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Fabhalta
iptacopan
Black Box Warnings .
Appropriate Use
restricted distribution program (FABHALTA REMS) due to risk of serious infections caused by encapsulated bacterial; prescribers and pharmacies must be certified and enroll at 1-833-993-2242 or www.FABHALTA-REMS.com
Serious Infections
may occur, esp. those caused by encapsulated bacteria, such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type B; life-threatening and fatal cases have occurred w/ complement inhibitors; may become rapidly life-threatening or fatal if not recognized and treated early; complete or update vaccination for encapsulated bacteria at least 2wk before tx start, unless tx delay risks outweigh serious infection risk; give antibacterial prophylaxis if urgent tx indicated in pt not up to date w/ vaccines, and admin. vaccines ASAP; comply w/ ACIP recommendations for vaccinations against encapsulated bacteria in pts receiving a complement inhibitor; revaccinate per ACIP recommendations, considering tx duration; pts at incr. risk for invasive dz caused by encapsulated bacteria even if antibodies developed after vaccination; monitor for early signs of serious infection and eval. immediately if infection suspected
Adult Dosing .
Dosage forms: CAP: 200 mg
Restricted Distribution in US
- [1-833-993-2242 or www.FABHALTA-REMS.com for more info]
paroxysmal nocturnal hemoglobinuria
- [200 mg PO bid]
- Info: if switching from eculizumab, initiate 1st iptacopan dose w/in 1wk after last eculizumab dose; if switching from ravulizumab, initiate 1st iptacopan dose w/in 6wk after last ravulizumab dose; do not open/crush/chew cap
IgA nephropathy, primary
- [200 mg PO bid]
- Info: for pts w/ rapid progression risk; do not open/crush/chew cap
complement 3 glomerulopathy
- [200 mg PO bid]
- Info: do not open/crush/chew cap
renal dosing
- [see below]
- eGFR >25: no adjustment; eGFR <25: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- Child-Pugh Class C: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- encapsulated bacterial infection, active serious
- N. meningitidis infection, active serious
- Streptococcus pneumoniae infection, active serious
- Haemophilus influenzae infection, active serious
- pts unvaccinated against N. meningitidis
- pts unvaccinated against Streptococcus pneumoniae
- hepatic impairment, Child-Pugh Class C
- avoid: breastfeeding during tx and x5 days after D/C
- caution: systemic infection, active
- caution: upon D/C (paroxysmal nocturnal hemoglobinuria use)
Drug Interactions .
Overview
iptacopan
complement inhibitor
- CYP2C8 substrate
- immunosuppressive effects
Contraindicated
- BCG live intravesical
- talimogene laherparepvec
Avoid/Use Alternative
- cladribine oral
- etrasimod
- gemfibrozil
- natalizumab
- pimecrolimus topical
Monitor/Modify Tx
- carfilzomib
- everolimus
- sipuleucel-T
- temsirolimus
Caution Advised
- abatacept
- abemaciclib
- abrocitinib
- acalabrutinib
- adalimumab
- afamitresgene autoleucel
- aldesleukin
- alemtuzumab
- anakinra
- anifrolumab
- anti-thymocyte globulin
- atidarsagene autotemcel
- avacopan
- axicabtagene ciloleucel
- azacitidine
- azathioprine
- baricitinib
- basiliximab
- beclomethasone inhaled
- beclomethasone nasal
- belatacept
- belimumab
- belinostat
- bendamustine
- betamethasone
- bimekizumab
- blinatumomab
- bortezomib
- brentuximab vedotin
- brexucabtagene autoleucel
- brodalumab
- budesonide
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- busulfan
- cabazitaxel
- canakinumab
- carbamazepine
- carboplatin
- carmustine
- certolizumab pegol
- chlorambucil
- ciltacabtagene autoleucel
- cisplatin
- cladribine injection
- clobetasol ophthalmic
- clofarabine
- copanlisib
- corticotropin
- cortisone
- crovalimab
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- danicopan
- daratumumab
- daunorubicin
- decitabine
- deflazacort
- deucravacitinib
- deuruxolitinib
- dexamethasone
- dexamethasone ophthalmic
- difluprednate ophthalmic
- dimethyl fumarate
- dinutuximab
- diroximel fumarate
- docetaxel
- doxorubicin
- dupilumab
- duvelisib
- eculizumab
- efgartigimod alfa
- elivaldogene autotemcel
- elotuzumab
- elranatamab
- emapalumab
- epcoritamab
- epirubicin
- eribulin
- etanercept
- etoposide
- fingolimod
- floxuridine
- fludarabine
- fludrocortisone
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluorouracil
- fluticasone furoate
- fluticasone propionate
- fruquintinib
- gemcitabine
- gemtuzumab ozogamicin
- glofitamab
- golimumab
- guselkumab
- hydrocortisone
- hydrocortisone ophthalmic
- hydroxyurea
- ibritumomab tiuxetan
- ibrutinib
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- inebilizumab
- infliximab
- inotuzumab ozogamicin
- irinotecan
- isatuximab
- ixabepilone
- ixekizumab
- lebrikizumab
- leflunomide
- lenalidomide
- lifileucel
- lisocabtagene maraleucel
- lomustine
- loncastuximab tesirine
- loteprednol ophthalmic
- lymphocyte immune globulin, anti-thymocyte globulin
- melphalan
- mercaptopurine
- methotrexate
- methylprednisolone
- mirikizumab
- mitoxantrone
- mogamulizumab
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- monomethyl fumarate
- mosunetuzumab
- mycophenolate mofetil
- mycophenolic acid
- nadofaragene firadenovec intravesical
- nelarabine
- obecabtagene autoleucel
- obinutuzumab
- ocrelizumab
- ofatumumab
- omacetaxine mepesuccinate
- oxaliplatin
- ozanimod
- paclitaxel
- panobinostat
- pegcetacoplan
- pentostatin
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- ponatinib
- ponesimod
- pozelimab
- prednisolone
- prednisolone ophthalmic
- prednisone
- procarbazine
- quizartinib
- ravulizumab
- regorafenib
- rifampin
- rilonacept
- risankizumab
- ritlecitinib
- rituximab
- romidepsin
- ropeginterferon alfa-2b
- rozanolixizumab
- ruxolitinib
- ruxolitinib topical
- sarilumab
- satralizumab
- secukinumab
- selinexor
- siltuximab
- siponimod
- sirolimus
- sirolimus albumin-bound
- spesolimab
- sulfasalazine
- sutimlimab
- tacrolimus
- tafasitamab
- talquetamab
- tarlatamab
- teclistamab
- temozolomide
- teplizumab
- teriflunomide
- thioguanine
- thiotepa
- tildrakizumab
- tisagenlecleucel
- tocilizumab
- tofacitinib
- topotecan
- tralokinumab
- triamcinolone
- tuberculin purified protein derivative
- ublituximab
- upadacitinib
- ustekinumab
- vamorolone
- vedolizumab
- venetoclax
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- zanubrutinib
- zilucoplan
Adverse Reactions .
Serious Reactions
- meningococcal infection
- Streptococcus pneumoniae infection
- Haemophilus influenzae infection
- infection, serious
- hyperlipidemia
- thrombocytopenia
- hemolysis upon D/C (paroxysmal nocturnal hemoglobinuria use)
Common Reactions
- viral infection
- headache
- nasopharyngitis
- diarrhea
- abdominal pain
- bacterial infection
- nausea
- arthralgia
- dyslipidemia
- thrombocytopenia
- dizziness
- HTN
- rash
Safety/Monitoring .
Monitoring Parameters
Paroxysmal Nocturnal Hemoglobinuria: lipid panel; s/sx serious infection during tx and x2wk after D/C; Hgb, LDH, s/sx hemolysis for at least 2wk after D/C
IgA Nephropathy and Complement 3 Glomerulopathy: lipid panel; s/sx serious infection during tx and x2wk after D/C
Pregnancy/Lactation .
Pregnancy
Clinical Summary
benefits outweigh risks during pregnancy; inadequate human data available; no known risk of embryo-fetal toxicity based on animal data at 4-6x MRHD
Lactation
Clinical Summary
avoid breastfeeding during tx and x5 days after D/C; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: oxidation, N-dealkylation, O-deethylation, dehydrogenation, glucuronidation; CYP450: 2C8 (primary), 2D6 substrate; UGT: 1A1, 1A3, 1A8 substrate
Excretion: feces 72% (17% unchanged), urine 25% (18% unchanged); Half-life: 25h
Subclass: Complement Inhibitors, Hematologic ; Complement Inhibitors, Nephrological
Mechanism of Action
in paroxysmal nocturnal hemoglobinuria: binds alternative complement pathway factor B, regulating C3 cleavage and its downstream complement activation cascade, preventing C3b-mediated extravascular hemolysis and terminal complement-mediated intravascular hemolysis; in IgA nephropathy and complement 3 glomerulopathy: binds alternative complement pathway factor B, inhibiting the alternative pathway
Formulary .
No Formulary Selected
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