Inborn errors of metabolism:
Indications for TRIKAFTA:
Treatment of cystic fibrosis (CF) in patients ≥12yrs who have at least one F508del mutation in the CFTR gene.
Swallow whole. Take with fat-containing food (eg, eggs, cheeses, nuts, whole milk, meats). 2 tabs (100mg/50mg/75mg) in the AM and 1 tab (150mg) in the PM, approx. 12hrs apart. Moderate hepatic impairment (not recommended; if needed, use with caution at reduced dose): 2 tabs (100mg/50mg/75mg) once daily in the AM. Concomitant moderate CYP3A inhibitors: 2 tabs (100mg/50mg/75mg) once daily in the AM alternating with 1 tab (150mg) once daily in the AM. Concomitant strong CYP3A inhibitors: 2 tabs (100mg/50mg/75mg) twice a week in the AM, approx. 3–4 days apart.
<12yrs: not established.
If genotype is unknown, use an FDA-cleared CF mutation test to confirm the presence of at least 1 F508del mutation. Assess ALT/AST and bilirubin levels prior to initiating therapy, every 3 months during the first year of treatment, and annually thereafter. History of hepatobiliary disease or LFT elevations; consider more frequent monitoring. Interrupt dosing and monitor closely if ALT/AST >5×ULN or ALT/AST >3×ULN with bilirubin elevations >2×ULN; after resolution, consider restarting. Moderate hepatic impairment: see Adults and Children. Severe hepatic impairment: avoid. Severe renal impairment or ESRD. Perform baseline and follow-up eye exams. Pregnancy. Nursing mothers.
Cystic fibrosis transmembrane conductance regulator (CFTR) corrector + CFTR potentiator.
Potentiated by strong (eg, ketoconazole, itraconazole, posaconazole, voriconazole, telithromycin, and clarithromycin) or moderate (eg, fluconazole, erythromycin) CYP3A inhibitors; adjust dose (see Adults and Children). Avoid food or drink containing grapefruit. Antagonized by strong CYP3A inducers (eg, rifampin, rifabutin, phenobarbital, carbamazepine, phenytoin, St. John’s wort): avoid concomitant use. Caution with concomitant CYP2C9 substrates (eg, warfarin, glimepiride, glipizide), digoxin or other P-gp substrates with a narrow therapeutic index (eg, cyclosporine, everolimus, sirolimus, tacrolimus), OATP1B1 or OATP1B3 substrates (eg, statins, glyburide, nateglinide, repaglinide): monitor.
Headache, upper respiratory tract infection, abdominal pain, diarrhea, rash, ALT/AST increased, nasal congestion, blood CPK increased, rhinorrhea, rhinitis, influenza, sinusitis, blood bilirubin increased.