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Lumacaftor and ivacaftor (Oral)

loo-ma-KAF-tor, eye-va-KAF-tor

Medically reviewed on Oct 31, 2018

Commonly used brand name(s)

In the U.S.

  • Orkambi

Available Dosage Forms:

  • Tablet
  • Granule

Therapeutic Class: Respiratory Agent

Uses For lumacaftor and ivacaftor

Lumacaftor and ivacaftor combination is used to treat cystic fibrosis (CF) in patients 2 years of age and older. It is only used for patients who have two copies of F508del mutation in their CF transmembrane conductance regulator (CFTR) gene. Your doctor will use a test to check for the mutation before you receive the medicine.

Lumacaftor and ivacaftor is available only with your doctor's prescription.

Before Using lumacaftor and ivacaftor

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For lumacaftor and ivacaftor, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to lumacaftor and ivacaftor or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of lumacaftor and ivacaftor combination in children younger than 2 years of age. Safety and efficacy have not been established.

Geriatric

Appropriate studies on the relationship of age to the effects of lumacaftor and ivacaftor combination have not been performed in the geriatric population.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking lumacaftor and ivacaftor, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using lumacaftor and ivacaftor with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Doravirine
  • Isavuconazonium

Using lumacaftor and ivacaftor with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abemaciclib
  • Abiraterone Acetate
  • Acalabrutinib
  • Alfentanil
  • Aprepitant
  • Aripiprazole
  • Atazanavir
  • Axitinib
  • Benzhydrocodone
  • Bictegravir
  • Boceprevir
  • Bosutinib
  • Brigatinib
  • Budesonide
  • Buprenorphine
  • Buspirone
  • Carbamazepine
  • Ciprofloxacin
  • Clarithromycin
  • Clozapine
  • Cobicistat
  • Codeine
  • Conivaptan
  • Copanlisib
  • Crizotinib
  • Cyclosporine
  • Darifenacin
  • Darunavir
  • Dasatinib
  • Deflazacort
  • Desogestrel
  • Dienogest
  • Dihydrocodeine
  • Dihydroergotamine
  • Diltiazem
  • Dronedarone
  • Drospirenone
  • Duvelisib
  • Eletriptan
  • Eliglustat
  • Encorafenib
  • Enzalutamide
  • Eplerenone
  • Eravacycline
  • Ergotamine
  • Erlotinib
  • Erythromycin
  • Estradiol
  • Ethinyl Estradiol
  • Ethynodiol
  • Etonogestrel
  • Everolimus
  • Felodipine
  • Fentanyl
  • Fluconazole
  • Fluticasone
  • Fluvoxamine
  • Fosaprepitant
  • Fosnetupitant
  • Fosphenytoin
  • Fostamatinib
  • Gestodene
  • Hemin
  • Hydrocodone
  • Ibrutinib
  • Idelalisib
  • Imatinib
  • Indinavir
  • Itraconazole
  • Ivabradine
  • Ivosidenib
  • Ketoconazole
  • Letermovir
  • Levonorgestrel
  • Lopinavir
  • Lovastatin
  • Lurasidone
  • Macimorelin
  • Maraviroc
  • Meperidine
  • Mestranol
  • Methadone
  • Midazolam
  • Midostaurin
  • Mitotane
  • Morphine
  • Morphine Sulfate Liposome
  • Nefazodone
  • Nelfinavir
  • Neratinib
  • Netupitant
  • Nilotinib
  • Norethindrone
  • Norgestimate
  • Norgestrel
  • Olaparib
  • Osimertinib
  • Oxycodone
  • Paliperidone
  • Pentazocine
  • Perampanel
  • Phenytoin
  • Pimozide
  • Posaconazole
  • Quetiapine
  • Quinidine
  • Regorafenib
  • Ribociclib
  • Rifampin
  • Ritonavir
  • Saquinavir
  • Sildenafil
  • Simvastatin
  • Sirolimus
  • Stiripentol
  • St John's Wort
  • Sufentanil
  • Tacrolimus
  • Tamoxifen
  • Telaprevir
  • Telithromycin
  • Temsirolimus
  • Thiotepa
  • Tipranavir
  • Tofacitinib
  • Tolvaptan
  • Tramadol
  • Triazolam
  • Ulipristal
  • Valbenazine
  • Vardenafil
  • Velpatasvir
  • Vemurafenib
  • Verapamil
  • Voriconazole
  • Voxilaprevir

Using lumacaftor and ivacaftor with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aripiprazole Lauroxil
  • Risperidone

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using lumacaftor and ivacaftor with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use lumacaftor and ivacaftor, or give you special instructions about the use of food, alcohol, or tobacco.

  • Grapefruit Juice

Other Medical Problems

The presence of other medical problems may affect the use of lumacaftor and ivacaftor. Make sure you tell your doctor if you have any other medical problems, especially:

  • Cataracts or
  • Hypertension (high blood pressure) or
  • Lung or breathing problems or
  • Organ transplant, history of—Use with caution. May make these conditions worse.
  • Kidney disease, severe or
  • Liver disease, moderate to severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of lumacaftor and ivacaftor

Take lumacaftor and ivacaftor exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

Lumacaftor and ivacaftor comes with a patient information insert. Read and follow the instructions carefully. Ask your doctor if you have any questions.

Take lumacaftor and ivacaftor with fat-containing foods such as avocado, butter, cheese pizza, eggs, nuts, peanut butter, or whole milk dairy products (eg, whole milk, cheese, yogurt).

If you are using the granules, mix the entire content of each packet with 1 teaspoon (5 milliliters [mL]) of cool to room temperature soft food (eg, puréed fruits, flavored yogurt, pudding) or liquid (eg, milk, juice). Take this mixture within 1 hour.

Tell your doctor if you stopped taking lumacaftor and ivacaftor for more than 1 week. Your doctor may need to change your dose of Orkambi® or other medicines you take.

Dosing

The dose of lumacaftor and ivacaftor will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of lumacaftor and ivacaftor. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (granules, tablets):
    • For cystic fibrosis:
      • Adults and children 12 years of age and older—2 tablets every 12 hours, taken with fat-containing food. Each tablet contains 200 milligrams (mg) lumacaftor and 125 mg ivacaftor.
      • Children 6 to 11 years of age—2 tablets every 12 hours, taken with fat-containing food. Each tablet contains 100 milligrams (mg) lumacaftor and 125 mg ivacaftor.
      • Children 2 to 5 years of age and weighing 14 kilograms (kg) or more—1 packet of granules every 12 hours, taken with fat-containing food. Each packet contains 150 milligrams (mg) lumacaftor and 188 mg ivacaftor.
      • Children 2 to 5 years of age and weighing less than 14 kg—1 packet of granules every 12 hours, taken with fat-containing food. Each packet contains 100 milligrams (mg) lumacaftor and 125 mg ivacaftor.
      • Children younger than 2 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of lumacaftor and ivacaftor, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you miss a dose and it is 6 hours or less from the time you normally take your medicine, take a dose as soon as you can. If it is more than 6 hours, wait until then to use the medicine and skip the missed dose. Do not take extra medicine to make up for a missed dose.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using lumacaftor and ivacaftor

It is very important that your doctor check your or your child's progress at regular visits to make sure that lumacaftor and ivacaftor is working properly. Blood tests will be needed to check for unwanted effects. You may also need to monitor your blood pressure at home. If you notice any changes to your normal blood pressure, call your doctor right away.

Birth control pills and other forms of hormone-based contraceptives (eg, patches, rings, implants, and injections) may not work while you are using lumacaftor and ivacaftor. To keep from getting pregnant, use another form of birth control (eg, condoms, diaphragm, or a contraceptive foam or jelly) while using Orkambi®.

Liver problems may be more likely to occur if you already have an existing liver disease (eg, cirrhosis). Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin.

Check with your doctor right away if you or your child have a cough, trouble breathing, chest tightness, or any type of breathing problem when starting treatment with lumacaftor and ivacaftor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

Lumacaftor and ivacaftor Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

  • Difficult or labored breathing
  • tightness in the chest
  • upper abdominal or stomach pain

Incidence not known

  • Blurred vision
  • dark urine
  • discomfort in the upper right stomach area
  • dizziness
  • general feeling of tiredness or weakness
  • headache
  • light-colored stools
  • loss of appetite
  • nausea
  • nervousness
  • pounding in the ears
  • slow or fast heartbeat
  • stomach pain, continuing
  • unusual tiredness
  • vomiting
  • yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Absent, missed, or irregular menstrual periods
  • bloated feeling
  • body aches or pain
  • chills
  • cough
  • cough producing mucus
  • cramps
  • diarrhea
  • ear congestion
  • excess air or gas in the stomach or bowels
  • feeling of fullness
  • fever
  • heavy bleeding
  • increased sputum production
  • longer or heavier menstrual periods
  • loss of voice
  • muscle aches
  • passing gas
  • rash
  • sneezing
  • sore throat
  • stopping of menstrual bleeding
  • stuffy or runny nose
  • unusual weakness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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