Zytiga 500mg Uses

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What is Zytiga 500mg?

Note: Women of childbearing potential should not use or handle Zytiga 500mg tablets without protection (e.g., gloves).

Zytiga 500mg is used in combination with prednisone to treat patients with metastatic castration-resistant prostate cancer (prostate cancer that is resistant to medical or surgical treatments that lower testosterone and has already spread to other parts of the body). Zytiga 500mg is used in patients who have received cancer treatments, such as docetaxel.

Zytiga 500mg is available only with your doctor's prescription.

Zytiga 500mg indications

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Zytiga 500mg is indicated with prednisone or prednisolone for the treatment of metastatic castration resistant prostate cancer in adult men who are asymptomatic or mildly symptomatic after failure of androgen deprivation therapy in whom chemotherapy is not yet clinically indicated; the treatment of metastatic castration resistant prostate cancer in adult men whose disease has progressed on or after a docetaxel-based chemotherapy regimen.

How should I use Zytiga 500mg?

Use Zytiga 500mg as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Zytiga 500mg.

Uses of Zytiga 500mg in details

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This medication is used along with prednisone to treat men with prostate cancer that has spread to other areas of the body and has not responded to surgical treatment that lowers testosterone levels. Zytiga 500mg belongs to a class of drugs known as anti-androgens (anti-testosterone). Testosterone, a natural hormone, helps prostate cancer to grow and spread. Zytiga 500mg works by blocking the production of testosterone, thereby slowing the growth and spread of prostate cancer.

This medication should not be given to women or children.

How to use Zytiga 500mg

Read the Patient Information Leaflet if available from your pharmacist before you start taking Zytiga 500mg and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth on an empty stomach, as directed by your doctor, usually once daily. Do not eat for at least 2 hours before and 1 hour after taking Zytiga 500mg. Taking Zytiga 500mg with food greatly increases the amount of this drug in your body and increases the risk of side effects.

Swallow whole. Do not crush or chew before swallowing. Pregnant women should wear gloves if handling the tablets. If the tablet is crushed or broken, women who are pregnant or who may become pregnant should not handle it or breathe the dust from it.

The dosage is based on your medical condition, lab results, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Do not stop any medications for your prostate cancer unless told to do so by your doctor. Stopping your medications could allow the cancer to spread more rapidly.

Tell your doctor if your condition persists or worsens (such as urination becomes more difficult, bone pain increases).

Zytiga 500mg description

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Zytiga 500mg is a derivative of steroidal progesterone and is an innovative drug that offers clinical benefit to patients with hormone refractory prostate cancer. Zytiga 500mg is administered as an acetate salt prodrug because it has a higher bioavailability and less susceptible to hydrolysis than Zytiga 500mg itself. FDA approved on April 28, 2011.

Zytiga 500mg dosage

Zytiga 500mg Dosage

Generic name: Zytiga 500mg ACETATE 125mg

Dosage form: tablet

Medically reviewed on June 5, 2018.

Recommended Dosage

The recommended dose of Zytiga 500mg is 500 mg (four 125 mg tablets) administered orally once daily in combination with methylprednisolone 4 mg administered orally twice daily.

Important Administration Instructions

To avoid medication errors and overdose, be aware that Zytiga 500mg (Zytiga 500mg acetate) tablets may have different dosing and food effects than other Zytiga 500mg acetate products. Patients receiving Zytiga 500mg should also receive a gonadotropin-releasing hormone (GnRH) analog concurrently or should have had bilateral orchiectomy.

Zytiga 500mg tablets can be taken with or without food. The tablets should be swallowed whole with water. Do not crush or chew tablets.

Dose Modification Guidelines in Hepatic Impairment and Hepatotoxicity

Hepatic Impairment

In patients with baseline moderate hepatic impairment (Child-Pugh Class B), reduce the recommended dose of Zytiga 500mg to 125 mg once daily. In patients with moderate hepatic impairment monitor ALT, AST, and bilirubin prior to the start of treatment, every week for the first month, every two weeks for the following two months of treatment and monthly thereafter. If elevations in ALT and/or AST greater than 5X upper limit of normal (ULN) or total bilirubin greater than 3X ULN occur in patients with baseline moderate hepatic impairment, discontinue Zytiga 500mg and do not re-treat patients with Zytiga 500mg acetate.

Do not use Zytiga 500mg in patients with baseline severe hepatic impairment (Child-Pugh Class C).

Hepatotoxicity

For patients who develop hepatotoxicity during treatment with Zytiga 500mg (ALT and/or AST greater than 5X ULN or total bilirubin greater than 3X ULN), interrupt treatment with Zytiga 500mg. Treatment may be restarted at a reduced dose of 375 mg once daily following return of liver function tests to the patient’s baseline or to AST and ALT less than or equal to 2.5X ULN and total bilirubin less than or equal to 1.5X ULN. For patients who resume treatment, monitor serum transaminases and bilirubin at a minimum of every two weeks for three months and monthly thereafter.

If hepatotoxicity recurs at the dose of 375 mg once daily, re-treatment may be restarted at a reduced dose of 250 mg once daily following return of liver function tests to the patient’s baseline or to AST and ALT less than or equal to 2.5X ULN and total bilirubin less than or equal to 1.5X ULN.

If hepatotoxicity recurs at the reduced dose of 250 mg once daily, discontinue treatment with Zytiga 500mg acetate.

Permanently discontinue Zytiga 500mg for patients who develop a concurrent elevation of ALT greater than 3 x ULN and total bilirubin greater than 2 x ULN in the absence of biliary obstruction or other causes responsible for the concurrent elevation.

Dose Modification Guidelines for Strong CYP3A4 Inducers

Avoid concomitant strong CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital) during Zytiga 500mg treatment.

If a strong CYP3A4 inducer must be co-administered, increase the Zytiga 500mg dosing frequency to twice a day only during the co-administration period (e.g., from 500 mg once daily to 500 mg twice a day). Reduce the dose back to the previous dose and frequency, if the concomitant strong CYP3A4 inducer is discontinued.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

More about Zytiga 500mg (Zytiga 500mg)

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Zytiga 500mg interactions

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What other drugs will affect Zytiga 500mg?

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Drugs That Inhibit Or Induce CYP3A4 Enzymes

Based on in vitro data, Zytiga 500mg is a substrate of CYP3A4.

In a dedicated drug interaction trial, co-administration of rifampin, a strong CYP3A4 inducer, decreased exposure of Zytiga 500mg by 55%. Avoid concomitant strong CYP3A4 inducers during Zytiga 500mg treatment. If a strong CYP3A4 inducer must be co-administered, increase the Zytiga 500mg dosing frequency.

In a dedicated drug interaction trial, co-administration of ketoconazole, a strong inhibitor of CYP3A4, had no clinically meaningful effect on the pharmacokinetics of Zytiga 500mg.

Effects Of Zytiga 500mg On Drug Metabolizing Enzymes

Zytiga 500mg is an inhibitor of the hepatic drug-metabolizing enzymes CYP2D6 and CYP2C8. In a CYP2D6 drug-drug interaction trial, the Cmax and AUC of dextromethorphan (CYP2D6 substrate) were increased 2.8-and 2.9-fold, respectively, when dextromethorphan was given with Zytiga 500mg acetate 1,000 mg daily and prednisone 5 mg twice daily. Avoid co-administration of Zytiga 500mg acetate with substrates of CYP2D6 with a narrow therapeutic index (e.g., thioridazine). If alternative treatments cannot be used, exercise caution and consider a dose reduction of the concomitant CYP2D6 substrate drug.

In a CYP2C8 drug-drug interaction trial in healthy subjects, the AUC of pioglitazone (CYP2C8 substrate) was increased by 46% when pioglitazone was given together with a single dose of 1,000 mg Zytiga 500mg acetate. Therefore, patients should be monitored closely for signs of toxicity related to a CYP2C8 substrate with a narrow therapeutic index if used concomitantly with Zytiga 500mg.

Zytiga 500mg side effects

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What are the possible side effects of Zytiga 500mg?

The most common adverse reactions seen with Zytiga 500mg are peripheral edema, hypokalemia, urinary tract infection and hypertension.

Zytiga 500mg may cause hypertension, hypokalemia and fluid retention as a pharmacodynamic consequence of its mechanism of action. In a phase 3 study anticipated mineralocorticoid effects were seen more commonly in patients treated with Zytiga 500mg versus patients treated with placebo: Hypokalemia 21% versus 11%, hypertension 16% versus 11% and fluid retention (peripheral edema) 26% versus 20%, respectively. In patients treated with Zytiga 500mg, grades 3 and 4 hypokalemia and grades 3 and 4 hypertension were observed in 4% and 2% of patients, respectively. Mineralocorticoid effects generally were able to be successfully managed medically. Concomitant use of a corticosteroid reduces the incidence and severity of these adverse drug reactions.

In studies of patients with metastatic advanced prostate cancer who were using a LHRH agonist, or were previously treated with orchiectomy, Zytiga 500mg was administered at a dose of 1 g daily in combination with low-dose prednisone or prednisolone (10 mg daily). Patients were intolerant to or had failed up to 2 prior chemotherapy regimens, 1 of which contained a taxane.

Adverse drug reactions due to Zytiga 500mg that occurred at a rate of ≥1% (all grades) are shown in Table 4.

The adverse drug reaction, adrenal insufficiency, occurred in the phase 3 clinical study at a rate of <0.5 % in taking Zytiga 500mg and at a rate of 0.2% in patients taking placebo.

Cardiovascular Effects: Both phase 3 studies excluded patients with uncontrolled hypertension, clinically significant heart disease as evidenced by myocardial infarction, arterial thrombotic events in the past 6 months, severe or unstable angina, NYHA class III or IV heart disease (study 301) or class II to IV heart failure (study 302) or cardiac ejection fraction measurement of <50%. All patients enrolled (both active and placebo-treated patients) were concomitantly treated with androgen deprivation therapy, predominantly with the use of LHRH agonists, which has been associated with diabetes, myocardial infarction, cerebrovascular accident and sudden cardiac death. The incidence of cardiovascular adverse reactions in the phase 3 studies in patients taking Zytiga 500mg versus patients taking placebo were as follows: Atrial fibrillation 3.4% versus 3.4%, tachycardia 2.7% versus 1.7%, angina pectoris 1.9% versus 0.9%, cardiac failure 1.9% versus 0.6% and arrhythmia 1.1% versus 0.4%.

Hepatotoxicity: Drug-associated hepatotoxicity with elevated ALT, aspartate transaminase (AST) and total bilirubin has been reported in patients treated with Zytiga 500mg. Across all clinical studies, liver function test elevations (ALT or AST increases of >5 times ULN or bilirubin increases >1.5 times ULN) were reported in approximately 4% of patients who received Zytiga 500mg, typically during the first 3 months after starting treatment. In the 301 clinical study, patients whose baseline ALT or AST was elevated were more likely to experience liver function test elevations than those beginning with normal values. When elevations of either ALT or AST >5 times ULN, or elevations in bilirubin >3 times ULN were observed, Zytiga 500mg was withheld or discontinued. In 2 instances marked increases in liver function tests occurred. These 2 patients with normal baseline hepatic function, experienced ALT or AST elevations >5 times ULN or elevations in bilirubin >3 times ULN were observed, Zytiga 500mg was withheld or discontinued. In 2 instances marked increases in liver function tests occurred. These 2 patients with normal baseline hepatic function, experienced ALT or AST elevations 15-40 times ULN and bilirubin elevations 2-6 times ULN. Upon discontinuation of Zytiga 500mg, both patients had normalization of their liver function tests and 1 patient was retreated with Zytiga 500mg without recurrence of the elevations. In study 302, grade 3 or 4 ALT or AST elevations were observed in 35 (6.5%) patients treated with Zytiga 500mg. Aminotransferase elevations resolved in all but 3 patients (2 with new multiple liver metastases and 1 with AST elevation approximately 3 weeks after the last dose of Zytiga 500mg. Treatment discontinuations due to ALT and AST increases were reported in 1.7% and 1.3% of patients treated with Zytiga 500mg and 0.2% and 0% of patients treated with placebo, respectively. No deaths were reported due to hepatotoxicity event.

In clinical trials, the risk for hepatotoxicity was mitigated by exclusion of patients with baseline hepatitis or significant abnormalities of liver function tests. In the 302 trial, patients with liver metastases were not eligible and patients with baseline ALT and AST ≥2.5 times ULN were excluded. Abnormal liver function tests developing in patients participating in clinical trials were vigorously managed by requiring treatment interruption and permitting re-treatment only after return of liver function tests to the patient’s baseline. Patients with elevations of ALT or AST >20 times ULN were not retreated. The safety of re-treatment in such patients is unknown. The mechanism for hepatotoxicity associated with Zytiga 500mg is not understood.

Zytiga 500mg contraindications

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What is the most important information I should know about Zytiga 500mg?

You should not use this medication if you are allergic to Zytiga 500mg, if you have severe liver disease, or if you are pregnant.

Before you take Zytiga 500mg, tell your doctor if you have liver disease, low levels of potassium in your blood, any type of infection, high blood pressure, congestive heart failure, or a history of heart disease, fluid retention, recent heart attack, or problems with your adrenal gland or pituitary gland.

Although Zytiga 500mg is not for use by women, this medicine can harm an unborn baby or cause birth defects. Zytiga 500mg tablets should not be handled by a woman who is pregnant or who may become pregnant.

While you are taking Zytiga 500mg and for at least 1 week after your treatment ends: Use a condom to prevent transfer of this medication to your sexual partner if she is pregnant. Use a condom plus another form of effective birth control if your sexual partner could become pregnant.

Zytiga 500mg must be taken on an empty stomach.

Active ingredient matches for Zytiga 500mg:

Abiraterone in Austria, Germany, Switzerland.


List of Zytiga 500mg substitutes (brand and generic names)

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Unit description / dosage (Manufacturer)Price, USD
ABIRAPRO 250MG TABLET 1 packet / 60 tablets each (Glenmark)$ 677.59
ABIRAPRO 250MG TABLET 1 packet / 120 tablets each (Glenmark)$ 1273.66
ABIRAPRO 250MG TABLET 1 strip / 30 tablets each (Glenmark)$ 327.02
ABIRAPRO tab 250 mg x 120's (Glenmark)$ 1273.67
ABIRAPRO tab 250 mg x 30's (Glenmark)$ 343.37
ABIRAPRO tab 250 mg x 60's (Glenmark)$ 668.67
Abirapro 250mg Tablet (Glenmark)$ 10.61
ZYTIGA 250 MG TABLET 1 packet / 120 tablets each (Janssen)$ 1807.23
Zytiga tab 250 mg 120's (Janssen)
ZYTIGA tab 250 mg x 120's (Janssen)
Zytiga tablet 250 mg (Janssen)
Zytiga tablet 250 mg/1 (Janssen)
Zytiga tablet 500 mg (Janssen)
Zytiga 250mg Tablet (Janssen)$ 15.06

References

  1. PubChem. "Abiraterone". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  2. DrugBank. "Abiraterone". http://www.drugbank.ca/drugs/DB05812 (accessed September 17, 2018).
  3. DTP/NCI. "Abiraterone: The NCI Development Therapeutics Program (DTP) provides services and resources to the academic and private-sector research communities worldwide to facilitate the discovery and development of new cancer therapeutic agents.". https://dtp.cancer.gov/dtpstandard/s... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology

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