Skip to Content

Carfilzomib Dosage

Applies to the following strength(s): 60 mg ; 30 mg

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 Multiple Myeloma

IN COMBINATION WITH LENALIDOMIDE AND DEXAMETHASONE:
-RECOMMENDED DOSE (CYCLE 1): 20 mg/m2 IV, over 10 minutes, in Cycle 1 on Days 1 and 2; if tolerated, increase to the target dose of 27 mg/m2 in Cycle 1 on Days 8, 9, 15, and 16, followed by a 12-day rest period (Days 17 to 28). From Cycle 13, omit the Day 8 and 9 doses. Discontinue therapy after Cycle 18.

Duration of therapy:
-Each 28-day period is considered one treatment cycle.
-Continue maintenance dose until disease progression or until unacceptable toxicity occurs.

Comments:
-The dose is calculated using the patient's actual BSA at baseline. Patients with a BSA greater than 2.2 m2 should receive a dose based upon a BSA of 2.2 m2. Dose adjustments do not need to be made for weight changes of less than or equal to 20%.
-Consult current manufacturer product information for dexamethasone and lenalidomide dosing.
-Continue maintenance dose until disease progression or until unacceptable toxicity occurs.

Use: In combination with lenalidomide and dexamethasone for the treatment of patients with relapsed multiple myeloma who have received 1 to 3 prior lines of therapy

MONOTHERAPY:
-RECOMMENDED DOSE (CYCLE 1): 20 mg/m2 IV, over 10 minutes, in Cycle 1 on Days 1 and 2; if tolerated, increase to the target dose of 27 mg/m2 in Cycle 1 on Days 8, 9, 15, and 16, followed by a 12-day rest period (Days 17 to 28). From Cycle 13, omit the Day 8 and 9 doses.

Duration of therapy:
-Each 28-day period is considered one treatment cycle.

Comments:
-The dose is calculated using the patient's actual BSA at baseline. Patients with a BSA greater than 2.2 m2 should receive a dose based upon a BSA of 2.2 m2. Dose adjustments do not need to be made for weight changes of less than or equal to 20%.
-Consult current manufacturer product information for dexamethasone and lenalidomide dosing.
-Continue maintenance dose until disease progression or until unacceptable toxicity occurs.

Use: As a single agent for the treatment of patients with multiple myeloma who have received at least 2 prior therapies including bortezomib and an immunomodulatory agent and have demonstrated disease progression on or within 60 days of completion of the last therapy

Renal Dose Adjustments

-If renal toxicity (serum creatinine 2 x baseline or greater, OR CrCl is less than 15 mL/min, OR CrCl decreased to 50% or less of baseline, OR need for dialysis) develops during treatment:
-Withhold dose and continue monitoring renal function (serum creatinine or creatinine clearance)
-If attributable to this drug, resume when renal function has recovered to within 25% of baseline; start at 1 dose level reduction
-If not attributable to this drug, dosing may be resumed at the discretion of the physician
-For patients on dialysis receiving this drug, the dose is to be administered after the dialysis procedure.

Liver Dose Adjustments

Cases of hepatic failure (some fatal) have been reported (less than 1%) during treatment with this drug. It can cause increased serum transaminases. Liver enzymes should be monitored regularly and the dose should be reduced or withheld as appropriate.

Dose Adjustments

FOR ALL TOXICITIES:
-Withhold therapy until resolved or returned to baseline.
-Consider restarting the next scheduled treatment at one dose level reduction.

HEMATOLOGIC TOXICITY:
-ABSOLUTE NEUTROPHIL COUNT LESS THAN 0.5 X 10(9)/L: Withhold dose; if recovered to 10 x 10(9)/L and/or bleeding is controlled, continue at the same dose level. For subsequent drops to less than 10 x 10(9) /L, follow the same recommendations as above and consider one dose level reduction when restarting therapy.
PLATELETS LESS THAN 10 X 10(9)/L OR EVIDENCE OF BLEEDING WITH THROMBOCYTOPENIA: Withhold dose; if recovered to greater than or equal to 10 x 10(9)/L and/or bleeding is controlled, continue at the same dose level. For subsequent drops to less than 10 x 10(9) /L, follow the same recommendations as above and consider one dose level reduction when restarting therapy.

RENAL TOXICITY (Serum creatinine greater than or equal to 2 x baseline OR CrCl less than 15 mL/min, OR CrCl decreases to less than or equal to 50% of baseline, OR need for dialysis:
-Withhold dose and continue monitoring renal function (serum creatinine or creatinine clearance).
-If attributable to this drug, resume when renal function has recovered to within 25% of baseline; start at one dose level reduction.
-If not attributable to this drug, dosing may be resumed at the discretion of the physician.
-For patients on dialysis receiving this drug, the dose is to be administered after the dialysis procedure.

Dialysis

This drug should be administered after the dialysis procedure since dialysis clearance of this drug has not been studied.

Other Comments

Administration advice:
-The IV administration line should be flushed with normal saline or 5% dextrose injection immediately before and after drug administration.
-This drug is available for IV use only.
-Do not administer this drug as a bolus.
-Do not mix this drug with or administer as an infusion with other medicinal products.
-HYDRATION: Patients should be hydrated to reduce the risk of renal toxicity and of tumor lysis syndrome. Prior to each dose in Cycle 1, give 250 mL to 500 mL of IV normal saline or other appropriate IV fluid. Give an additional 250 mL to 500 mL of IV fluids as needed following drug administration. Continue IV hydration, as needed, in subsequent cycles. Maintain adequate fluid volume status throughout treatment and monitor for fluid overload and blood chemistries.
-DEXAMETHASONE PRE-MEDICATION: Pre-medicate with dexamethasone 4 mg orally or IV prior to all doses during Cycle 1 and prior to all doses during the first cycle of dose escalation to 27 mg/m2 to reduce the incidence and severity of infusion reactions. Reinstate dexamethasone pre-medication (4 mg orally or IV) if symptoms of infusion reaction develop or reappear during subsequent cycles.

Storage requirements:
-Unopened vials should be stored refrigerated (2 degrees to 8 degree Celsius; 36 degrees to 46 degrees Fahrenheit) and in the original package to protect from light.

Reconstitution/preparation techniques:
-Consult the manufacturer's product information.

General:
-The quantity of drug contained in one single-use via may exceed the required dose; caution should be used in calculating dosage to prevent overdosing.
-Clinical benefit, such as improvement in survival or symptoms, has not been verified.
-Approval of this drug is based on response rate.

Monitoring:
-Cardiovascular: Fluid overload, cardiac complications
-Hematologic: Blood chemistries, platelet counts, Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome
-Hepatic: Liver function (transaminases, bilirubin)
-Nervous: Posterior Reversible Encephalopathy Syndrome
-Oncologic: Tumor Lysis Syndrome
-Other: Infusion reactions (immediately following or up to 24 hours after treatment administration)
-Renal: Renal function (serum creatinine)
-Respiratory: Dyspnea, pulmonary arterial hypertension

Hide