Bevatas 100mg/4ml

Category: Monoclonal antibody or Anti-angiogenesis drug Bevacizumab is sold under the brand name Bevatas which belongs to vascular endothelial growth factor directed antibody, the main ingredient which is used as bevacizumab. Bevatas consist of human framework regions and murine complimentarily-determining regions. Bevatas is a combined human monoclonal antibody IgG1, that predicament to and prohibits the biological activity of human vascular endothelial growth factor (VEGF)

Bevatas 

INDICATION

Bevatas is indicated for the treatment
• In combination with 5-fluorouracil chemotherapy administered intravenously, first or second line drug of choice for Metastatic colon or rectal cancer
• Concurrent use with carboplatin and paclitaxel as first line therapy for Non-squamous, non-small cell lung cancer
• Used in the treatment of recurrent Glioblastoma in adults
• Concurrent use with interferon alfa for Metastatic renal cell cancer
• Concurrent use with paclitaxel & cisplatin or paclitaxel & topotecan for Metastatic cervical cancer
• In combination with paclitaxel, pegylated liposomal doxorubicin or topotecan for Epithelial ovarian, fallopian tube or peritoneal cancer.

MECHANISM OF ACTION

Bevatas constitute an active ingredient like Bevacizumab which joined to VEGF and will not have communication of VEGF to its receptors like Flt-1 & KDR that present on the surface of the cells. While this interaction inhibits endothelial cell proliferation and new blood vessel production occurs Hence in counts discontinuation of metastatic tumor cells growth happens.

Key point :

Avoid administrating Bevatas before at least 28 days following surgery and the wound is completely cured

Metastatic colorectal carcinoma :

The Bevatas usual dosage by concomitant with 5-fluorouracil based chemotherapy. Bevatas 5mg/kg for every 2 weeks IV in concomitant with bolus IFL Bevatas 10mg/kg for every 2 weeks IV in combination with FOLFOX4 Bevatas 5mg/kg IV for every 2 weeks or Bevatas 7.5 mg/kg as IV every 3 weeks by concurrently take with fluoropyrimidine Irinotecan or fluoropyrimidine oxaliplatin based therapy

Non-small cell lung cancer :

The patients regular dosage of Bevatas is 15mg/kg IV for every 3 weeks by interacting with carboplatin and paclitaxel

Glioblastoma :

Bevatas 10mg/kg administered IV for every 2 weeks

Metastatic renal cell cancer :

Concurrent use with interferon alfa.: The usual dose of Bevatas is 10mg/kg IV for every 2 weeks

Metastatic cervical cancer :

The usual dose of Bevatas; Bevatas 15mg/kg given intravenously for every 3 weeks by combining with paclitaxel and cisplatin or with paclitaxel and topotecan
Epithelial ovarian, fallopian tube or peritoneal cancer :
The usual dose of Bevatas for Platinum opposing:; 10mg/kg of Bevatas for every 2 weeks by concurrent use with paclitaxel, pegylated liposomal doxorubicin or topotecan Or The regular dosage of Bevatas; 15mg/kg of Bevatas given through IV for every 3 weeks by combining with topotecan The usual dose of Bevatas for Platinum responsive; 15mg/kg given IV for 3 weeks in concomitant with carboplatin and paclitaxel for 6 to 8 cycles The recommended dosage of Bevatas; 15mg/kg of Bevatas given IV for 3 weeks by combining with gemcitabine & carboplatin for 6 to 10 cycles.

PHARMACOKINETICS

The pharmacokinetic form of Bevatas is assayed by measuring total serum Bevacizumab concentration.

Distribution:

The volume of distribution is 2.9 (22%) L

Elimination:

The terminal half life period of Bevacizumab is 20days (11 to 50days)

PREPARATION & ADMINISTRATION

Bevatas is intravenous solution At initial infusion: given IV infusion over 90 minutes Following infusions: give second infusion over 60 minutes, if tolerated Administer all following infusion over 30minutes BevatasIV infusion is prepared in aseptic condition Bevatas 400mg containing 16ml solution whereas 100mg containing 4ml Bevatas dilute into 100ml of 0.9% NS Do not dilute with dextrose solution Dispose the remaining drug which is left in a vial under guidance of pharmacist.

MISSED DOSE

If patient fail to take the dose or missed the cycle means must consult with oncologist and follow the regular dosing schedule Do not take overdose

PRECAUTION

Previously If you have taking or ever had DPD (dihydropyrimidine dehydrogenase) deficiency of enzyme . Inform the doctor about this then your doctor may preferably inform you avoid taking Bevatas. Discuss with the doctor that you have or have ever had renal, hepatic, or cardiac problem Discuss with the doctor that are you pregnant or plan to become pregnant. Avoid planning to have children while on treatment with Bevatas. You should use a essential method of conceiving to prevent pregnancy in yourself or your partner during your treatment with Bevatas. The drug will harm the fetus. Avoid breast feeding while on treatment with Bevatas While using Bevatas these are some other complications occurred during therapy, care should be taken Hypertension Posterior reversible encephalopathy syndrome Gastrointestinal perforations Wound healing complications Hemorrhage Arterial thromboembolic events Venous thromboembolic events Embryo fetal toxicity occurs

PREGNANCY0

Pregnancy category: D while administrating Bevatas in pregnant women, positive evidence on fetal risk depends on human studies but potential benefits by using the drug may have common risk against fetus.

CONTRAINDICATION

No contraindication occurred

SIDE EFFECTS

Gastrointestinal perforation and fistulae
Surgery and wound healing complication
Hemorrhage
Arterial thromboembolic events
Venous thromboembolic events
Hypertension
Posterior reversible encephalopathy syndrome
Renal injury & Proteinuria
Infusion reactions
Ovarian failure
Congestive heart failure
Neutropenia, mucosal inflammation, infection, neuropathy, Epistaxis, erythrodysaesthesia.

STORAGE

Bevatas vial should be stored at 2 to 8℃ (36 to 46℉) Single use vial Discard the left out medicine under guidance of pharmacist

Bevarest 100mg/4ml 

Category: Monoclonal antibody or Anti-angiogenesis drug Bevacizumab is sold under the brand name Bevarest which belongs to vascular endothelial growth factor directed antibody, the main ingredient which is used as bevacizumab. Bevarest consist of human framework regions and murine complementarity-determining regions. Bevarest is a combined human monoclonal antibody IgG1, that predicament to and prohibits the biological activity of human vascular endothelial growth factor (VEGF)

Bevarest 100mg 

INDICATION

Bevarest is indicated for the treatment :
• In combination with 5-fluorouracil chemotherapy administered intravenously, first or second line drug of choice for Metastatic colon or rectal cancer
• Concurrent use with carboplatin and paclitaxel as first line therapy for Non-squamous, non-small cell lung cancer
• Used in the treatment of recurrent Glioblastoma in adults
• Concurrent use with interferon alfa for Metastatic renal cell cancer
• Concurrent use with paclitaxel & cisplatin or paclitaxel & topotecan for Metastatic cervical cancer
• In combination with paclitaxel, pegylated liposomal doxorubicin or topotecan for Epithelial ovarian, fallopian tube or peritoneal cancer.

Key point :

Avoid administrating Bevarest before at least 28 days following surgery and the wound is completely cured

Metastatic colorectal carcinoma :

The Bevarest usual dosage by concomitant with 5-fluorouracil based chemotherapy. Bevarest 5mg/kg for every 2 weeks IV in concomitant with bolus IFL Bevarest 10mg/kg for every 2 weeks IV in combination with FOLFOX4 Bevarest 5mg/kg IV for every 2 weeks or Bevarest 7.5 mg/kg as IV every 3 weeks by concurrently take with fluoropyrimidine Irinotecan or fluoropyrimidine oxaliplatin based therapy

Non-small cell lung cancer :

The patients regular dosage of Bevarest is 15mg/kg IV for every 3 weeks by interacting with carboplatin and paclitaxel

Glioblastoma :

Bevarest 10mg/kg administered IV for every 2 weeks

Metastatic renal cell cancer :

Concurrent use with interferon alfa: The usual dose of Bevarest is 10mg/kg IV for every 2 weeks

Metastatic cervical cancer :

The usual dose of Bevarest; Bevarest 15mg/kg given intravenously for every 3 weeks by combining with paclitaxel and cisplatin or with paclitaxel and topotecan
Epithelial ovarian, fallopian tube or peritoneal cancer :
The usual dose of Bevarest for Platinum opposing:; 10mg/kg of Bevarest for every 2 weeks by concurrent use with paclitaxel, pegylated liposomal doxorubicin or topotecan Or The regular dosage of Bevarest; 15mg/kg of Bevarest given through IV for every 3 weeks by combining with topotecan The usual dose of Bevarest for Platinum responsive; 15mg/kg given IV for 3 weeks in concomitant with carboplatin and paclitaxel for 6 to 8 cycles The recommended dosage of Bevarest; 15mg/kg of Bevarest given IV for 3 weeks by combining with gemcitabine & carboplatin for 6 to 10 cycles.

PHARMACOKINETICS

The pharmacokinetic form of Bevarest is assayed by measuring total serum Bevacizumab concentration.

Distribution:

The volume of distribution is 2.9 (22%) L

Elimination:

The terminal half life period of Bevacizumab is 20days (11 to 50days)

MECHANISM

Bevarest constitute an active ingredient like Bevacizumab which joined to VEGF and will not have communication of VEGF to its receptors like Flt-1 & KDR that present on the surface of the cells. While this interaction inhibits endothelial cell proliferation and new blood vessel production occurs Hence in counts discontinuation of metastatic tumor cells growth happens.

STORAGE

Bevarest vial should be stored at 2 to 8℃ (36 to 46℉) Single use vial Discard the left out medicine under guidance of pharmacist.

PRECAUTION

Caution with use in the conditions like;
Previously If you have taking or ever had DPD (dihydropyrimidine dehydrogenase) deficiency of enzyme . Inform the doctor about this then your doctor may preferably inform you avoid taking Bevarest. Discuss with the doctor that you have or have ever had renal, hepatic, or cardiac problem Discuss with the doctor that are you pregnant or plan to become pregnant. Avoid planning to have children while on treatment with Bevarest. You should use a essential method of conceiving to prevent pregnancy in yourself or your partner during your treatment with Bevarest. The drug will harm the fetus. Avoid breast feeding while on treatment with Bevarest While using Bevarest these are some other complications occurred during therapy, care should be taken Hypertension Posterior reversible encephalopathy syndrome Gastrointestinal perforations Wound healing complications Hemorrhage Arterial thromboembolic events Venous thromboembolic events Embryo fetal toxicity occurs

DRUG INTERACTION

If you missed a dose take it as soon as possible, if time reach for next dose, While interaction of Bevarest with paclitaxel & Carboplatin, leads to lowering in exposure of paclitaxel after four cycles of therapy. Interaction of Bevarest with paclitaxel & Carboplatin leads to increase the paclitaxel exposure at day 6

MISSED DOSE

If patient fail to take the dose or missed the cycle means must consult with oncologist and follow the regular dosing schedule Do not take overdose.

SIDE EFFECTS

Gastrointestinal perforation and fistulae
Surgery and wound healing complication
Hemorrhage
Arterial thromboembolic events
Venous thromboembolic events
Hypertension
Posterior reversible encephalopathy syndrome
Renal injury & Proteinuria
Infusion reactions
Ovarian failure
Congestive heart failure
Neutropenia, mucosal inflammation, infection, neuropathy, Epistaxis, erythrodysaesthesia.

Bevacizumab 400mg/16ml & 100mg/4ml

Category: Monoclonal antibody or Anti-angiogenesis drug Bevacizumab is sold under the brand name Avastin which belongs to vascular endothelial growth factor directed antibody, the main ingredient which is used as bevacizumab. Avastin consist of human framework regions and murine complementarity-determining regions. Avastin is a combined human monoclonal antibody IgG1, that predicament to and prohibits the biological activity of human vascular endothelial growth factor (VEGF)

Bevacizumab 

INDICATION

Avastin is indicated for the treatment:
• In combination with 5-fluorouracil chemotherapy administered intravenously, first or second line drug of choice for Metastatic colon or rectal cancer
• Concurrent use with carboplatin and paclitaxel as first line therapy for Non-squamous, non-small cell lung cancer
• Used in the treatment of recurrent Glioblastoma in adults
• Concurrent use with interferon alfa for Metastatic renal cell cancer
• Concurrent use with paclitaxel & cisplatin or paclitaxel & topotecan for Metastatic cervical cancer
• In combination with paclitaxel, pegylated liposomal doxorubicin or topotecan for Epithelial ovarian, fallopian tube or peritoneal cancer

PHARMACOLOGY

Avastin constitute an active ingredient like Bevacizumab which joined to VEGF and will not have communication of VEGF to its receptors like Flt-1 & KDR that present on the surface of the cells. While this interaction inhibits endothelial cell proliferation and new blood vessel production occurs Hence in counts discontinuation of metastatic tumor cells growth happens

DOSAGE

Key point:

Avoid administrating Avastin before at least 28 days following surgery and the wound is completely cured

Metastatic colorectal carcinoma:

The Avastin usual dosage by concomitant with 5-fluorouracil based chemotherapy. Avastin 5mg/kg for every 2 weeks IV in concomitant with bolus IFL Avastin 10mg/kg for every 2 weeks IV in combination with FOLFOX4 Avastin 5mg/kg IV for every 2 weeks or Avastin 7.5 mg/kg as IV every 3 weeks by concurrently take with fluoropyrimidine Irinotecan or fluoropyrimidine oxaliplatin based therapy

Non-small cell lung cancer:

The patients regular dosage of Avastin is 15mg/kg IV for every 3 weeks by interacting with carboplatin and paclitaxel

Glioblastoma:

Avastin 10mg/kg administered IV for every 2 weeks

Metastatic renal cell cancer:

Concurrent use with interferon alfa.: The usual dose of Avastin is 10mg/kg IV for every 2 weeks.

Metastatic cervical cancer:

The usual dose of Avastin; Avastin 15mg/kg given intravenously for every 3 weeks by combining with paclitaxel and cisplatin or with paclitaxel and topotecan
Epithelial ovarian, fallopian tube or peritoneal cancer:
The usual dose of Avastin for Platinum opposing:; 10mg/kg of Avastin for every 2 weeks by concurrent use with paclitaxel, pegylated liposomal doxorubicin or topotecan Or The regular dosage of Avastin; 15mg/kg of Avastin given through IV for every 3 weeks by combining with topotecan The usual dose of Avastin for Platinum responsive; 15mg/kg given IV for 3 weeks in concomitant with carboplatin and paclitaxel for 6 to 8 cycles The recommended dosage of Avastin; 15mg/kg of Avastin given IV for 3 weeks by combining with gemcitabine & carboplatin for 6 to 10 cycles.

PHARMACOKINETICS

The pharmacokinetic form of Avastin is assayed by measuring total serum Bevacizumab concentration.

Distribution:

The volume of distribution is 2.9 (22%) L

Elimination:

The terminal half life period of Bevacizumab is 20days (11 to 50days)

PREPARATION & ADMINSITRATION

Avastin is intravenous solution At initial infusion: given IV infusion over 90 minutes Following infusions: give second infusion over 60 minutes, if tolerated Administer all following infusion over 30minutes AvastinIV infusion is prepared in aseptic condition Avastin 400mg containing 16ml solution whereas 100mg containing 4ml Avastin dilute into 100ml of 0.9% NS Do not dilute with dextrose solution Dispose the remaining drug which is left in a vial under guidance of pharmacist.

PRECAUTION

Caution with use in the conditions like;
Previously If you have taking or ever had DPD (dihydropyrimidine dehydrogenase) deficiency of enzyme . Inform the doctor about this then your doctor may preferably inform you avoid taking Avastin. Discuss with the doctor that you have or have ever had renal, hepatic, or cardiac problem Discuss with the doctor that are you pregnant or plan to become pregnant. Avoid planning to have children while on treatment with Avastin. You should use a essential method of conceiving to prevent pregnancy in yourself or your partner during your treatment with Avastin. The drug will harm the fetus. Avoid breast feeding while on treatment with AvastinWhile using Avastin these are some other complications occurred during therapy, care should be taken
Hypertension Posterior reversible encephalopathy syndrome Gastrointestinal perforations Wound healing complications Hemorrhage Arterial thromboembolic events Venous thromboembolic events Embryo fetal toxicity occurs

CONTRAINDICATION

No contraindication occurred

DRUG INTERACTION

While interaction of Avastin with paclitaxel & Carboplatin, leads to lowering in exposure of paclitaxel after four cycles of therapy. Interaction of Avastin with paclitaxel & Carboplatin leads to increase the paclitaxel exposure at day 6

MISSED DOSE

If patient fail to take the dose or missed the cycle means must consult with oncologist and follow the regular dosing schedule Do not take overdose.

SIDE EFFECTS

Gastrointestinal perforation and fistulae
Surgery and wound healing complication
Hemorrhage
Arterial thromboembolic events
Venous thromboembolic events
Hypertension
Posterior reversible encephalopathy syndrome
Renal injury & Proteinuria
Infusion reactions
Ovarian failure
Congestive heart failure
Neutropenia, mucosal inflammation, infection, neuropathy, Epistaxis, erythrodysaesthesia.

Jakavi 20mg 

Jakavi 20mg belongs to the type of targeted therapy. It is an oral receptor tyrosine kinase inhibitor. It acts by inhibiting certain enzymes in the body which affect blood cell production.
Jakavi 20mg is prescription drug provided under supervision of doctors or pharmacists

INDICATION

Jakavi 20mg is indicated for the treatment in patients with intermediate and high-risk myelofibrosis.

DOSAGE

Myelofibrosis :

Kinase inhibitor uses for treatment of patients with intermediate or high-risk myelofibrosis, involving mainly myelofibrosis, post-PolycythemiaVera myelofibrosis and post-essential thrombocythemia myelofibrosis
Starting recommended doses for myelofibrosis
If Platelet count >200 x10^9/L the dose given is 20 mg PO BID
If Platelet count 100-200 x10^9/L the dose given is 15 mg PO BID
If Platelet count 50 to <100 x10^9/L the dose given is 5 mg PO BID
Titrate dose based on response; not to exceed 25 mg PO BID
Polycythemia Vera
The recommended dose is 10mg PO BID
Undergo CBC and platelet count prior starting and q2-4wk until doses are stabilized, and then as clinically used.

MECHANISM

Ruxolitinib is also knowns kinase inhibitor which is discriminating for the Janus analogue Kinases (JAK) 1 and 2. These kinases are required for the mediation of cytokine and growth factor signalling which in turn effect immune function and hematopoiesis.
The communicate process involves signal transducers and transcription activators (STAT) that modulate gene expression. Patients having myelofibrosis consist of abnormal JAK1 and JAK2 activity, Therefore Ruxolitinib function to regulate this.

PHARMACOKINETICS

Fast absorption and not affected by food maximum plasma level is 1.5 hours.
volume of distribution is 76.6 L plasma protein binding
Jakavi metabolized by CYP3A4
Jakavi eliminated via urine 74% and unchanged drug is <1% and through urine 22%,<1 % as unchanged drug

PRECAUTION

Treatment with Jakavi 20mg can resultedin thrombocytopenia, Anemia and neutropenia. Control thrombocytopenia by decreasing the dose or temporarily interfere with Jakavi 20mg. Platelet transfusions may be necessary.
Risk of infection occurs by delay initiate treatment with Jakavi 20mg until active severe infection have resolved. Tuberculosis infection has been reported in patients receiving Jakavi 20mg. Observe patients receiving Jakavi 20mg for signs and symptoms of active tuberculosis and manage promptly.
Progressive multifocal leukoencephalopathy (PML) has occurred with Jakavi 20mg treatment. If PML is suspected, stop Jakavi 20mg and evaluate
Non-melanoma skin cancers including basal cell, squamous cell, and Merkel cell carcinoma have occurred in patients treated with Jakavi 20mg. Perform periodic skin examinations.

DRUG INTERACTION

Concomitant use with fluconazole doses greater than 200mg daily may increase Ruxolitinib exposure leads to increase the risks of exposure related adverse reaction.
Interaction of Jakavi 20mg with strong CYP3A4 inhibitors will increases Ruxolitinib exposure.
Interaction of Jakavi 20mg with strong CYP3A4 inducers will decreases Ruxolitinib exposure.

CONTRAINDICATION

Hypersensitivity

MISSED DOSE

If dose is missed the have the dose immediately before next dose timing reaches or skip the missed dose and continue the regular schedule. Consult doctors regarding missed dose. Avoid taking double the dose.

SIDE EFFECTS

• Bruising
• Swelling
• Neutropenia
• Dizziness
• Increased cholesterol
• Shortness of breath
• Nasopharyngitis
• Anemia
• Thrombocytopenia
• Increased liver enzymes
• Diarrhea
• Headache
• Constipation
• Nausea & Vomiting
• Insomnia.

Jakavi 5mg

Jakavi 5mg belongs to the type of targeted therapy. It is an oral receptor tyrosine kinase inhibitor. It acts by inhibiting certain enzymes in the body which affect blood cell production.
Jakavi 5mg is prescription drug provided under supervision of doctors or pharmacists

INDICATION

Jakavi 5mg capsule is indicated for the treatment in patients with intermediate and high-risk myelofibrosis.

DOSAGE

Myelofibrosis :

Kinase inhibitor uses for treatment of patients with intermediate or high-risk myelofibrosis, involving mainly myelofibrosis, post-polycythemiavera myelofibrosis and post-essential thrombocythemia myelofibrosis
Starting recommended doses for myelofibrosis:
If Platelet count >200 x10^9/L the dose given is 20 mg PO BID
If Platelet count 100-200 x10^9/L the dose given is 15 mg PO BID
If Platelet count 50 to <100 x10^9/L the dose given is 5 mg PO BID
Titrate dose based on response; not to exceed 25 mg PO BID.

Polycythemia Vera :

The recommended dose is 10mg PO BID
Undergo CBC and platelet count prior starting and q2-4wk until doses are stabilized, and then as clinically used.

MECHANISM

Ruxolitinib is also knowns kinase inhibitor which is discriminating for the Janus analogue Kinases (JAK) 1 and 2. These kinases are required for the mediation of cytokine and growth factor signalling which in turn effect immune function and hematopoiesis.
The communicate process involves signal transducers and transcription activators (STAT) that modulate gene expression. Patients having myelofibrosis consist of abnormal JAK1 and JAK2 activity,Therefore Ruxolitinibfunction to regulate this.

ADME

Fast absorption and not affected by food maximum plasma level is 1.5 hours.
volume of distribution is 76.6 L plasma protein binding is
Jakavi metabolized by CYP3A4
Jakavi eliminatedvia urine 74% and unchanged drug is <1% and through urine 22% ,<1 % as unchanged drug.

PRECAUTION

Treatment with Jakavi 5mg can resulted in thrombocytopenia, Anemia and neutropenia. Control thrombocytopenia by decreasing the dose or temporarily interfere with Jakavi 5mg. Platelet transfusions may be necessary.
Risk of infection occurs by delay initiate treatment with Jakavi 5mg until active severe infection have resolved.
Tuberculosis infection has been reported in patients receiving Jakavi 5mg. Observe patients receiving Jakavi 5mg for signs and symptoms of active tuberculosis and manage promptly.
Progressive multifocal leukoencephalopathy (PML) has occurred with Jakavi 5mgtreatment. If PML is suspected, stop Jakavi 5mg and evaluate Non-melanoma skin cancers including basal cell, squamous cell, and Merkel cell carcinoma have occurred in patients treated with Jakavi 5mg. Perform periodic skin examinations.

DRUG INTERACTION

Concomitant use with fluconazole doses greater than 200mg daily may increase Ruxolitinib exposure leads to increase the risks of exposure related adverse reaction.
Interaction of Jakavi 5mg with strong CYP3A4 inhibitors will increases Ruxolitinib exposure.
Interaction of Jakavi 5mg with strong CYP3A4 inducers will decreases Ruxolitinib exposure.

CONTRAINDICATION

Hypersensitivity

STORAGE

Jakavi 5mg capsule  stored at 20℃ to 25℃
Protect away from light and moisture
Dispense in its original container

MISSED DOSE

If dose is missed the have the dose immediately before next dose timing reaches or skip the missed dose and continue the regular schedule.Consult doctors regarding missed dose. Avoid taking double the dose.

SIDE EFFECTS

Side effects caused due to Jakavi 5mg
• Bruising
• Swelling
• Neutropenia
• Dizziness
• Increased cholesterol
• Shortness of breath
• Nasopharyngitis
• Anemia
• Thrombocytopenia
• Increased liver enzymes
• Diarrhea
• Headache
• Constipation
• Nausea & Vomiting
• Insomnia.

Jakavi 25mg 

Jakavi 25mg belongs to the type of targeted therapy. It is an oral receptor tyrosine kinase inhibitor. It acts by inhibiting certain enzymes in the body which affect blood cell production.
Jakavi 25mg is prescription drug provided under supervision of doctors or pharmacists

INDICATION

Jakavi 25mg is indicated for the treatment in patients with intermediate and high-risk myelofibrosis.

DOSAGE

Myelofibrosis :

Kinase inhibitor uses for treatment of patients with intermediate or high-risk myelofibrosis, involving mainly myelofibrosis, post-PolycythemiaVera myelofibrosis and post-essential thrombocythemia myelofibrosis
Starting recommended doses for myelofibrosis
If Platelet count >200 x10^9/L the dose given is 20 mg PO BID
If Platelet count 100-200 x10^9/L the dose given is 15 mg PO BID
If Platelet count 50 to <100 x10^9/L the dose given is 5 mg PO BID
Titrate dose based on response; not to exceed 25 mg PO BID
Polycythemia Vera
The recommended dose is 10mg PO BID
Undergo CBC and platelet count prior starting and q2-4wk until doses are stabilized, and then as clinically used.

MECHANISM

Ruxolitinib is also knowns kinase inhibitor which is discriminating for the Janus analogue Kinases (JAK) 1 and 2. These kinases are required for the mediation of cytokine and growth factor signalling which in turn effect immune function and hematopoiesis.
The communicate process involves signal transducers and transcription activators (STAT) that modulate gene expression. Patients having myelofibrosis consist of abnormal JAK1 and JAK2 activity, Therefore Ruxolitinib function to regulate this.

PHARMACOKINETICS

Fast absorption and not affected by food maximum plasma level is 1.5 hours.
volume of distribution is 76.6 L plasma protein binding
Jakavi capsule  metabolized by CYP3A4
Jakavi eliminated via urine 74% and unchanged drug is <1% and through urine 22%,<1 % as unchanged drug

PRECAUTION

Treatment with Jakavi 25mg can resultedin thrombocytopenia, Anemia and neutropenia. Control thrombocytopenia by decreasing the dose or temporarily interfere with Jakavi 25mg. Platelet transfusions may be necessary.
Risk of infection occurs by delay initiate treatment with Jakavi 25mg capsule until active severe infection have resolved. Tuberculosis infection has been reported in patients receiving Jakavi 25mg. Observe patients receiving Jakavi 25mg capsule  for signs and symptoms of active tuberculosis and manage promptly.
Progressive multifocal leukoencephalopathy (PML) has occurred with Jakavi 25mg capsule treatment. If PML is suspected, stop Jakavi 25mg and evaluate
Non-melanoma skin cancers including basal cell, squamous cell, and Merkel cell carcinoma have occurred in patients treated with Jakavi 25mg. Perform periodic skin examinations.

DRUG INTERACTION

Concomitant use with fluconazole doses greater than 200mg daily may increase Ruxolitinib exposure leads to increase the risks of exposure related adverse reaction.
Interaction of Jakavi 25mg capsule with strong CYP3A4 inhibitors will increases Ruxolitinib exposure.
Interaction of Jakavi 25mg with strong CYP3A4 inducers will decreases Ruxolitinib exposure.

CONTRAINDICATION

Hypersensitivity

MISSED DOSE

If dose is missed the have the dose immediately before next dose timing reaches or skip the missed dose and continue the regular schedule. Consult doctors regarding missed dose. Avoid taking double the dose.

SIDE EFFECTS

• Bruising
• Swelling
• Neutropenia
• Dizziness
• Increased cholesterol
• Shortness of breath
• Nasopharyngitis
• Anemia
• Thrombocytopenia
• Increased liver enzymes
• Diarrhea
• Headache
• Constipation
• Nausea & Vomiting
• Insomnia.

Jakavi 10mg

Jakavi 10mg belongs to the type of targeted therapy. It is an oral receptor tyrosine kinase inhibitor. It acts by inhibiting certain enzymes in the body which affect blood cell production.
Jakavi 10mg is prescription drug provided under supervision of doctors or pharmacists

INDICATION

Jakavi 10mg is indicated for the treatment in patients with intermediate and high-risk myelofibrosis.

DOSAGE

Myelofibrosis :

Kinase inhibitor uses for treatment of patients with intermediate or high-risk myelofibrosis, involving mainly myelofibrosis, post-PolycythemiaVera myelofibrosis and post-essential thrombocythemia myelofibrosis
Starting recommended doses for myelofibrosis
If Platelet count >200 x10^9/L the dose given is 20 mg PO BID
If Platelet count 100-200 x10^9/L the dose given is 15 mg PO BID
If Platelet count 50 to <100 x10^9/L the dose given is 5 mg PO BID
Titrate dose based on response; not to exceed 25 mg PO BID
Polycythemia Vera
The recommended dose is 10mg PO BID
Undergo CBC and platelet count prior starting and q2-4wk until doses are stabilized, and then as clinically used.

MECHANISM

Ruxolitinib is also knowns kinase inhibitor which is discriminating for the Janus analogue Kinases (JAK) 1 and 2. These kinases are required for the mediation of cytokine and growth factor signalling which in turn effect immune function and hematopoiesis.
The communicate process involves signal transducers and transcription activators (STAT) that modulate gene expression. Patients having myelofibrosis consist of abnormal JAK1 and JAK2 activity, Therefore Ruxolitinib function to regulate this.

PHARMACOKINETICS

Fast absorption and not affected by food maximum plasma level is 1.5 hours.
volume of distribution is 76.6 L plasma protein binding
Jakavi metabolized by CYP3A4
Jakavi eliminated via urine 74% and unchanged drug is <1% and through urine 22%,<1 % as unchanged drug

PRECAUTION

Treatment with Jakavi 10mg can resultedin thrombocytopenia, Anemia and neutropenia. Control thrombocytopenia by decreasing the dose or temporarily interfere with Jakavi 10mg. Platelet transfusions may be necessary.
Risk of infection occurs by delay initiate treatment with Jakavi 10mg until active severe infection have resolved. Tuberculosis infection has been reported in patients receiving Jakavi 10mg. Observe patients receiving Jakavi 10mg for signs and symptoms of active tuberculosis and manage promptly.
Progressive multifocal leukoencephalopathy (PML) has occurred with Jakavi 10mg treatment. If PML is suspected, stop Jakavi 10mg and evaluate
Non-melanoma skin cancers including basal cell, squamous cell, and Merkel cell carcinoma have occurred in patients treated with Jakavi 10mg. Perform periodic skin examinations.

DRUG INTERACTION

Concomitant use with fluconazole doses greater than 200mg daily may increase Ruxolitinib exposure leads to increase the risks of exposure related adverse reaction.
Interaction of Jakavi 10mg with strong CYP3A4 inhibitors will increases Ruxolitinib exposure.
Interaction of Jakavi 10mg with strong CYP3A4 inducers will decreases Ruxolitinib exposure.

CONTRAINDICATION

Hypersensitivity

MISSED DOSE

If dose is missed the have the dose immediately before next dose timing reaches or skip the missed dose and continue the regular schedule. Consult doctors regarding missed dose. Avoid taking double the dose.

SIDE EFFECTS

• Bruising
• Swelling
• Neutropenia
• Dizziness
• Increased cholesterol
• Shortness of breath
• Nasopharyngitis
• Anemia
• Thrombocytopenia
• Increased liver enzymes
• Diarrhea
• Headache
• Constipation
• Nausea & Vomiting
• Insomnia.

ADDRESS

No. 24, K. M. A. Garden,
Industrial Estate Chinandimadam Kodungaiyur,
Chennai- 600118, Tamil Nadu, India.

CONTACT

Mail:info@beemainfratech.com

Phone:+91 9381028255, +91 9489004466, +91 9489004433, 044-25267437 / 42064966.

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ADDRESS

No. 24, K. M. A. Garden,

Industrial Estate Chinandimadam Kodungaiyur, 

Chennai- 600118, Tamil Nadu, India.

CONTACT

Mail:info@beemainfratech.com

Phone:+91 9381028255, +91 9489004466, +91 9489004433, 044-25267437 / 42064966.

                                       Pomalid 4mg 

Pomalid (pomalidomide)4mg is a Natco pharma product which is endorsed by FDA, containing an active anti-cancer drug called pomalidomide. Pomalid(pomalyst) 4mg is available as orally bioavailable thalidomide derivative with various therapeutic activities such as; Immuno modulatory Anti-angiogenesis Anti-neoplastic Pomalid(pomalidomide) 4mg is similar to thalidomide & Lenalidomide with related to decreased rate of serum aminotransferase elevations during treatment. This may leads to severe liver injury.Pomalid 4mg is involved in the treatment for regression & unmanageable multiple myeloma. Pomalid(pomalidomide) 4mg is used in the patients who are failing to response for Lenalidomide treatment. Pomalid(pomalyst) 4mg is used in combination with dexamethasone.

INDICATION

The major therapeutic indication of Pomalid(pomalidomide) 4mg is involved in the treatment of multiple myeloma. This treatment is occurred by combining with dexamethasone for reducing the side effect associated with Pomalid 4mgomide. Pomalid 4mg is majorly indicated in patients who are not reacts for prior two therapies like Lenalidomide & proteasome inhibitor.
During hematological toxicities

Neutropenia :

ANC (absolute neutrophils count) <500/mcl: Postpone the Pomalid therapy and provide CBC weekly ANC more than or equal to 500/mcl: Continue the Pomalid 3mg daily.

Thrombocytopenia :

Platelets count <25,000/mcL: postpone the Pomalid treatment & follow the CBC >50,000/mcL: continue 3mg of Pomalid
Pomalid(pomalidomide) 4mg with potent CYP1A2 inhibitor :
During this combination reduce the dose of Pomalid by 50%

In renal impairment :

Initial dose of Pomalid(pomalyst) is 3mg

In hepatic impairment :

Mild to moderate condition, an initial dose of Pomalid is 3mg; in severe condition, the initial dose of Pomalid is 2mg.
Pomalid(pomalidomide) 4mg WORKS

Pomalid 4mg exhibits various activities like;
Anti-neoplastic activity

Prohibits proliferation Promote apoptosis of hematopoietic cancer cells Co adjuvant with dexamethasone in both Lenalidomide sensitive & resistant myeloma cells to activate the tumor cell apoptosis
Immuno modulatory

Boosted the T-cells & natural killer cell mediate immunity. The drug is prohibited the formation of pro-inflammatory cytokines by monocytes.
Anti-angiogenesis

Interfere with formation of new vessels and leads to inhibit the cell division.

WARNING

There are two major worsening condition may occur during the treatment using with Pomalid(pomalidomide) 4mg.
Embryo fetal damage

Pomalid(pomalyst) 4mg capsules are contraindicated to pregnancy period. During the treatment, patients avoid to becoming pregnant. Use effective contraceptives for preventing pregnancy during therapy.
Venous & arterial thromboembolism

Patient who are receiving Pomalid(pomalidomide) 4mg capsules have chance of getting deep vein thrombosis, pulmonary embolism, myocardial infarction & stroke. This type of condition should be treated by initiating prophylactic anti-thrombotic drugs. The patients who are acquiring this condition then thromboprophylaxis should be provided

CONTRAINDICATION

Pomalid(pomalidomide) 4mg should be contraindicated to pregnancy & lactating women. The pregnancy category of Pomalid 4mg is X.

DRUG INTERACTION

Pomalidomide metabolism is mediated by CYP1A2 & CYP3A4. The concomitant use of Pomalid 4mg with CYP1A2 drugs like Fluoxamine causes elevation of Cmax & AUC of Pomalidomide and concludes as increased concentration of Pomalid leads to higher extent of adverse effects associated with Pomalid In this condition, reduce the dose of Pomalid(pomalidomide) 4mg and recommended.

                                        Pomalong 1mg

Pomalong 1mg is a Sun Pharmaceuticals product which is endorsed by FDA, containing an active anti-cancer drug called Pomalidomide.
Pomalong 1mg is available as orally bioavailable thalidomide derivative with various therapeutic activities such as;
Immuno modulatory
Anti-angiogenesis
Anti-neoplastic
Pomalong 1mg is like thalidomide & Lenalidomide with related to decreased rate of serum aminotransferase elevations during treatment.
This may lead to severe liver injury.
Pomalong 1mg is involved in the treatment for regression & unmanageable multiple myeloma.
Pomalong 1mg capsule is used in the patients who are failing to response for Lenalidomide treatment.
Pomalong 1mg is used in combination with dexamethasone.

INDICATION

The major therapeutic indication of Pomalong 1mg capsule  is involved in the treatment of multiple myeloma.
This treatment is occurred by combining with dexamethasone for reducing the side effect associated with Pomalong 1mg omide.
Pomalong 1mg is majorly indicated in patients who are not reacts for prior two therapies like Lenalidomide & proteasome inhibitor.

DOSAGE & ADMINISTRATION

The prescribed dose of Pomalong in multiple myeloma is 4mg should be administered orally as once a day on day 1 to 21 of reciprocated 28-day cycles.
Pomalong 1mg should be concomitant with dexamethasone.
Pomalong 1mg Capsules should be taken with or without food.
During hematological toxicities:

Neutropenia:

ANC (absolute neutrophils count) <500/mcl: Postpone the Pomalong therapy and provide CBC weekly
ANC more than or equal to 500/mcl: Continue the Pomalong 3mg daily.

Thrombocytopenia:

Platelets count <25,000/mcL: postpone the Pomalong treatment & follow the CBC
>50,000/mcL: continue 3mg of Pomalong
Pomalong 1mg with potent CYP1A2 inhibitor:
During this combination reduce the dose of Pomalong by 50%

In renal impairment:

Initial dose of Pomalong is 3mg

In hepatic impairment:

Mild to moderate condition, an initial dose of Pomalong is 3mg; in severe condition, the initial dose of Pomalong is 2mg.

WORK AS

Pomalong 1mg exhibits various activities like;

Anti-neoplastic activity:

Prohibits proliferation
Promote apoptosis of hematopoietic cancer cells
Co adjuvant with dexamethasone in both Lenalidomide sensitive & resistant myeloma cells to activate the tumor cell apoptosis

Immuno modulatory:

Boosted the T-cells & natural killer cell mediate immunity.
The drug is prohibited the formation of pro-inflammatory cytokines by monocytes.

Anti-angiogenesis:

Interfere with formation of new vessels and leads to inhibit the cell division.

WARNING

There are two major worsening condition may occur during the treatment using with Pomalong 1mg.

Embryo fetal damage :

Pomalong 1mg Capsules are contraindicated to pregnancy period.
During the treatment, patients avoid to becoming pregnant.
Use effective contraceptives for preventing pregnancy during therapy.

Venous & arterial thromboembolism :

Patient who are receiving Pomalong 1mg Capsules have chance of getting deep vein thrombosis, pulmonary embolism, myocardial infarction & stroke.
This type of condition should be treated by initiating prophylactic anti-thrombotic drugs.
The patients who are acquiring this condition then thromboprophylaxis should be provided

DRUG INTERACTION

Pomalidomide metabolism is mediated by CYP1A2 & CYP3A4.
The concomitant use of Pomalong 1mg with CYP1A2 drugs like Fluvoxamine causes elevation of Cmax& AUC of Pomalidomide and concludes as increased concentration of Pomalong leads to higher extent of adverse effects associated with Pomalid
In this condition, reduce the dose of Pomalong 1mg and recommended.

CONTRAINDICATION

Pomalong 1mg should be contraindicated to pregnancy & lactating women. The pregnancy category of Pomalong 1mg is X.

SIDE EFFECTS

More common effects :

If taken during pregnancy, Severe life-threatening human birth defects
Fatigue
Weakness
Low white blood cell count
Anemia
Constipation
Nausea
Diarrhea
Shortness of breath
Upper respiratory infections
Back pain
Fever.
Less common effects :
Neuropathy
Dizziness
Confusion.

ABEVMY - 400MG / 16ML

Category: Monoclonal antibody or Anti-angiogenesis drug
Bevacizumab is sold under the brand name Abevmy 400mg which belongs to vascular endothelial growth factor directed antibody.
Abevmy 400mg consist of human framework regions and murine complementarity-determining regions.
Abevmy 400mg is a combined human monoclonal antibody IgG1, that predicament to and prohibits the biological activity of human vascular endothelial growth factor (VEGF)

INDICATION

Abevmy 400mg is indicated for the treatment
• In combination with 5-fluorouracil chemotherapy administered intravenously, first or second line drug of choice for Metastatic colon or rectal cancer
• Concurrent use with carboplatin and paclitaxel as first line therapy for Non-squamous, non-small cell lung cancer
• Used in the treatment of recurrent Glioblastoma in adults
• Concurrent use with interferon alfa for Metastatic renal cell cancer
• Concurrent use with paclitaxel & cisplatin or paclitaxel & topotecan for Metastatic cervical cancer
• In combination with paclitaxel, pegylated liposomal doxorubicin or topotecan for Epithelial ovarian, fallopian tube or peritoneal cancer

DOSAGE

Key point:
Avoid administrating Abevmy before at least 28 days following surgery and the wound is completely cured
Metastatic colorectal carcinoma:
The Abevmy usual dosage by concomitant with 5-fluorouracil based chemotherapy.
Abevmy 5mg/kg for every 2 weeks IV in concomitant with bolus IFL
Abevmy 10mg/kg for every 2 weeks IV in combination with FOLFOX4
Abevmy 5mg/kg IV for every 2 weeks or Abevmy 7.5 mg/kg as IV every 3 weeks by concurrently take with fluoropyrimidine Irinotecan or fluoropyrimidine oxaliplatin based therapy

Non-small cell lung cancer:

The patient’s regular dosage of Abevmy is 15mg/kg IV for every 3 weeks by interacting with carboplatin and paclitaxel

Glioblastoma:

Abevmy 10mg/kg administered IV for every 2 weeks
Metastatic renal cell cancer:
Concurrent use with interferon alfa.: The usual dose of Abevmy is 10mg/kg IV for every 2 weeks
Metastatic cervical cancer:
The usual dose of Abevmy; Abevmy 15mg/kg given intravenously for every 3 weeks by combining with paclitaxel and cisplatin or with paclitaxel and topotecan
Epithelial ovarian, fallopian tube or peritoneal cancer:
The usual dose of Abevmy for Platinum opposing: 10mg/kg of Abevmy for every 2 weeks by concurrent use with paclitaxel, pegylated liposomal doxorubicin or topotecan
Or The regular dosage of Abevmy; 15mg/kg of Abevmy given through IV for every 3 weeks by combining with topotecan
The usual dose of Abevmy for Platinum responsive; 15mg/kg given IV for 3 weeks in concomitant with carboplatin and paclitaxel for 6 to 8 cycles
The recommended dosage of Abevmy; 15mg/kg of Abevmy given IV for 3 weeks by combining with gemcitabine & carboplatin for 6 to 10 cycles.

Preparation & administration:

Abevmy is intravenous solution
At initial infusion: given IV infusion over 90 minutes
Following infusions: give second infusion over 60 minutes, if tolerated
Administer all following infusion over 30minutes
Abevmy IV infusion is prepared in aseptic condition
Abevmy 400mg containing 16ml solution whereas 100mg containing 4ml
Abevmy dilute into 100ml of 0.9% NS
Do not dilute with dextrose solution
Dispose the remaining drug which is left in a vial under guidance of pharmacist.

MECHANISM OF ACTION

Abevmy 400mg constitute an active ingredient like Bevacizumab which joined to VEGF and will not have communication of VEGF to its receptors like Flt-1 & KDR that present on the surface of the cells.
While this interaction inhibits endothelial cell proliferation and new blood vessel production occurs
Hence in counts discontinuation of metastatic tumor cells growth happens

PHARMACOKINETICS

The pharmacokinetic form of Abevmy is assayed by measuring total serum Bevacizumab concentration.

Distribution:

The volume of distribution is 2.9 (22%) L

Elimination:

The terminal half-life period of Bevacizumab is 20days (11 to 50days)

PRECAUTIONS

Caution with use in the conditions like;
Previously If you have taking or ever had DPD (dihydropyridine dehydrogenase) deficiency of enzyme.Inform the doctor about this then your doctor may preferably inform you avoid taking Abevmy 400mg.
Discuss with the doctor that you have or have ever had renal, hepatic, or cardiac problem
Discuss with the doctor that are you pregnant or plan to become pregnant. Avoid planning to have children while on treatment with Abevmy 100mg. You should use an essential method of conceiving to prevent pregnancy in yourself or your partner during your treatment with Abevmy 400mg. The drug will harm the fetus.
Avoid breast feeding while on treatment with Abevmy 400mg
While using Abevmy 400mg these are some other complications occurred during therapy, care should be taken
Hypertension
Posterior reversible encephalopathy syndrome
Gastrointestinal perforations
Wound healing complications
Hemorrhage
Arterial thromboembolic events
Venous thromboembolic events
Embryo fetal toxicity occurs.

DRUG INTERACTION

While interaction of Abevmy 400mg with paclitaxel & Carboplatin, leads to lowering in exposure of paclitaxel after four cycles of therapy. Interaction of Abevmy 400mg with paclitaxel & Carboplatin leads to increase the paclitaxel exposure at day 6

CONTRAINDICATION

No contraindication occurred

SIDE EFFECTS

Gastrointestinal perforation and fistulae
Surgery and wound healing complication
Hemorrhage
Arterial thromboembolic events
Venous thromboembolic events
Hypertension
Posterior reversible encephalopathy syndrome
Renal injury & Proteinuria
Infusion reactions
Ovarian failure
Congestive heart failure
Neutropenia, mucosal inflammation, infection, neuropathy, Epistaxis, erythrodysesthesia.

STORAGE

Abevmy 400mg vial should be stored at 2 to 8℃ (36 to 46℉)
Single use vial
Discard the left-out medicine under guidance of pharmacist

MISSED DOSE

If patient fail to take the dose or missed the cycle means must consult with oncologist and follow the regular dosing schedule Do not take overdose