Ixabepilone Dosage

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Breast Cancer

40 mg/m2 infused intravenously over 3 hours every 3 weeks. The dosage for patients with a BSA exceeding 2.2 m2 should be calculated based on a 2.2 m2 body surface area.

Premedication: all patients must be premedicated approximately 1 hour prior to ixabepilone administration (to minimize the chance of a hypersensitivity reaction) as follows:
1. with an H1 antagonist (e.g., diphenhydramine 50 mg orally or an equivalent agent) plus
2. an H2 antagonist (e.g., ranitidine 150 mg to 300 mg orally or an equivalent agent)

Patients experiencing a hypersensitivity reaction in one cycle of ixabepilone treatment must be premedicated in subsequent cycles with a corticosteroid (e.g., dexamethasone 20 mg intravenously 30 minutes prior to ixabepilone infusion, or orally 60 minutes prior to infusion) in addition to the H1 and H2 antagonists. Extension of the infusion time should also be considered.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

The dosage of ixabepilone in patients with hepatic impairment is dependent on the patient's level of hepatic impairment.

Combination therapy: Ixabepilone in combination with capecitabine is contraindicated in patients with AST or ALT greater than or equal to 2.5 times the upper limit of normal (ULN), or in patients with a bilirubin of greater than 1 times the ULN. Patients with AST or ALT less than or equal to 2.5 times the ULN and bilirubin less than or equal to 1 times the ULN may receive the standard dose of 40 mg/m2 infused intravenously over 3 hours every 3 weeks.

Monotherapy: Ixabepilone is not recommended for use as monotherapy in patients with AST or ALT greater than 10 times the ULN, or in patients with a bilirubin of greater than 3 times the ULN. Patients with AST or ALT less than or equal to 2.5 times the ULN and bilirubin less than or equal to 1 times the ULN may receive the standard dose of 40 mg/m2 infused intravenously over 3 hours every 3 weeks. Patients with AST or ALT less than or equal to 10 times the ULN and bilirubin less than or equal to 1 times the ULN may be given 32 mg/m2 infused intravenously over 3 hours every 3 weeks. Patients with AST or ALT less than or equal to 10 times the ULN and bilirubin greater than 1.5 but less than or equal to 3 times the ULN may be given 20 to 30 mg/m2 infused intravenously over 3 hours every 3 weeks.

Dose Adjustments

Dose adjustments are necessary in patients experiencing both hematologic and nonhematologic toxicities depending on whether or not ixabepilone is used in combination with capecitabine. The following dosage adjustment recommendations should be followed for monotherapy based on the type of toxicity:

Nonhematologic:
Grade 2 neuropathy (moderate) lasting 7 days or more: decrease the dose by 20%
Grade 3 neuropathy (severe) lasting less than 7 days: decrease the dose by 20%
Grade 3 neuropathy (severe) lasting 7 days or more or disabling neuropathy: discontinue treatment
Any grade 3 toxicity (severe) other than neuropathy: decrease the dose by 20%
Transient grade 3 arthralgia/myalgia or fatigue/Grade 3 hand-foot syndrome (palmar-plantar erythrodysesthesia): no change in dose of ixabepilone
Any grade 4 toxicity (disabling): discontinue treatment

Hematologic:
Neutrophil less than 500 cells/mm3 for 7 days or more: decrease the dose by 20%
Febrile neutropenia: decrease the dose by 20%
Platelets less than 25,000/mm3 or platelets less than 50,000/mm3 with bleeding: decrease the dose by 20%

The following dosage adjustment recommendations should be followed for combination therapy with capecitabine based on the type of toxicity:

Nonhematologic: Dose according to capecitabine labeling

Hematologic:
Platelets less than 25,000/mm3 or less than 50,000/mm3 with bleeding: hold for concurrent diarrhea or stomatitis until platelet count greater than 50,000/mm3, then continue at same dose.
Neutrophils less than 500 cells/mm3 for 7 days or more or febrile neutropenia: hold for concurrent diarrhea or stomatitis until neutrophil count greater than 1000 cells/mm3, then continue at same dose.

In addition, if toxicities recur, an additional dosage reduction of 20% should be made.

Dosage adjustments at the beginning of a cycle should be based on nonhematologic toxicity or blood counts from the preceding cycle. Patients should not begin a new cycle of treatment unless the neutrophil count is at least 1500 cells/mm3, the platelet count is at least 100,000 cells/mm3, and the nonhematologic toxicities have improved to grade 1 or have resolved.

Precautions

Efficacy has not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Hide
(web3)