Warnings and Precautions
- Ocular Toxicities: Ocular toxicities, including visual impairment and vitreoretinal disorders, occurred. Perform comprehensive ophthalmic evaluation at baseline, prior to cycle 2, every three cycles thereafter, and as clinically indicated. Withhold Avmapki Fakzynja Co‑Pack for ocular toxicities until improvement at the same or reduced dose. Permanently discontinue Avmapki Fakzynja Co‑Pack for any grade 4 toxicity.
- Serious Skin Toxicities: Skin toxicities, including photosensitivity and Severe Cutaneous Adverse Reactions (SCARs), occurred. Adhere to concomitant medications. Monitor for skin toxicities and interrupt, reduce or permanently discontinue Avmapki Fakzynja Co‑Pack based on severity, tolerability and duration.
- Hepatotoxicity: Monitor liver function tests prior to each cycle, on day 15 of the first 4 cycles, and as clinically indicated. Withhold, reduce or discontinue Avmapki Fakzynja Co‑Pack based on severity and persistence of abnormality.
- Rhabdomyolysis: Monitor creatine phosphokinase prior to the start of each cycle, on day 15 of the first four cycles, and as clinically indicated. If increased CPK occurs, evaluate patients for rhabdomyolysis or other causes. Withhold, reduce or permanently discontinue Avmapki Fakzynja Co‑Pack based on severity and duration of the adverse reaction.
- Embryo-Fetal Toxicity: Avmapki Fakzynja Co‑Pack can cause fetal harm. Advise patients of the potential risk to a fetus and to use effective contraception.
Adverse Reactions
- The most common (≥ 25%) adverse reactions, including laboratory abnormalities, were increased creatine phosphokinase, nausea, fatigue, increased aspartate aminotransferase, rash, diarrhea, musculoskeletal pain, edema, decreased hemoglobin, increased alanine aminotransferase, vomiting, increased blood bilirubin, increased triglycerides, decreased lymphocyte count, abdominal pain, dyspepsia, dermatitis acneiform, vitreoretinal disorders, increased alkaline phosphatase, stomatitis, pruritus, visual impairment, decreased platelet count, constipation, dry skin, dyspnea, cough, urinary tract infection, and decreased neutrophil count.
Drug Interactions
- Strong and moderate CYP3A4 inhibitors: Avoid concomitant use with Avmapki Fakzynja Co‑Pack.
- Strong and moderate CYP3A4 inducers: Avoid concomitant use with Avmapki Fakzynja Co‑Pack.
- Warfarin: Avoid concomitant use of Avmapki Fakzynja Co‑Pack with warfarin and use an alternative to warfarin.
- Gastric acid reducing agents: Avoid concomitant use of Avmapki Fakzynja Co‑Pack with proton pump inhibitors (PPIs) or H2 receptor antagonists. If use of an acid-reducing agent cannot be avoided, administer Fakzynja 2 hours before or 2 hours after the administration of a locally acting antacid.
Use in Specific Populations
- Lactation: Advise not to breastfeed.
- Fertility: May impair fertility in males and females.
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