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Warnings 

EMBRYO-FETAL TOXICITY

IMPAVIDO may cause fetal harm. Fetal death and teratogenicity occurred in animals administered miltefosine at doses lower than the recommended human dose. Do not administer IMPAVIDO to pregnant women. Obtain a serum or urine pregnancy test in females of reproductive potential prior to prescribing IMPAVIDO. Females of reproductive potential should be advised to use effective contraception during IMPAVIDO therapy and for 5 months after therapy.

Description 

Description:
IMPAVIDO capsules contain the active ingredient miltefosine, an antileishmanial agent. The chemical name of miltefosine is 2-[[(hexadecyloxy)hydroxyphosphenyl]oxy]-N,N,Ntrimethylethylammonium inner salt. Miltefosine is a white powder that is freely soluble in water, 0.1 N HCl or NaOH, methanol, and ethanol. It has the empirical formula of C21H46NO4P with a molecular weight of 407.6

Clinical pharmacology

Mechanism of Action:
Miltefosine is an anti-leishmanial agent.

Indications and usage 

INDICATIONS AND USAGE:
IMPAVIDO (miltefosine) capsules are indicated in adults and adolescents geq 12 years of age weighing geq30 kg for the treatment of:

  • Visceral leishmaniasis caused by Leishmania donovani [see see package insert for Clinical Trials].
  • Cutaneous leishmaniasis caused by Leishmania braziliensis, Leishmania guyanensis, and Leishmania panamensis [see package insert for Clinical Trials].
  • Mucosal leishmaniasis caused by Leishmania braziliensis [see  see package insert for Clinical Trials].

Limitations of Use

  • Leishmania species studied in clinical trials evaluating IMPAVIDO were based on epidemiologic data .
  • There may be geographic variation in clinical response of the same Leishmania species to IMPAVIDO.
  • The efficacy of IMPAVIDO in the treatment of other Leishmania species has not been evaluated.

Contraindications

Contraindications:
Pregnancy
Sjögren-Larsson-Syndrome
Hypersensitivity to miltefosine or any of its excipients

Precautions

WARNINGS AND PRECAUTIONS:

  1. Embryo Fetal Toxicity. Do not use in pregnant women. Obtain a urine or serum pregnancy test prior to initiation of therapy. Advise use of effective contraception in females of reproductive potential (Boxed
    Warning).
  2. Reproductive effects. Miltefosine caused testicular atrophy and impaired fertility in male rats and impaired fertility in female rats. Advise patients of reproductive toxicities in animal studies and that the
    potential effects on human fertility have not been adequately evaluated
  3. Renal Effects. Monitor serum creatinine during therapy and for 4 weeks
    after end of therapy
  4. Hepatic Effects. Monitor transaminases and bilirubin during therapy
  5. Gastrointestinal Effects. Encourage fluid intake (5.5).
  6. Thrombocytopenia. Monitor platelet count during therapy for visceral
    leishmaniasis
  7. Absorption of Oral Contraceptives. Advise use of alternative method of contraception if vomiting and/or diarrhea occur
  8. Stevens-Johnson syndrome. Discontinue IMPAVIDO

Adverse reactions

ADVERSE REACTIONS:

Adverse reactions occurring in geq2% of patients include nausea,
vomiting, diarrhea, headache, decreased appetite,dizziness, abdominal
pain, pruritus, somnolence, elevated transaminases, and elevated creatinine

See PACKAGE INSERT for PATIENT COUNSELING INFORMATION and Medication Guide.

DRUG INTERACTIONS
——————————-
•IMPAVIDO did not inhibit human cytochrome P450 enzymes in vitro.
•IMPAVIDO did not induce cytochrome 3A activity in rats

Dosage and administration 

DOSAGE AND ADMINISTRATION:
The treatment duration is 28 consecutive days. Administer with food to ameliorate gastrointestinal adverse reactions.

Miltefosine Dosage

Weight Dosage and Administration
30 kg to 44 kg One 50 mg capsule twice daily with food (breakfast and dinner)
45 kg or greater One 50 mg capsule three times daily with food (breakfast, lunch, and dinner)

 

How supplied

DOSAGE FORMS AND STRENGTHS:

IMPAVIDO® (miltefosine) oral capsules are opaque, red, hard gelatin capsules with “PLB” imprinted on the capsule body and “MILT 50” imprinted on the cap using a white ink. Each capsule contains 50 mg miltefosine [see DESCRIPTION, Storage and Handling].

Storage And Handling
Each IMPAVIDO capsule contains 50 mg miltefosine in an opaque, red, hard gelatin capsule. IMPAVIDO capsules are supplied in a folded peel/push-through blister card. Each blister card contains 14 capsules. Each carton contains two blister cards (NDC 61744-050-01).

Store at 20-25°C (68–77 °F); excursions permitted to 15-30°C (59 – 86°F). [See USP Controlled Room Temperature]. Protect from moisture.

Dispense only in the original carton.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user’s use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer