Inborn errors of metabolism:
Indications for KALYDECO:
Treatment of cystic fibrosis (CF) in patients ≥12mos who have one mutation in the CFTR gene that is responsive to ivacaftor potentiation based on clinical and/or in vitro assay data.
Adults and Children:
<12mos: not recommended. Oral granules should be mixed with 1 tsp (5mL) of soft-food or liquid (eg, yogurt, applesauce, milk, or juice) and completely consumed. Take with fat-containing food (eg, eggs, butter, peanut butter, cheese pizza, dairy products). 12mos–<6yrs: (7–<14kg): 50mg packet every 12hrs; (≥14kg): 75mg packet every 12hrs. ≥6yrs: 150mg tab every 12hrs. Concomitant strong CYP3A inhibitors: 150mg tab or 50mg packet (<14kg) or 75mg packet (≥14kg) twice weekly. Concomitant moderate CYP3A inhibitors: 150mg tab or 50mg packet (<14kg) or 75mg packet (≥14kg) once daily. Moderate hepatic impairment: 150mg tab or 50mg packet (<14kg) or 75mg packet (≥14kg) once daily. Severe hepatic impairment: 150mg tab or 1 packet once daily or less frequently.
If genotype is unknown, use an FDA-cleared CF mutation test to detect the presence of a CFTR mutation followed by verification with bi-directional sequencing when recommended by the mutation test instructions. Assess ALT/AST levels prior to initiating therapy, every 3 months during the first year of treatment, and annually thereafter. History of ALT/AST elevations: monitor LFTs more frequently. If increased ALT/AST levels develop, monitor closely until abnormalities resolved. Interrupt dosing if ALT/AST is >5xULN; after resolution, consider restarting. Perform baseline and follow-up eye exams. Hepatic impairment. Severe renal impairment or ESRD. Pregnancy. Nursing mothers.
Cystic fibrosis transmembrane conductance regulator (CFTR) potentiator.
Concomitant strong CYP3A inducers (eg, rifampin, rifabutin, phenobarbital, carbamazepine, phenytoin, St. John’s Wort): not recommended. Potentiated by strong CYP3A inhibitors (eg, ketoconazole, itraconazole, posaconazole, voriconazole, telithromycin, clarithromycin) and moderate CYP3A inhibitors (eg, fluconazole, erythromycin); see Adults and Children. May be potentiated by grapefruit and Seville oranges; avoid. Potentiates CYP3A and/or P-gp substrates (eg, digoxin, cyclosporine, tacrolimus); monitor.
Headache, oropharyngeal pain, upper respiratory tract infection, nasal congestion, abdominal pain, nasopharyngitis, diarrhea, rash, nausea, dizziness.
Tabs—56, 60; Oral granules—56