General MedicationsORALHigh Alert

Kalydeco

IVACAFTOR

Standard Dose

2 DOSAGE AND ADMINISTRATION Age Weight Dosage Administration 1 month to less than 2 months 3 kg or greater One 5.8 mg packet every 12 hours Mixed with one teaspoon (5 mL) of soft food or liquid and administered orally with fat-containing food 2 months to less than 4 months 3 kg or greater One 13.4 mg packet every 12 hours 4 months to less than 6 months 5 kg or greater One 25 mg packet every 12 hours 6 months to less than 6 years 5 kg to less than 7 kg One 25 mg packet every 12 hours 7 kg to less than 14 kg One 50 mg packet every 12 hours 14 kg or greater One 75 mg packet every 12 hours 6 years and older - One 150 mg tablet every 12 hours Taken orally with fat-containing food See full prescribing information for the recommended dosage in patients aged 6 months and older with moderate or severe hepatic impairment. ( 2.3 , 8.6 ) See full prescribing information for dosage modifications due to drug interactions with KALYDECO. ( 2.4 , 7.1 ) Not recommended in pediatric patients less than 1 month of age. ( 2.2 , 8.4 ) Not recommended in patients 1 month to less than 6 months of age with any level of hepatic impairment and/or taking concomitant moderate or strong CYP3A inhibitors. ( 2.3 , 2.4 , 8.6 ) 2.1 Recommended Dosage in Adults and Pediatric Patients Aged 6 Years and Older The recommended dosage of KALYDECO for adults and pediatric patients aged 6 years and older is 150 mg orally every 12 hours (300 mg total daily dose) with fat-containing food [ see Dosage and Administration (2.5) ]. 2.2 Recommended Dosage in Pediatric Patients Aged 1 Month to Less than 6 Years The recommended dosage of KALYDECO (oral granules) for pediatric patients aged 1 month to less than 6 years is weight-based provided in Table 1. Take KALYDECO orally with fat-containing food [see Dosage and Administration (2.5) ] . Table 1: Recommended Dosage of KALYDECO Oral Granules by Body Weight in Pediatric Patients Aged 1 Month to Less than 6 Years Age Body Weight (kg) KALYDECO Dosage 1 month to less than 2 months KALYDECO is not recommended for use in pediatric patients under 1 month of age. Use of KALYDECO in pediatric patients aged 1 to less than 6 months born at a gestational age less than 37 weeks has not been evaluated. 3 kg or greater One packet (containing 5.8 mg ivacaftor) every 12 hours 2 months to less than 4 months 3 kg or greater One packet (containing 13.4 mg ivacaftor) every 12 hours 4 months to less than 6 months 5 kg or greater One packet (containing 25 mg ivacaftor) every 12 hours 6 months to less than 6 years of age 5 kg to less than 7 kg One packet (containing 25 mg ivacaftor) every 12 hours 7 kg to less than 14 kg One packet (containing 50 mg ivacaftor) every 12 hours 14 kg or greater One packet (containing 75 mg ivacaftor) every 12 hours 2.3 Recommended Dosage for Patients with Hepatic Impairment KALYDECO is not recommended in patients less than 6 months of age with any level of hepatic impairment. The following is the recommended dosage of KALYDECO taken with fat-containing food [see Dosage and Administration (2.5) ] for patients aged 6 months and older with hepatic impairment: Mild Hepatic Impairment (Child-Pugh Class A): Less than 6 months of age: KALYDECO is not recommended. No dosage adjustment is necessary for patients aged 6 months or older [see Clinical Pharmacology (12.3) ] . Moderate Hepatic Impairment (Child-Pugh Class B): Less than 6 months of age: KALYDECO is not recommended. 6 months to less than 6 years of age: one packet (containing 25 mg, 50 mg, or 75 mg ivacaftor) of oral granules once daily based on dosing recommended for age and weight in Table 1 [see Dosage and Administration (2.2) ]. 6 years of age and older: 150 mg orally once daily. Severe Hepatic Impairment (Child-Pugh Class C): Should not be used in patients less than 6 months of age. In patients aged 6 months and older should be used with caution. KALYDECO has not been studied in patients with severe hepatic impairment (Child-Pugh Class C), but exposure is expected to be higher than in patients with moderate hepatic impairment. Therefore, use with caution at a reduced dosage, in patients aged 6 months or older with severe hepatic impairment after weighing the risks and benefits of treatment [see Dosage and Administration (2.1 , 2.2) and Clinical Pharmacology (12.3) ] . Less than 6 months of age: KALYDECO is not recommended. 6 months to less than 6 years of age: one packet (containing 25 mg, 50 mg, or 75 mg ivacaftor) of oral granules once daily or less frequently based on dosing recommended for age and weight in Table 1 [see Dosage and Administration (2.2) ]. 6 years of age and older: 150 mg orally once daily or less frequently. 2.4 Dosage Modification for Patients Taking Drugs that are CYP3A Inhibitors Concomitant use of moderate or strong CYP3A inhibitors is not recommended in patients below 6 months of age. Food or drink containing grapefruit should be avoided [see Drug Interactions (7.1) and Clinical Pharmacology (12.3) ]. Take KALYDECO with fat-containing food [see Dosage and Administration (2.5) ]. Dosage modification for patients 6 months of age and older taking CYP3A inhibitors : Moderate CYP3A inhibitors: Less than 6 months of age: KALYDECO is not recommended. 6 months to less than 6 years of age: one packet (containing 25 mg, 50 mg, or 75 mg ivacaftor) of oral granules once daily based on dosing recommended for age and weight in Table 1 [see Dosage and Administration (2.2) ]. 6 years of age and older: 150 mg orally once daily. Strong CYP3A inhibitors : Less than 6 months of age: KALYDECO is not recommended. 6 months to less than 6 years of age: one packet (containing 25 mg, 50 mg, or 75 mg ivacaftor) of oral granules twice a week based on dosing recommended for age and weight in Table 1 [see Dosage and Administration (2.2) ]. 6 years of age and older: 150 mg orally twice weekly. 2.5 Administration Information Administer KALYDECO tablets or oral granules with fat-containing food. Examples include eggs, butter, peanut butter, cheese pizza, whole-milk dairy products (such as whole milk, cheese, yogurt, breast milk, or infant formula), etc. [see Clinical Pharmacology (12.3) ]. Instruction for Administration of Tablets Swallow tablets whole. Instruction for Administration of Oral Granules Administer each dose of KALYDECO oral granules immediately before or after ingestion of fat-containing food. Mix the entire contents of each packet of oral granules with one teaspoon (5 mL) of age-appropriate soft food or liquid that is at or below room temperature. Some examples of soft foods or liquids may include puréed fruits or vegetables, yogurt, applesauce, water, breast milk, infant formula, milk, or juice. Food or liquid should be at or below room temperature. Once mixed, the product should be completely consumed within one hour.

Max Dose

See official label

Primary Use

1 INDICATIONS AND USAGE KALYDECO is indicated for the treatment of cystic fibrosis (CF) in patients aged 1 month and older who have at least one mutation in the CFTR gene that is responsive to ivacaftor potentiation based on clinical and/or in vitro assay data [see Clinical Pharmacology (12.1) and Clinical Studies (14) ] .

Summary

If the patient's genotype is unknown, an FDA-cleared CF mutation test should be used to detect the presence of a CFTR mutation followed by verification with bi-directional sequencing when recommended by the mutation test instructions for use.

Structured Monograph

Clinical summary

Indications and usage 1 INDICATIONS AND USAGE KALYDECO is indicated for the treatment of cystic fibrosis (CF) in patients aged 1 month and older who have at least one mutation in the CFTR gene that is responsive to ivacaftor potentiation based on clinical and/or in vitro assay data [see Clinical Pharmacology (12.1) and Clinical Studies (14) ] . If the patient's genotype is unknown, an FDA-cleared CF mutation test should be used to detect the presence of a CFTR mutation followed by verification with bi-directional sequencing when recommended by the mutation test instructions for use. KALYDECO is a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator indicated for the treatment of cystic fibrosis (CF) in patients aged 1 month and older who have at least one mutation in the CFTR gene that is responsive to ivacaftor based on clinical and/or in vitro assay data. ( 12.1 , 14 ) If the patient's genotype is unknown, an FDA-cleared CF mutation test should be used to detect the presence of a CFTR mutation followed by verification with bi-directional sequencing when recommended by the mutation test instructions for use. ( 1 ) Dosage and administration 2 DOSAGE AND ADMINISTRATION Age Weight Dosage Administration 1 month to less than 2 months 3 kg or greater One 5.8 mg packet every 12 hours Mixed with one teaspoon (5 mL) of soft food or liquid and administered orally with fat-containing food 2 months to less than 4 months 3 kg or greater One 13.4 mg packet every 12 hours 4 months to less than 6 months 5 kg or greater One 25 mg packet every 12 hours 6 months to less than 6 years 5 kg to less than 7 kg One 25 mg packet every 12 hours 7 kg to less than 14 kg One 50 mg packet every 12 hours 14 kg or greater One 75 mg packet every 12 hours 6 years and older - One 150 mg tablet every 12 hours Taken orally with fat-containing food See full prescribing information for the recommended dosage in patients aged 6 months and older with moderate or severe hepatic impairment. ( 2.3 , 8.6 ) See full prescribing information for dosage modifications due to drug interactions with KALYDECO. ( 2.4 , 7.1 ) Not recommended in pediatric patients less than 1 month of age. ( 2.2 , 8.4 ) Not recommended in patients 1 month to less than 6 months of age with any level of hepatic impairment and/or taking concomitant moderate or strong CYP3A inhibitors. ( 2.3 , 2.4 , 8.6 ) 2.1 Recommended Dosage in Adults and Pediatric Patients Aged 6 Years and Older The recommended dosage of KALYDECO for adults and pediatric patients aged 6 years and older is 150 mg orally every 12 hours (300 mg total daily dose) with fat-containing food [ see Dosage and Administration (2.5) ]. 2.2 Recommended Dosage in Pediatric Patients Aged 1 Month to Less than 6 Years The recommended dosage of KALYDECO (oral granules) for pediatric patients aged 1 month to less than 6 years is weight-based provided in Table 1. Take KALYDECO orally with fat-containing food [see Dosage and Administration (2.5) ] . Table 1: Recommended Dosage of KALYDECO Oral Granules by Body Weight in Pediatric Patients Aged 1 Month to Less than 6 Years Age Body Weight (kg) KALYDECO Dosage 1 month to less than 2 months KALYDECO is not recommended for use in pediatric patients under 1 month of age. Use of KALYDECO in pediatric patients aged 1 to less than 6 months born at a gestational age less than 37 weeks has not been evaluated. 3 kg or greater One packet (containing 5.8 mg ivacaftor) every 12 hours 2 months to less than 4 months 3 kg or greater One packet (containing 13.4 mg ivacaftor) every 12 hours 4 months to less than 6 months 5 kg or greater One packet (containing 25 mg ivacaftor) every 12 hours 6 months to less than 6 years of age 5 kg to less than 7 kg One packet (containing 25 mg ivacaftor) every 12 hours 7 kg to less than 14 kg One packet (containing 50 mg ivacaftor) every 12 hours 14 kg or greater One packet (containing 75 mg ivacaftor) every 12 hours 2.3 Recommended Dosage for Patients with Hepatic Impairment KALYDECO is not recommended in patients less than 6 months of age with any level of hepatic impairment. The following is the recommended dosage of KALYDECO taken with fat-containing food [see Dosage and Administration (2.5) ] for patients aged 6 months and older with hepatic impairment: Mild Hepatic Impairment (Child-Pugh Class A): Less than 6 months of age: KALYDECO is not recommended. No dosage adjustment is necessary for patients aged 6 months or older [see Clinical Pharmacology (12.3) ] . Moderate Hepatic Impairment (Child-Pugh Class B): Less than 6 months of age: KALYDECO is not recommended. 6 months to less than 6 years of age: one packet (containing 25 mg, 50 mg, or 75 mg ivacaftor) of oral granules once daily based on dosing recommended for age and weight in Table 1 [see Dosage and Administration (2.2) ]. 6 years of age and older: 150 mg orally once daily. Severe Hepatic Impairment (Child-Pugh Class C): Should not be used in patients less than 6 months of age. In patie

Monitoring

• 5 WARNINGS AND PRECAUTIONS Elevated transaminases (ALT or AST): Transaminases (ALT and AST) should be assessed prior to initiating KALYDECO, every 3 months during the first year of treatment, and annually thereafter.
• In patients with a history of transaminase elevations, more frequent monitoring of liver function tests should be considered.
• Patients who develop increased transaminase levels should be closely monitored until the abnormalities resolve.
• Interrupt dosing in patients with ALT or AST of greater than 5 times the upper limit of normal (ULN).

Interaction Notes

• 7 DRUG INTERACTIONS Potential for other drugs to affect ivacaftor CYP3A inhibitors: Reduce KALYDECO dosage in patients aged 6 months and older when co-administered with strong CYP3A inhibitors (e.g., ketoconazole) or moderate CYP3A inhibitors (e.g., fluconazole).
• KALYDECO is not recommended in patients aged 1 month to less than 6 months when co-administered with strong or moderate CYP3A inhibitors.
• Avoid food or drink containing grapefruit.
• ( 2.4 , 7.1 ) 7.1 Inhibitors of CYP3A Ivacaftor is a sensitive CYP3A substrate.