XTANDI is indicated for the treatment of patients with metastatic castration-resistant
prostate cancer (mCRPC) who have previously received docetaxel.
Important Safety Information
Contraindications XTANDI can cause fetal harm when administered
to a pregnant woman based on its mechanism of action. XTANDI is not indicated for
use in women. XTANDI is contraindicated in women who are or may become pregnant.
Warnings and Precautions In the randomized clinical trial,
seizure occurred in 0.9% of patients on XTANDI. No patients on the placebo arm experienced
seizure. Patients experiencing a seizure were permanently discontinued from therapy.
All seizures resolved. Patients with a history of seizure, taking medications known
to decrease the seizure threshold, or with other risk factors for seizure were excluded
from the clinical trial. Because of the risk of seizure associated with XTANDI use,
patients should be advised of the risk of engaging in any activity where sudden
loss of consciousness could cause serious harm to themselves or others.
Adverse Reactions The most common adverse drug reactions (≥
5%) reported in patients receiving XTANDI in the randomized clinical trial were
asthenia/fatigue, back pain, diarrhea, arthralgia, hot flush, peripheral edema,
musculoskeletal pain, headache, upper respiratory infection, muscular weakness,
dizziness, insomnia, lower respiratory infection, spinal cord compression and cauda
equina syndrome, hematuria, paresthesia, anxiety, and hypertension. Grade 1-4 neutropenia
occurred in 15% of XTANDI patients (1% grade 3-4) and in 6% of patients on placebo
(no grade 3-4). Grade 1-4 elevations in bilirubin occurred in 3% of XTANDI
patients and 2% of patients on placebo. One percent of XTANDI patients compared
to 0.3% of patients on placebo died from infections or sepsis. Falls or injuries
related to falls occurred in 4.6% of XTANDI patients vs 1.3% of patients on placebo.
Falls were not associated with loss of consciousness or seizure. Fall-related injuries
were more severe in XTANDI patients and included non-pathologic fractures, joint
injuries, and hematomas. Grade 1 or 2 hallucinations occurred in 1.6% of XTANDI
patients and 0.3% of patients on placebo, with the majority on opioid-containing
medications at the time of the event.
Drug Interactions: Effect of Other Drugs on XTANDI Administration
of strong CYP2C8 inhibitors can increase the plasma exposure to XTANDI. Coadministration
of XTANDI with strong CYP2C8 inhibitors should be avoided if possible. If coadministration
of XTANDI cannot be avoided, reduce the dose of XTANDI. Coadministration of XTANDI
with strong or moderate CYP3A4 and CYP2C8 inducers can alter the plasma exposure
of XTANDI and should be avoided if possible. Effect of XTANDI on Other Drugs
XTANDI is a strong CYP3A4 inducer and a moderate CYP2C9 and CYP2C19 inducer in humans.
Avoid CYP3A4, CYP2C9, and CYP2C19 substrates with a narrow therapeutic index, as
XTANDI may decrease the plasma exposures of these drugs. If XTANDI is coadministered
with warfarin (CYP2C9 substrate), conduct additional INR monitoring.
Please see Full Prescribing Information for complete