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Ponatinib (Oral route)

Pronunciation:

poe-NA-ti-nib

Brand Names:

  • Iclusig

Dosage Forms:

  • Tablet

Warnings:

Oral route(Tablet)

Arterial and venous thrombosis and occlusions have occurred in at least 27% of ponatinib hydrochloride-treated patients, including fatal myocardial infarction, stroke, stenosis of large arterial vessels of the brain, severe peripheral vascular disease, and the need for urgent revascularization procedures. Patients experienced these events with and without cardiovascular risk factors, including patients less than 50 years of age. Monitor for evidence of thromboembolism and vascular occlusion; interrupt or stop ponatinib hydrochloride immediately for vascular occlusion. Heart failure, including fatalities, occurred in 8% of ponatinib hydrochloride-treated patients. Monitor cardiac function; interrupt or stop ponatinib hydrochloride for new or worsening heart failure. Hepatotoxicity, liver failure, and death have occurred with ponatinib hydrochloride treatment. Monitor hepatic function; interruption may be necessary if hepatotoxicity is suspected .

Classifications:

Pharmacologic—

Tyrosine Kinase Inhibitor

Uses of This Medicine:

Ponatinib is used to treat chronic myeloid leukemia (CML) or Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) after other medicines did not work well. Leukemia is a type of cancer where the body makes abnormal white blood cells.

Ponatinib is an antineoplastic (cancer) medicine. It interferes with the growth of cancer cells, which are eventually destroyed by the body. Since the growth of normal cells may also be affected by ponatinib, other side effects can occur. Before you begin treatment, talk to your doctor about the benefits of this medicine as well as the possible risks of using it.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of ponatinib in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of ponatinib in the elderly. However, elderly patients are more likely to have unwanted effects (eg, decreased appetite, extra fluid, muscle spasms, trouble breathing), which may require caution and an adjustment in the dose for patients receiving ponatinib.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersDStudies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aprepitant
  • Atazanavir
  • Boceprevir
  • Carbamazepine
  • Ceritinib
  • Clarithromycin
  • Cobicistat
  • Conivaptan
  • Crizotinib
  • Dabrafenib
  • Efavirenz
  • Enzalutamide
  • Eslicarbazepine Acetate
  • Fosaprepitant
  • Fosphenytoin
  • Idelalisib
  • Indinavir
  • Itraconazole
  • Ketoconazole
  • Lopinavir
  • Mitotane
  • Nefazodone
  • Nelfinavir
  • Phenobarbital
  • Phenytoin
  • Piperaquine
  • Posaconazole
  • Primidone
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Ritonavir
  • Saquinavir
  • Siltuximab
  • St John's Wort
  • Telaprevir
  • Telithromycin
  • Tipranavir
  • Voriconazole

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Grapefruit Juice

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse, history of or
  • Anemia (low red blood cells) or
  • Bleeding problems or
  • Blood clotting problems or
  • Congestive heart failure or
  • Heart rhythm problems (eg, arrhythmia) or
  • Hypertension (high blood pressure) or
  • Hyperuricemia (high uric acid in the blood) or
  • Liver disease or
  • Neutropenia (low white blood cells) or
  • Pancreatitis, history of or
  • Stomach or bowel problems (eg, perforation) or
  • Thrombocytopenia (low platelets in the blood)—Use with caution. May make these conditions worse.
  • Diabetes or
  • Heart attack, history of or
  • Heart or blood vessel disease or
  • Hyperlipidemia (high cholesterol or fats in the blood) or
  • Stroke, history of—May cause side effects to become worse.
  • Lactose intolerance (stomach problem)—The tablet contains lactose, which can make this condition worse.

Proper Use of This Medicine:

Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance for unwanted effects.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

Take this medicine with or without food. Swallow the tablet whole. Do not crush, break, chew, or dissolve it.

Do not eat grapefruit or drink grapefruit juice while you are using this medicine. Grapefruit and grapefruit juice may cause the blood levels of this medicine to be higher than normal.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For treatment of leukemia:
      • Adults—At first, 45 milligrams (mg) once a day. Your doctor may adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. Use a highly effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

This medicine may cause blood clotting problems. Check with your doctor right away if you have chest pain, numbness or weakness in your arm, leg, or on one side of your body, trouble breathing, speech problems, or leg pain or swelling.

Check with your doctor right away if you have stomach pain, pale stools or dark urine, a loss of appetite, or yellow eyes or skin. These could be symptoms of a serious liver problem.

This medicine may cause fluid retention and heart failure. Check with your doctor if you are rapidly gaining weight, have chest pain or discomfort, extreme tiredness or weakness, trouble breathing, or swelling of the hands, wrist, ankles, or feet. These may be symptoms of heart problems or too much water in your body.

Pancreatitis may occur with this medicine. Tell your doctor right away if you have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness.

Check with your doctor immediately if you have vision changes, such as blurred vision, difficulty reading, or eye pain, dryness, irritation, or swelling, during treatment. Your doctor may want you to have your eyes checked by an eye doctor.

Check with your doctor right away if you are having decreased or increased sensitivity to pain or touch, or burning, numbness, tingling, or painful sensations in the arms, hands, legs, or feet. These could be symptoms of a nerve problem (eg, cranial or peripheral neuropathy).

Ponatinib can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

This medicine may cause a serious type of reaction called tumor lysis syndrome. Your doctor may give you a medicine to help prevent this. Call your doctor right away if you have a decrease or change in urine amount, joint pain, stiffness, or swelling, lower back, side, or stomach pain, a rapid weight gain, swelling of the feet or lower legs, or unusual tiredness or weakness.

This medicine may affect the way your body heals from cuts and wounds. Make sure any doctor who treats you knows that you are using this medicine. You might need to stop using this medicine several weeks before having surgery. If you have questions about this, talk to your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
Bladder pain
bleeding gums
bloating or swelling of the face, arms, hands, lower legs, or feet
blurred vision
chest pain
chills
cloudy urine
confusion
constipation
cough or hoarseness
coughing up blood
decreased urine output
difficult, burning, or painful urination
difficulty with breathing or swallowing
dilated neck veins
dizziness
extreme fatigue
fainting
frequent urge to urinate
increased menstrual flow or vaginal bleeding
indigestion
irregular breathing
joint pain, stiffness, or swelling
lightheadedness
lower back, side, or stomach pain
nervousness
nosebleeds
pains in the chest, groin, or legs, especially calves of the legs
pains in the stomach, side, or abdomen, possibly radiating to the back
pale skin
paralysis
pinpoint red spots on the skin
pounding in the ears
prolonged bleeding from cuts
rapid weight gain
rapid, shallow breathing
red or black, tarry stools
red or dark brown urine
severe headaches of sudden onset
slow or fast heartbeat
sore throat
sudden loss of coordination
sudden shortness of breath
sudden slurred speech
sudden vision changes
tingling of the hands or feet
ulcers, sores, or white spots in the mouth
unusual bleeding or bruising
unusual weight gain or loss
Less common
Anxiety
burning, numbness, tingling, or painful sensations
chest pain or discomfort
fast, pounding, or irregular heartbeat or pulse
pain, redness, or swelling in the arms or legs
sudden shortness of breath
unsteadiness or awkwardness
weakness in the arms, hands, legs, or feet
Incidence not known
Abdominal or stomach cramps or tenderness
blue-green halos seen around objects
clay-colored stools
dark urine
decreased appetite
diarrhea
dry eyes
fever
headache
itching or skin rash
loss of appetite
nausea and vomiting
sensitivity of the eyes to light
severe vomiting, sometimes with blood
unusual tiredness or weakness
yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Back or bone pain
cracked lips
difficulty having a bowel movement (stool)
difficulty with moving
dry skin
itching, pain, redness, swelling, tenderness, or warmth on the skin
lack or loss of strength
muscle aches
muscle pain or stiffness
sore throat
stuffy or runny nose
trouble sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 11/4/2014

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