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Pulmonary Arterial Hypertension
Tracleer® is indicated for the treatment of pulmonary arterial hypertension (PAH) (WHO Group 1) to improve exercise ability and to decrease clinical worsening. Studies establishing effectiveness included predominantly patients with NYHA Functional Class II-IV symptoms and etiologies of idiopathic or heritable PAH (60%), PAH associated with connective tissue diseases (21%), and PAH associated with congenital heart disease with left-to-right shunts (18%) [see Clinical Studies].
Considerations for use
Patients with WHO Class II symptoms showed reduction in the rate of clinical deterioration and a trend for improvement in walk distance. Physicians should consider whether these benefits are sufficient to offset the risk of hepatotoxicity in WHO Class II patients, which may preclude future use as their disease progresses.
DOSAGE AND ADMINISTRATION
Healthcare professionals who prescribe Tracleer must enroll in the Tracleer Access Program (T.A.P.) and must comply with the required monitoring to minimize the risks associated with Tracleer [see WARNINGS AND PRECAUTIONS].
Initiate treatment at 62.5 mg twice daily for 4 weeks and then increase to the maintenance dose of 125 mg twice daily. Doses above 125 mg twice daily did not appear to confer additional benefit sufficient to offset the increased risk of hepatotoxicity.
Tracleer should be administered in the morning and evening with or without food.
Dosage Adjustments for Patients Developing Aminotransferase Elevations
Measure liver aminotransferase levels prior to initiation of treatment and then monthly. If aminotransferase levels increase, revise the monitoring and treatment plan. The table below summarizes the dosage adjustment and monitoring recommendations for patients who develop aminotransferase elevations > 3 X ULN during therapy with Tracleer. Discontinue Tracleer if liver aminotransferase elevations are accompanied by clinical symptoms of hepatotoxicity (such as nausea, vomiting, fever, abdominal pain, jaundice, or unusual lethargy or fatigue) or increases in bilirubin ≥ 2 x ULN. There is no experience with the reintroduction of Tracleer in these circumstances.
Table 1: Dosage Adjustment and Monitoring in Patients
Developing Aminotransferase Elevations > 3 x ULN
|ALT/AST levels||Treatment and monitoring recommendations|
|> 3 and ≤ 5 x ULN||Confirm by another aminotransferase test; if confirmed, reduce the daily dose to 62.5 mg twice daily or interrupt treatment, and monitor aminotransferase levels at least every 2 weeks. If the aminotransferase levels return to pretreatment values, continue or reintroduce the treatment as appropriate*.|
|> 5 and ≤ 8 x ULN||Confirm by another aminotransferase test; if confirmed, stop treatment and monitor aminotransferase levels at least every 2 weeks. Once the aminotransferase levels return to pretreatment values, consider reintroduction of the treatment*.|
|> 8 x ULN||Treatment should be stopped and reintroduction of Tracleer should not be considered. There is no experience with reintroduction of Tracleer in these circumstances.|
* If Tracleer is re-introduced it should be at the starting dose; aminotransferase levels should be checkedwithin 3 days and thereafter according to the recommendations above.
Patients with Low Body Weight
In patients with a body weight below 40 kg but who are over 12 years of age, the recommended initial and maintenance dose is 62.5 mg twice daily. There is limited information about the safety and efficacy of Tracleer in children between the ages of 12 and 18 years [see Use in Specific Populations].
Use with Ritonavir
Coadministration of Tracleer in Patients on Ritonavir
In patients who have been receiving ritonavir for at least 10 days, start Tracleer at 62.5 mg once daily or every other day based upon individual tolerability [see DRUG INTERACTIONS].
Coadministration of Ritonavir in Patients on Tracleer
Discontinue use of Tracleer at least 36 hours prior to initiation of ritonavir. After at least 10 days following the initiation of ritonavir, resume Tracleer at 62.5 mg once daily or every other day based upon individual tolerability [see DRUG INTERACTIONS].
Use in Patients with Pre-existing Hepatic Impairment
Tracleer should generally be avoided in patients with moderate or severe liver impairment. Initiation of Tracleer should generally be avoided in patients with elevated aminotransferases > 3 x ULN. No dose adjustment is required in patients with mildly impaired liver function [see WARNINGS AND PRECAUTIONS, Use in Specific Populations, CLINICAL PHARMACOLOGY].
There is limited experience with abrupt discontinuation of Tracleer. No evidence for acute rebound has been observed. Nevertheless, to avoid the potential for clinical deterioration, gradual dose reduction (62.5 mg twice daily for 3 to 7 days) should be considered.
Dosage Forms And Strengths
62.5 mg and 125 mg film-coated, tablets for oral administration.
62.5 mg tablets: round, biconvex, orange-white tablets, embossed with identification marking “62,5”
125 mg tablets: oval, biconvex, orange-white tablets, embossed with identification marking “125”
Storage And Handling
62.5 mg film-coated, round, biconvex, orange-white tablets, embossed with identification marking “62,5”, packaged in a white high-density polyethylene bottle and a white polypropylene child-resistant cap or in foil blister-strips for hospital unit-dosing.
NDC 66215-101-06: Bottle containing 60 tablets.
NDC 66215-101-03: Carton of 30 tablets in 10 blister strips of 3 tablets.
125 mg film-coated, oval, biconvex, orange-white tablets, embossed with identification marking “125”, packaged in a white high-density polyethylene bottle and a white polypropylene child-resistant cap or in foil blister-strips for hospital unit-dosing.
NDC 66215-102-06: Bottle containing 60 tablets.
NDC 66215-102-03: Carton of 30 tablets in 10 blister strips of 3 tablets.
Store at 20°C – 25°C (68°F – 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F). [See USP Controlled Room Temperature].
Manufactured for: Actelion Pharmaceuticals US, Inc., South San Francisco, CA 94080, USA. Revised October 2012This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 7/12/2013
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