Medical Editor: John P. Cunha, DO, FACOEP
What Is Orladeyo?
Orladeyo (berotralstat) is a plasma kallikrein inhibitor indicated for prophylaxis to prevent attacks of hereditary angioedema (HAE) in adults and pediatric patients 12 years and older.
What Are Side Effects of Orladeyo?
Side effects of Orladeyo include:
- abdominal pain,
- vomiting,
- diarrhea,
- back pain, and
- gastroesophageal reflux disease (GERD).
Dosage for Orladeyo
The recommended dosage of Orladeyo is one capsule (150 mg) taken orally once daily with food.
Orladeyo In Children
The safety and effectiveness of Orladeyo for prophylaxis to prevent attacks of hereditary angioedema have been established in pediatric patients aged 12 and older.
The safety and effectiveness of Orladeyo in pediatric patients under 12 years of age have not been established.
What Drugs, Substances, or Supplements Interact with Orladeyo?
Orladeyo may interact with other medicines such as:
- P-gp or BCRP inhibitors (e.g., cyclosporine),
- P-gp inducers (e.g., rifampin, St. John's wort),
- P- gp substrates (e.g., digoxin),
- CYP2D6 substrates (e.g., thioridazine, pimozide), and
- CYP3A4 substrates (e.g., cyclosporine, fentanyl)
Orladeyo During Pregnancy and Breastfeeding
Tell your doctor if you are pregnant or plan to become pregnant before using Orladeyo; it is unknown how it would affect a fetus. It is unknown if Orladeyo passes into breast milk. Consult your doctor before breastfeeding.
Additional Information
Our Orladeyo (berotralstat) Capsules, for Oral Use Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
SIDE EFFECTS
The following clinically significant adverse reaction is described elsewhere in the labeling:
- QT Prolongation [see WARNINGS AND PRECAUTIONS]
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The safety of ORLADEYO is primarily based on 24-week (Part 1) data from a 3-part, double-blind, parallel-group, and placebo-controlled study (Trial 1) in 120 patients with Type I or II HAE randomized and dosed with either ORLADEYO 110 mg, 150 mg or placebo, once daily with food. After Week 24, patients who continued in the study received active treatment through 48 weeks.
In Trial 1, a total of 81 patients aged 12 years and older with HAE received at least one dose of ORLADEYO in Part 1. Overall, 66% of patients were female and 93% of patients were Caucasian with a mean age of 41.6 years. The proportion of patients who discontinued study drug prematurely due to adverse reactions was 7% and 3% for patients treated with 110 mg and 150 mg ORLADEYO, respectively, and 3% for placebo-treated patients. No deaths occurred in the trial.
The safety profile of ORLADEYO was generally similar across all subgroups of patients, including analysis by age, sex, and geographic region.
Table 1 shows adverse reactions occurring in ≥10% of patients in any ORLADEYO treatment group that also occurred at a higher rate than in the placebo treatment group in Trial 1.
Table 1: Adverse Reactions Observed in ≥10% of Patients in any ORLADEYO Treatment Group (Trial 1)
| Adverse Reaction | Placebo (N=39) | ORLADEYO | ||
| 110 mg (N=41) | 150 mg (N=40) | Total (N=81) | ||
| n (%) | n (%) | n (%) | n (%) | |
| Abdominal Pain* | 4 (10) | 4 (10) | 9 (23) | 13 (16) |
| Vomiting | 1 (3) | 4 (10) | 6 (15) | 10 (12) |
| Diarrhea†| 0 | 4 (10) | 6 (15) | 10 (12) |
| Back Pain | 1 (3) | 1 (2) | 4 (10) | 5 (6) |
| Gastroesophageal Reflux Disease | 0 | 4 (10) | 2 (5) | 6 (7) |
| * includes Abdominal pain, Abdominal discomfort, Abdominal pain upper, and Abdominal tenderness †includes Diarrhea and Frequent bowel movements | ||||
Gastrointestinal reactions, including abdominal pain, vomiting, and diarrhea occurred more frequently in patients receiving ORLADEYO 150 mg versus ORLADEYO 110 mg or placebo. These reactions generally occurred early after initiation of treatment with ORLADEYO, became less frequent with time, and typically self-resolved. No patients in the ORLADEYO 150 mg dose group and 1 patient in the ORLADEYO 110 mg dose group discontinued treatment due to a gastrointestinal adverse reaction.
Less Common Adverse Reactions
Other adverse reactions that occurred in Part 1 of Trial 1 with an incidence between 5% and <10% at a higher incidence in ORLADEYO-treated patients compared to placebo included headache (9% versus 5%), fatigue (6% versus 3%), and flatulence (6% versus 3%).
A maculopapular drug rash was reported in less than 1% of patients treated with ORLADEYO. The rash resolved, including in subjects who continued dosing.
Safety data are also available from 227 patients enrolled in an ongoing, open-label, long-term safety study (Trial 2) who received ORLADEYO 110 mg (N=100) or 150 mg (N=127) once daily with food and are consistent with the 24-week controlled safety data from Trial 1 (Part 1).
Laboratory Abnormalities
Transaminase Elevations
In Part 1 of Trial 1, a single 150 mg ORLADEYO-treated patient discontinued treatment due to asymptomatic elevated transaminases (ALT >8x the upper limit of normal [ULN] and AST >3x ULN). Total bilirubin was normal. No subject receiving 110 mg or placebo developed transaminase levels >3x ULN. In addition to this patient, 2 ORLADEYO-treated patients developed laboratory-related hepatic adverse events compared to 1 placebo-treated patient. No patient reported serious adverse reactions of elevated transaminases.
Read the entire FDA prescribing information for Orladeyo (Berotralstat Capsules)