Drug Action
Volanesorsen is an antisense oligonucleotide which inhibits the formation of the Cardiovascular system apolipoprotein apoC–III, thereby lowering serum triglycerides.
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Drug reference
Volanesorsen is an antisense oligonucleotide which inhibits the formation of the Cardiovascular system apolipoprotein apoC–III, thereby lowering serum triglycerides.
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Familial chylomicronaemia syndrome (specialist use only) ▶BY SUBCUTANEOUS INJECTION ▶Adult: Initially 285 mg once weekly for 3 months, then reduced to 285 mg every 2 weeks, review and adjust dosing based on serum triglycerides—consult product literature
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Chronic or unexplained thrombocytopenia (platelet count less than 140 6 109/litre)
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Body-weight less than 70 kg (increased risk of thrombocytopenia)
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→Appendix 1: volanesorsen
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▶Common or very common Arthritis. asthenia. chills. cough . diabetes mellitus. diarrhoea. dizziness. dry mouth. dyspnoea. eosinophilia. facial swelling. feeling hot. fever . gastrointestinal discomfort. haemorrhage. headaches. hot flush. hypersensitivity. hypertension. immunisation reaction. influenza like illness. insomnia. joint disorders. leucopenia. malaise. muscle complaints. myositis. nasal congestion. nausea. numbness. oedema. oral disorders. pain. polymyalgia rheumatica. proteinuria. skin reactions . sweat changes. syncope. throat oedema. thrombocytopenia. tremor. vision blurred. vomiting. wheezing ▶Frequency not known Nephrotoxicity
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Manufacturer advises avoid—limited information; animal studies do not indicate toxicity.
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Manufacturer advises avoid—present in very low levels in milk in animal studies.
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▶Manufacturer advises monitor platelet count before treatment and then at least every 2 weeks during treatment. ▶Manufacturer advises monitor liver function, erythrocyte sedimentation rate, and urine dipstick every 3 months during treatment.
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Manufacturer advises administer injection into the upper thigh or abdomen, or upper arm (if not self-administered). Patients may self- administer Waylivra ® after appropriate training in subcutaneous injection technique. l HANDLING AND STORAGE Manufacturer advises store in a refrigerator (2°C–8°C) and protect from light—consult product literature about storage outside refrigerator.
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection A ▶Waylivra (Akcea Therapeutics UK Ltd) Volanesorsen (as Volanesorsen sodium) 190 mg per 1 ml Waylivra 285mg/1.5ml solution for injection pre-filled syringes | 1 pre-filled disposable injection P s Myocardial ischaemia Cardiovascular system Stable angina Description of condition Stable angina is characterised by predictable chest pain or pressure, often precipitated by physical exertion or emotional stress causing an increase in myocardial oxygen demand. Although pain typically occurs in the front of the chest, it may also radiate to the neck, shoulders, jaw or arms; the pain is relieved with rest. Stable angina usually results from atherosclerotic plaques in the coronary arteries that restrict blood flow and oxygen supply to the heart; it can lead to cardiovascular complications such as stroke, unstable angina, myocardial infarction, and sudden cardiac death. For information about unstable angina and myocardial infarction, see Acute coronary syndromes. Prinzmetal’s or vasospastic angina is a rare form of angina caused by narrowing or occlusion of proximal coronary arteries due to spasm, in which pain is experienced at rest rather than during activity. Aims of treatment Antianginal drug therapy and revascularisation aims to prevent or minimise angina symptoms, in order to improve quality of life and long-term morbidity and mortality. The aim of drug therapy for secondary prevention is to minimise the risk of cardiovascular events such as myocardial infarction and stroke. Drug treatment Antianginal drug therapy g Acute attacks of stable angina should be managed with sublingual glyceryl trinitrate p. 232, which can also be used as a preventative measure immediately before performing activities that are known to bring on an attack. For long-term prevention of chest pain in patients with stable angina, a beta-blocker (such as atenolol p. 164, bisoprolol fumarate p. 165, metoprolol tartrate p. 166 or propranolol hydrochloride p. 162) should be given as first- line therapy. A rate-limiting calcium-channel blocker (such as verapamil hydrochloride p. 175 or diltiazem hydrochloride p. 169) should be considered as an alternative if beta- blockers are contra-indicated, for example in patients with Prinzmetal’s angina or decompensated heart failure. Dihydropyridine derivative calcium-channel blockers (such as amlodipine p. 168) may be effective in patients with Prinzmetal’s angina. If a beta-blocker alone fails to control symptoms adequately, a combination of a beta-blocker and a calcium- channel blocker should be considered. If this combination is not appropriate due to intolerance of, or contra-indication to, either beta-blockers or calcium-channel blockers, NICE CG126 recommends to consider addition of either a long- acting nitrate, ivabradine p. 225, nicorandil p. 225, or ranolazine p. 224. A long-acting nitrate, ivabradine p. 225, nicorandil p. 225, or ranolazine p. 224, should also be considered as monotherapy in patients who cannot tolerate beta-blockers and calcium-channel blockers, if both are contra-indicated, or when they both fail to adequately control angina symptoms. Response to treatment should be assessed every 2–4 weeks following initiation or change of drug therapy; drug doses should be titrated to the maximum tolerated effective dose. If a combination of two drugs at a maximum therapeutic dose fails to control angina symptoms, patients should be considered for referral to a specialist. h Secondary prevention of cardiovascular events All patients with angina are assumed to be at high-risk for cardiovascular events. The occurrence of cardiovascular events can be prevented by management of cardiovascular risk factors through lifestyle changes (such as smoking cessation, weight management, increased physical activity), psychological support, and drug treatment. g All patients with stable angina due to atherosclerotic disease should be given long-term treatment with low-dose aspirin p. 130 and a statin. Treatment with an ACE inhibitor should also be considered, particularly if the patient has diabetes. h See also Secondary prevention in Cardiovascular disease risk assessment and prevention p. 201 for further information. Non-drug treatment g Revascularisation by coronary artery bypass graft or percutaneous coronary intervention should be considered for patients with stable angina who remain symptomatic whilst on optimal drug therapy. h See also Antiplatelet drugs and coronary stents in Antiplatelet drugs p. 129. Advanced Pharmacy Services Patients with stable angina may be eligible for the New Medicines Service / Medicines Use Review service provided by a community pharmacist. For further information, see Advanced Pharmacy Services in Medicines optimisation p. 18. Useful Resources Management of stable angina. Scottish Intercollegiate Guidelines Network. A national clinical guideline 151. April 2018. www.sign.ac.uk/assets/sign151.pdf Stable angina: management. National Institute for Health and Care Excellence. Clinical guideline 126. July 2011 (updated August 2016). www.nice.org.uk/guidance/cg126 Other drugs used for Myocardial ischaemia Acebutolol, p. 163. Bivalirudin, p. 145. Carvedilol, p. 160. Felodipine, p. 171. Fondaparinux sodium, p. 136. Nadolol, p. 161. Nicardipine hydrochloride, p. 173. Nifedipine, p. 174. Pindolol, p. 161. Timolol maleate, p. 163 ANTITHROMBOTIC DRUGS › ANTIPLATELET DRUGS
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Manufacturer advises patients should immediately report any signs of bleeding, neck stiffness, or atypical severe headache. Missed doses Manufacturer advises if a dose is more than 48 hours late, the missed dose should be omitted and the next dose given at the normal time.
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Initially 285 mg once weekly for 3 months, then
First-line fragment. Read the complete Indications and Dose section above.
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