Select a medication above to begin.
Iwilfin
eflornithine
Adult Dosing .
Dosage forms: TAB: 192 mg
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments; recalculate dose q3mo based on changes in BSA
high-risk neuroblastoma relapse risk reduction
- [BSA 0.75-1.5 m^2]
- Dose: 576 mg PO bid x2y; Info: for pts w/ at least partial response to prior tx, incl. anti-GD2 immunotherapy
- [BSA >1.5 m^2]
- Dose: 768 mg PO bid x2y; Info: for pts w/ at least partial response to prior tx, incl. anti-GD2 immunotherapy
renal dosing
- [BSA 0.75-1.5 m^2]
- eGFR <30: 384 mg qam, 192 mg qpm; Info: caution advised if eGFR 30-60
- HD/PD: not defined
- [BSA >1.5 m^2]
- eGFR <30: 384 mg bid; Info: caution advised if eGFR 30-60
- HD/PD: not defined
hepatic impairment
- [see below]
- mild impairment: no adjustment; moderate-severe impairment: not defined
Peds Dosing .
- Dosage forms: TAB: 192 mg
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments; recalculate dose q3mo based on changes in BSA
high-risk neuroblastoma relapse risk reduction
- [BSA 0.25-0.49 m^2]
- Dose: 192 mg PO bid x2y; Info: for pts w/ at least partial response to prior tx, incl. anti-GD2 immunotherapy
- [BSA 0.5-0.74 m^2]
- Dose: 384 mg PO bid x2y; Info: for pts w/ at least partial response to prior tx, incl. anti-GD2 immunotherapy
- [BSA 0.75-1.5 m^2]
- Dose: 576 mg PO bid x2y; Info: for pts w/ at least partial response to prior tx, incl. anti-GD2 immunotherapy
- [BSA >1.5 m^2]
- Dose: 768 mg PO bid x2y; Info: for pts w/ at least partial response to prior tx, incl. anti-GD2 immunotherapy
renal dosing
- [BSA 0.25-0.49 m^2]
- eGFR <30: 192 mg qd; Info: caution advised if eGFR 30-60
- HD/PD: not defined
- [BSA 0.5-0.74 m^2]
- eGFR <30: 192 mg bid; Info: caution advised if eGFR 30-60
- HD/PD: not defined
- [BSA 0.75-1.5 m^2]
- eGFR <30: 384 mg qam, 192 mg qpm; Info: caution advised if eGFR 30-60
- HD/PD: not defined
- [BSA >1.5 m^2]
- eGFR <30: 384 mg bid; Info: caution advised if eGFR 30-60
- HD/PD: not defined
hepatic dosing
- [see below]
- mild impairment: no adjustment; moderate-severe impairment: not defined
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- avoid: breastfeeding during tx and x1wk after D/C
- caution: female pts of reproductive potential
- caution: male pts of reproductive potential
- caution: eGFR <60
Drug Interactions .
Overview
eflornithine
ornithine decarboxylase inhibitor
- myelosuppressive oncologic agent
- ototoxicity
Avoid/Use Alternative
- amikacin
- amikacin inhaled
- chloramphenicol
- cladribine oral
- deferiprone
- ethacrynic acid
- fexinidazole
- ganciclovir
- gentamicin
- palifermin
- penicillamine
- plazomicin
- primaquine
- radium Ra 223 dichloride
- ropeginterferon alfa-2b
- streptomycin
- tobramycin
- tobramycin inhaled
- valganciclovir
Monitor/Modify Tx
- albendazole
- alemtuzumab
- allopurinol
- amphotericin
- anti-thymocyte globulin
- asenapine
- atidarsagene autotemcel
- auranofin
- avanafil
- azathioprine
- balsalazide
- baricitinib
- benznidazole
- betibeglogene autotemcel
- bumetanide
- carboplatin
- chloroquine
- cidofovir
- cisplatin
- clozapine
- colchicine
- cyclophosphamide
- dapsone
- deferasirox
- deferoxamine
- deuruxolitinib
- dexrazoxane
- docetaxel
- efbemalenograstim alfa
- eflapegrastim (G-CSF)
- elivaldogene autotemcel
- everolimus
- exagamglogene autotemcel
- fenoprofen
- filgrastim (G-CSF)
- flucytosine
- fludarabine
- fluphenazine
- foscarnet
- fostamatinib
- furosemide
- galsulfase
- givinostat
- hydroxychloroquine
- hydroxyurea
- iloperidone
- interferon beta 1a
- interferon beta 1b
- interferon gamma 1b
- isotretinoin
- itraconazole
- leflunomide
- linezolid
- lonafarnib
- lovotibeglogene autotemcel
- lumateperone
- lymphocyte immune globulin, anti-thymocyte globulin
- mercaptopurine
- mesalamine
- mesalamine rectal
- methotrexate
- mycophenolate mofetil
- mycophenolic acid
- naproxen
- neomycin
- neomycin otic
- olsalazine
- oxaliplatin
- paromomycin
- pegfilgrastim (G-CSF)
- peginterferon alfa 2a
- peginterferon beta 1a
- pentamidine
- proguanil
- pyrimethamine
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- ribavirin
- rifabutin
- rituximab
- ruxolitinib topical
- salsalate
- sargramostim (GM-CSF)
- sarilumab
- satralizumab
- sildenafil
- sirolimus
- stiripentol
- succimer
- sulfasalazine
- tadalafil
- teplizumab
- teprotumumab
- teriflunomide
- thalidomide
- tocilizumab
- tofacitinib
- torsemide
- trimethoprim
- upadacitinib
- valproic acid
- vancomycin
- vardenafil
- vinblastine
- vincristine
- vinorelbine
- zidovudine
Adverse Reactions .
Serious Reactions
- neutropenia
- thrombocytopenia
- anemia
- bone marrow failure
- febrile neutropenia
- skin infection
- hepatotoxicity
- hearing loss
Common Reactions
- otitis media
- diarrhea
- cough
- sinusitis
- pneumonia
- ALT or AST incr.
- URI
- conjunctivitis
- allergic rhinitis
- fever
- vomiting
- hearing loss
- skin infection
- UTI
- rash
- extremity pain
- alopecia
- neutropenia
- anemia
Safety/Monitoring .
Monitoring Parameters
pregnancy test at baseline; CBC w/ diff at baseline and as clinically indicated during tx; LFTs at baseline, qmo x6mo, then q3mo or as clinically indicated; audiogram at baseline, then q6mo or as clinically indicated
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; risk of skeletal variations and decr. fetal wt based on animal data at 0.8-2x recommended human dose, risk of embryo-fetal death at 1-2x or greater recommended human dose
Individuals of Reproductive Potential
obtain pregnancy test before tx start; avoid pregnancy by using effective contraception during tx and x1wk after D/C in female and male pts
Lactation
Clinical Summary
avoid breastfeeding during tx and x1wk after D/C; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: unknown; CYP450: unknown
Excretion: unknown; Half-life: 3.5h
Subclass: Ornithine Decarboxylase Inhibitors
Mechanism of Action
irreversibly inhibits ornithine decarboxylase, decreasing polyamines biosynthesis, exerting cytostatic effects in neuroblastoma cells by inducing G1 arrest and suppressing neurosphere formation
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.