly scheduled time • Storage: Protect from light, store at room temperature below 86°F (30°C)
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Assess: • Bradycardia: Heart rate <50 beats per minute. Monitor heart rate and B/P regu- larly. If symptomatic bradycardia (non- life-threatening) occurs, withhold treat- ment until recovery to asymptomatic bradycardia or to a heart rate of ≥60 beats per minute • Hepatotoxicity: Monitor liver function tests (ALT, AST, and total bilirubin) every 2 wk during the first 3 mo and then once a mo and as needed; monitor more fre- quently in patients who develop trans- aminase and bilirubin elevations. May re- quire therapy interruption, dose reduction, or permanent discontinuation • Myalgia: Monitor for muscle pain, ten- derness, or weakness. Assess CPK every 2 wk for the first mo of therapy and then as needed • Photosensitivity: Patients should avoid sun exposure (during treatment and for 7 days after the final dose) and use a sunscreen • Pulmonary toxicity: Monitor for ILD/ pneumonitis; evaluate worsening of res piratory symptoms or signs/symptoms of ILD/pneumonitis (cough, dyspnea, fever). Immediately interrupt for confirmed ILD/ pneumonitis; permanently discontinue if these occur • Renal toxicity: Monitor for renal toxic- ity, may require discontinuation • Pregnancy/breastfeeding: Do not use during pregnancy or breastfeeding, use contraception during and for 1 wk after last dose if of childbearing potential; males should use contraception during and for 3 mo after last dose if female partner is of childbearing potential Patient/family teaching • To report constipation, vomiting, nau- sea, diarrhea, weight gain, headache if these are severe or do not go away • To report liver problems like dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin • To report symptoms of infection • To report lung problems like short- ness of breath or other trouble breath- ing, cough that is new or worse • To report kidney problems like un- able to pass urine, blood in the urine, change in amount of urine passed, or weight gain • To report high blood sugar like confu- sion, fatigue, increased thirst, increased hunger, passing a lot of urine, flushing, fast breathing, or breath that smells like fruit • To report electrolyte problems like mood changes, confusion, muscle pain or weakness, abnormal heartbeat, sei- zures, lack of appetite, or severe nausea or vomiting • To report severe loss of strength and energy • To report slow heartbeat, dizziness, passing out • To report muscle pain, back pain, muscle weakness • To report swelling in arms, legs, or vision changes • To report allergic reactions, like rash; hives; itching; red, swollen, blistered; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat • To notify your prescriber if preg- nancy is planned or suspected, or if breastfeeding
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PHARMACOKINETICS Onset unknown, peak 4 hr, duration unknown, 99% protein binding, metabo- lized by the liver, excreted by the kidney
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• Adult: PO 600 mg bid, with food, until disease progression or unacceptable toxicity Hepatic Dose A Adult: Child-Pugh Class C 450 mg bid
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