Names and pronunciation
(roo-kap′a-rib) Rubraca
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Drug reference
(roo-kap′a-rib) Rubraca
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Func. class.: Antineoplastic
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Chem. class.: Poly (ADP-ribose) polymerase (PARP) inhibitor
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ACTION: Inhibits poly (ADP-ribose) polymerase (PARP) enzymes; inhibition of PARP enzyme activity results in increased PARP-DNA complexes, causing DNA damage, apoptosis, and cell death
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USES: BRCA mutation–positive (germline and/or somatic), prostate cancer in patients who have received 2 or more prior chemotherapy regimens, as monotherapy, BRCA 1/2 castration-resistant prostate cancer (mCRPc)
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CONTRAINDICATIONS: Hypersensitivity Precautions: Breastfeeding, contracep- tive requirements, leukemia, myelodys- plastic syndrome (MDS), pregnancy, pregnancy testing, reproductive risk
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SIDE EFFECTS CNS: Fatigue, dizziness, fever, asthenia GI: Nausea, vomiting, constipation, anorexia, abdominal pain, diarrhea, dysgeusia HEMA: Anemia, thrombocytopenia, neu- tropenia, febrile neutropenia, myelodys- plastic syndrome (MDS)/acute myeloid leukemia INTEG: Pruritus, rash, photosensitivity, hand-foot syndrome RESP: Dyspnea
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INTERACTIONS None known Drug/Lab: Increase: AST, ALT, cholesterol Decrease: ANC, Hb, platelets
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DOSAGE AND ROUTES BRCA mutation–positive • Adult: PO 600 mg bid; continue until disease progression or severe toxicity
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Available forms: Tabs 200 mg, 250 mg, 300 mg
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Assess: • Myelodysplastic syndrome (MDS)/ acute myeloid leukemia (AML): monitor for signs and symptoms of MDS/AML; monitor CBC baseline and monthly; do not R start until prior hematologic toxicity resolves to grade ≤1. For prolonged he- matologic toxicity (>4 wk), hold therapy or reduce dose and check a CBC weekly until recovery; discontinue if a diagnosis of MDS or AML occurs • Pregnancy/breastfeeding: assess use of effective contraception during treatment and for 6 mo after last dose; pregnancy testing should be done before use; can cause fetal harm or death; do not breastfeed during treatment and for 2 wk after the final dose, obtain pregnancy test in those of reproductive potential • Monitor AST/ALT, cholesterol, creati- nine; all may be elevated
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Evaluate: • Therapeutic response: decrease in growth, spread of ovarian cancer
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To notify prescriber of all OTC, Rx, and herbal products taken; not to start new products without prescriber approval • Myelodysplastic syndrome (MDS)/ acute myeloid leukemia (AML): to report weakness, fatigue, bruising, bleeding, trou- ble breathing, blood in urine, stool, emesis; that continuing blood work will be needed • Photosensitivity: to wear protective clothing, sunscreen or to stay out of sun to prevent burns • Pregnancy/breastfeeding: that prod- uct can cause fetal harm or death; that pregnancy testing should be done before use; to use effective contraception during treatment and for 6 mo after final dose; not to breastfeed during treatment or for 2 wk after final dose
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PHARMACOKINETICS 70% protein binding, peak 1.9 hr, half-life 17-19 hr, metabolized by CYP2D6 (major) and CYP3A4, CYP1A2 (minor)
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• Adult: PO 600 mg bid; continue until disease progression or severe toxicity
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