Names and pronunciation
(doo-krav-a-sih-ti-nib) Sotyktu
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Drug reference
(doo-krav-a-sih-ti-nib) Sotyktu
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Func. class.: Systemic antipsoriasis agent
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Chem. class.: Tyrosine kinase 2 (TYK2) inhibitor
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ACTION: Mediates multiple cytokine pathways and also pairs with JAK2 to transmit signals through activation of sig- nal transducers and activators of tran- scription (STATs). By binding to TYK2, deucravacitinib stabilizes an inhibitory interaction between the regulatory and catalytic domains of the enzyme
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USES: Moderate to severe plaque pso- riasis
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CONTRAINDICATIONS Hypersensitivity Precautions: Pregnancy, children, geriatric patients, breastfeeding, car- diac/hepatic/neoplastic disease, HF, hepatitis B carriers, infections, MI, stroke, rhabdomyolysis, thromboem- bolism, immunosuppression
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SIDE EFFECTS EENT: Sinusitis, rhinitis, stomatitis, oral ulceration INTEG: Rash, angioedema, severe hyper- sensitivity reactions MS: Rhabdomyolysis MISC: Infection, increased cancer risk
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INTERACTIONS Do not give concurrently with live virus vaccines; immunizations should be brought up to date before treatment Drug/Lab Test: Increase: ALT, choles- terol, lipids
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DOSAGE AND ROUTES Plaque psoriasis Adult: PO 6 mg once daily
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Available forms: Tablet 6 mg
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Administer: PO route • Swallow whole; do not cut, break, crush • Give without regard to food
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Assess: • Plaque psoriasis: improvement in raised, red, inflamed lesions; dry skin with cracking and bleeding; itching, burning, or painful skin; silvery, scaly plaques; pitted nails or separation from the nail bed • Monitor serum triglycerides • Infections (fever, flulike symptoms, dyspnea, change in urination, redness/ swelling around any wounds), stop treatment if some serious infections oc- cur, may be fatal; patients with active infections should not be started on this product • May reactivate hepatitis B in chronic carriers, may be fatal, monitor hepati- tis B serology, plasma hepatitis C RNA, LFTs; watch for reactivation in these individuals • Latent TB before therapy; obtain TB test; if positive, treat before starting this product • Neoplastic disease (lymphomas/leu- kemia): monitor for primary cancers • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected, effects in pregnancy or breastfeeding are unknown
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Evaluate: APPENDIX A • Therapeutic response: improvement in symptoms of plaque psoriasis
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • The reason for the medication and expected result • Not to take any live virus vaccines dur- ing, bring up to date before treatment • Treatment and to read the “medica- tion guide” • To report signs of infection, allergic reaction, TB, immediately • To advise all health care professionals of Rx, OTC, herbals, supplements taken • To do regular skin assessments and report changes to provider • That rhabdomyolysis may occur, to report muscle pain, weakness, especially with fever • That continuing laboratory exams will be needed • Pregnancy/breastfeeding: to advise health care professional if pregnancy is planned or suspected or if breastfeeding
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PHARMACOKINETICS Protein binding 90%, terminal half-life 10 hr, peak 2-3 hr, metabolized by CYP1A2, CYP2B6, CYP2D6, CES2, and UGT1A9. The drug is also a substrate for the transporters P-gp, BCRP, and OCT1, an inhibitor of BCRP and OATP1B3
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