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Metvixia (methyl aminolevulinate cream) Cream is intended for topical use in the physician's office by physicians. Metvixia (methyl aminolevulinate cream) Cream has not been studied for more than one course which consists of two treatment sessions one week apart. There is no information available regarding the recurrence rate for lesions treated with this therapy. Clinical studies did not follow patients beyond 3 months, and the recurrence rate of treated lesions is unknown.
During the time period between the application of Metvixia (methyl aminolevulinate cream) Cream and exposure to Aktilite red light illumination, the treatment site will become photosensitive.
If for any reason the patient cannot have the Aktilite red light treatment after application of Metvixia (methyl aminolevulinate cream) Cream, the cream should be rinsed off, and the patient should protect the treated area from sunlight, prolonged or intense light for two days. Prolonged exposure for greater than 4 hours to Metvixia (methyl aminolevulinate cream) Cream should be avoided.
After Metvixia (methyl aminolevulinate cream) Cream application, patients should avoid exposure of the photosensitive treatment sites to sunlight or bright indoor light (e.g., examination lamps, operating room lamps, tanning beds, or lights at close proximity) during the period prior to red light treatment. Exposure to light may result in a stinging and/or burning sensation and may cause erythema and/or edema of the lesions. Before exposure to sunlight, patients should, therefore, protect treated lesions from the sun by wearing a wide-brimmed hat or similar head covering of light-opaque material. Sunscreens will not protect against photosensitivity reactions caused by visible light. The treated site should be protected from extreme cold with adequate clothing or remaining indoors between application of Metvixia (methyl aminolevulinate cream) Cream and Aktilite red light treatment.
After illumination of Metvixia (methyl aminolevulinate cream) Cream, the area treated should be kept covered and away from light for at least 48 hours.
Because of the potential for skin to become photosensitized, the Metvixia (methyl aminolevulinate cream) Cream should be used by a trained physician to apply drug only to non-hyperkeratotic actinic keratoses and perilesional skin within 5 mm of the lesion. Redness, swelling, burning, and stinging are expected as a result of therapy; however, if these symptoms increase in severity and persist longer than 3 weeks, the patient should contact their doctor.
Metvixia (methyl aminolevulinate cream) Cream has demonstrated a high rate of contact sensitization (allergenicity) [See ADVERSE REACTIONS]. Care should be taken by the physician applying Metvixia (methyl aminolevulinate cream) Cream to avoid inadvertent skin contact. Nitrile gloves should be worn when applying and removing the cream. Vinyl and latex gloves do not provide adequate protection when using this product.
Metvixia (methyl aminolevulinate cream) Cream is formulated with refined peanut and almond oil.
Metvixia (methyl aminolevulinate cream) Cream has not been tested in patients who are allergic to peanuts.
Metvixia (methyl aminolevulinate cream) Cream has not been tested on patients with inherited or acquired coagulation defects.
Before operating the Aktilite CL128 lamp, personnel should refer to the Operators Manual for specific warnings, cautions and instructions. Care should be exercised when positioning and operating the lamp. During the red light illumination period, the patient, operator and other persons present should wear protective goggles that sufficiently screen out the appropriate spectrum of red light. The protective goggles or eye shields provided for the patient are dark or of metal to block visible light. The green professional protective glasses provided for the operator screen out the relevant spectrum of red light and the room will still appear bright for the operator to see. Do not stare into the beam.
For lamp assembly, maintenance, service and technical data the personnel should refer to the Operators Manual.
Patient Counseling Information
The physician should provide and discuss the attached Patient Package Insert with each patient.
Carcinogenesis, Mutagenesis and Impairment of Fertility
Long-term studies to evaluate the carcinogenic potential of Metvixia Cream have not been performed.
Methyl aminolevulinate was negative for genetic toxicity in the Ames assay, and the chromosomal aberration assay in Chinese hamster ovary cells, tested with and without metabolic activation and in the presence and absence of light. Methyl aminolevulinate was also negative in the in vivo micronucleus assay in the rat. In contrast, at least one report in the literature has noted genotoxic effects in cultured rat hepatocytes after aminolevulinate (ALA) exposure with PpIX formation. Other studies have documented oxidative DNA damage in vivo and in vitro as a result of ALA exposure.
A fertility study was performed in male and female rats with intravenous doses of methyl aminolevulinate hydrochloride up to 500 mg/kg/day (3000 mg/m², 1158 times the MTHD based on mg/m² comparisons and an estimated maximum systemic uptake of 1%). Males were treated for 4 weeks prior to mating and for 5 additional weeks after mating. The females were treated for 2 weeks prior to mating and then until Day 6 of gestation. There were no treatment-related effects on fertility and mating performance seen in this study.
Use In Specific Populations
Teratogenic effects: Pregnancy Category C
There are no adequate and well-controlled studies with Metvixia (methyl aminolevulinate cream) Cream in pregnant women. Intravenous methyl aminolevulinate hydrochloride (HCl) was teratogenic in rabbits at a high dose. Metvixia (methyl aminolevulinate cream) cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
A Maximum Topical Human Dose (MTHD) of 2 g of Metvixia Cream 16.8% containing 420 mg methyl aminolevulinate hydrochloride corresponding to 7 mg/kg or 259 mg/m² for a 60 kg patient and an estimated maximum systemic uptake of 1% was used for the animal multiple of human systemic exposure calculations presented in this labeling.
In development toxicity studies, pregnant rabbits received intravenous doses of methyl aminolevulinate hydrochloride up to 926 times the MTHD on Days 6 to 18 of gestation. Slightly lower fetal body weights and increased incidences of fetuses with jugals connected/fused to maxilla, supernumerary ribs, incompletely ossified cranial bones and other ossification irregularities were noted in the high dose (926 times the MTHD) group, compared to the control group. The embryo-fetal effects in the high dose group were associated with maternal toxicity. These effects did not occur at 463 times the MTHD based on mg/m² comparisons and an estimated maximum systemic uptake of 1%. Developmental toxicity studies in rats were negative at daily exposure levels up to 1622 times the MTHD on a mg/m² basis.
In the prenatal and postnatal development toxicity study, pregnant rats received intravenous doses of methyl aminolevulinate hydrochloride up to 1160 X the MTHD from Day 6 of gestation to Day 24 of lactation. There were no treatment-related effects on litter size, pup mortality, pup weights, or post weaning performance in the pups (including development and reproduction). A slightly longer duration of gestation and a slight delay in pup physical development were noted in the 580-1160 X the MTHD groups. (see Nonclinical Toxicology)
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Metvixia (methyl aminolevulinate cream) Cream is administered to a nursing woman.
Actinic keratosis is not a condition generally seen within the pediatric population. The safety and effectiveness in pediatric patients below the age of 18 have not been established.
Of the 211 subjects in the clinical studies with Metvixia (methyl aminolevulinate cream) -PDT, 136 subjects were 65 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients , but greater sensitivity of some older individuals cannot be ruled out.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 8/4/2008
Additional Metvixia Information
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