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Tykerb consist of small molecule and a member of the 4-anilinoquinazoline class of kinase inhibitors. Tykerb tablets are classified as anti-neoplastic agent, which is orally active drug used for treating breast cancer. Tykerb tablets are comes under biological category which is targeted chemotherapy. These drugs work by ‘targeting’ essential proteins (receptors) which make cancer cells grow.
Lapatinib belongs to a type of targeted cancer regimen (biological therapy) called a protein kinase inhibitor (TKI). It is a targeted therapy required for cancers which have large amounts of a protein called HER2 (human epidermal growth factor receptor 2).
Some breast cancers have large amounts of HER2. They are called HER2 positive cancers. HER2 which makes the tumor cells develop and divide. Lapatinib blocks HER2 to make the cells stop developing or die.
The absorption of Tykerb is incomplete and insufficient, the maximum plasma concentration time of Lapatinib occurs relatively 4 hours after drug intake.
The steady state reaches within 6 to 7 days
Lapatinib is highly bounds to human plasma protein like albumin & alpha glycoprotein nearly 99%.
Lapatinib is a substrate of P-gp & BCRP and go through intensive metabolism by using CYPP3A4 & CYP3A5 with lesser contribution of CYP2C19 & CYP2C8.
Tykerb in single dose reaches half- life time in 14.2 hours and repeated dosing reaches in 24 hours. Elimination occurs via feces & urine.
The recommended dose of Tykerb is 1250mg should be administered orally as a single dose on day 1 to 21repeatedly combined with Capecitabine 2000mg/m2/day (should be taken orally in 2 doses relatively 12 hours apart) on day 1 to 14 in continuous 21-day cycle.
Totally 5 tablets of Tykerb should be taken at a time as whole.
The prescribed dose is 1500mg should be administered orally as a single dose by combining with letrozole.
The prescribed dose of letrozole is 2.5mg as a once a day.
In these total 6 tablets of Tykerb should be administered as such.
In patients with reduction of left ventricular ejection fraction with grade 2, treatment with Tykerb should be discontinued. In this condition, the dose of Tykerb should be initiated with 1000mg/day in combination with Capecitabine; whereas in combination with letrozole the dose of Tykerb restated with 1250mg/day after 2 weeks, if LVEF turns to normal.
For patient with severe hepatic impairment, the dose reduced from 1250mg/day to 750mg/day or from 1500mg/day to 1000mg/day.
Tykerb tablets should be restarted once the severity of diarrhea may reduce to grade I. permanently discontinued if diarrhea is persisting.
Tykerb should not be combined with CYP3A4 inhibitors; because of elevation of plasma concentration of Lapatinib occurs. For eradicate this effect, the dose of Tykerb should be reduced to 500mg/day.
In this combinational study, the dose of Tykerb should be elevate from 1250mg/day to 4500mg/day or from 1500mg/day to 5500mg/day.
Postpone or stop the Tykerb therapy may happens, in case of developing higher grade of toxicities which is greater than or equal to grade II.
Tykerb use in combination with Capecitabine should be resume at lower doses 1000mg/day and whereas in combination with letrozole should be resume at lower dose of 1250mg/day.
Tykerb tablets should be taken without food; administer 1 hour earlier or 2 hours after the food uptake.
Capecitabine should be administered with food or taken within 30 minutes after ingestion of food.
A hypersensitivity reaction occurs in patients who are contraindicated to the component present in Tykerb tablet.
Diarrhea: Severe diarrhea may lead to dehydration causes death also; if patient do not recover from this severity must discontinue with this therapy.
Reduction in left ventricular ejection fraction: Caution should be taken while using Tykerb in patient with LVEF
The virulence of LVEF should be decreased within first 12 weeks of treatment
Before starting the therapy with Tykerb, patient must be examining thoroughly if suspected with LVEF or not.
Liver damage: Increasing level of AST, ALT or bilirubin may leads to liver injury
To prevent this condition, periodic LFT should be maintained
Interstitial lung disease: Patient should be monitored with pulmonary symptoms and provide supportive measures.
On severe condition, treatment should be interrupt or discontinue
QT prolongation: Monitor ECG periodically
Provide substituent for this adverse condition
Hypokalemia and hypomagnesemia correction should be takes place
Pregnancy category: D
Tykerb should not be used in pregnancy condition
The potency of Tykerb has not been evaluated in pediatric patients.
In both renal & hepatic impairment patients, caution should be taken while using this medication
Breastfeeding should not be allowed
Tykerb carton should be kept at 25oC (77oF).
Keep the carton free from moisture, heat or light
Missed dose should be skipped and follow the regular dosing schedule for avoiding adverse conditions. If missed dose occurs, it should not be resume and continue the next schedule.
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