Tasigna Dosage

Generic name: NILOTINIB 200mg
Dosage form: capsule
Drug class: BCR-ABL tyrosine kinase inhibitors

Medically reviewed by Drugs.com. Last updated on Feb 29, 2024.

Recommended Dosage

Dose Tasigna twice daily at approximately 12-hour intervals on an empty stomach. No food should be consumed for at least 2 hours before the dose is taken and for at least 1 hour after the dose is taken. Advise patients to swallow the capsules whole with water [see Boxed Warning, Clinical Pharmacology (12.3)].

For patients who are unable to swallow capsules, the contents of each capsule may be dispersed in 1 teaspoon of applesauce (puréed apple). The mixture should be taken immediately (within 15 minutes) and should not be stored for future use [see Clinical Pharmacology (12.3)].

Tasigna may be given in combination with hematopoietic growth factors, such as erythropoietin or G-CSF if clinically indicated. Tasigna may be given with hydroxyurea or anagrelide if clinically indicated.

Dosage in Adult Patients with Newly Diagnosed Ph+ CML-CP

The recommended dosage of Tasigna is 300 mg orally twice daily.

Dosage in Adult Patients with Resistant or Intolerant Ph+ CML-CP and CML-AP

The recommended dosage of Tasigna is 400 mg orally twice daily.

Dosage in Pediatric Patients with Newly Diagnosed Ph+ CML-CP or Resistant or Intolerant Ph+ CML-CP and CML-AP

The recommended dosage of Tasigna for pediatric patients is 230 mg/m2 orally twice daily, rounded to the nearest 50 mg dose (to a maximum single dose of 400 mg) (see Table 1). If needed, attain the desired dose by combining different strengths of Tasigna capsules. Continue treatment as long as clinical benefit is observed or until unacceptable toxicity occurs.

Table 1: Pediatric Dosing of Tasigna (230 mg/m2 Twice Daily, Maximum Single Dose of 400 mg)
Body surface area	Single dose	Total daily dose
Up to 0.32 m2	50 mg	100 mg
0.33 – 0.54 m2	100 mg	200 mg
0.55 – 0.76 m2	150 mg	300 mg
0.77 – 0.97 m2	200 mg	400 mg
0.98 – 1.19 m2	250 mg	500 mg
1.20 – 1.41 m2	300 mg	600 mg
1.42 – 1.63 m2	350 mg	700 mg
≥ 1.64 m2	400 mg	800 mg

Discontinuation of Treatment After a Sustained Molecular Response (MR4.5) on Tasigna

Patient Selection

Eligibility for Discontinuation of Treatment

Ph+ CML-CP patients with typical BCR-ABL transcripts, who have been taking Tasigna for a minimum of 3 years and have achieved a sustained molecular response (MR4.5, corresponding to = BCR-ABL/ABL ≤ 0.0032% IS), may be eligible for treatment discontinuation [see Clinical Studies (14.3, 14.4)]. Information on FDA authorized tests for the detection and quantitation of BCR-ABL transcripts to determine eligibility for treatment discontinuation is available at http://www.fda.gov/CompanionDiagnostics.

Patients with typical BCR-ABL transcripts (e13a2/b2a2 or e14a2/b3a2), who achieve the sustained MR4.5 criteria, are eligible for discontinuation of Tasigna. Patients must continue to be monitored for possible loss of molecular remission after treatment discontinuation. Use the same FDA-authorized test to consistently monitor molecular response levels while on and off treatment.

Consider discontinuation in patients with newly diagnosed Ph+ CML-CP who have:

been treated with Tasigna for at least 3 years
maintained a molecular response of at least MR4.0 (corresponding to = BCR-ABL/ABL ≤ 0.01% IS) for one year prior to discontinuation of therapy
achieved an MR4.5 for the last assessment taken immediately prior to discontinuation of therapy
been confirmed to express the typical BCR-ABL transcripts (e13a2/b2a2 or e14a2/b3a2)
no history of accelerated phase or blast crisis
no history of prior attempts of treatment-free remission discontinuation that resulted in relapse.

Consider discontinuation in patients with Ph+ CML-CP that are resistant or intolerant to imatinib who have achieved a sustained molecular response (MR4.5) on Tasigna who have:

been treated with Tasigna for a minimum of 3 years
been treated with imatinib only prior to treatment with Tasigna
achieved a molecular response of MR4.5 (corresponding to = BCR-ABL/ABL ≤ 0.0032% IS)
sustained an MR4.5 for a minimum of one year immediately prior to discontinuation of therapy
been confirmed to express the typical BCR-ABL transcripts (e13a2/b2a2 or e14a2/b3a2)
no history of accelerated phase or blast crisis
no history of prior attempts of treatment-free remission discontinuation that resulted in relapse.

Monitor BCR-ABL transcript levels and complete blood count (CBC) with differential in patients who have discontinued Tasigna therapy monthly for one year, then every 6 weeks for the second year, and every 12 weeks thereafter [see Warnings and Precautions (5.16)].

Upon the loss of MR4.0 (corresponding to = BCR-ABL/ABL ≤ 0.01% IS) during the treatment-free phase, monitor BCR-ABL transcript levels every 2 weeks until BCR-ABL levels remain lower than major molecular response [(MMR), corresponding to MR3.0 or = BCR-ABL/ABL ≤ 0.1% IS] for 4 consecutive measurements. The patient can then proceed to the original monitoring schedule.

Reinitiation of Treatment in Patients Who Lose Molecular Response After Discontinuation of Therapy With Tasigna

Newly diagnosed patients who lose MMR must reinitiate treatment within 4 weeks at the dose level prior to discontinuation of therapy [see Warnings and Precautions (5.16)]. Patients who reinitiate Tasigna therapy should have their BCR-ABL transcript levels monitored monthly until major molecular response is re-established and every 12 weeks thereafter.
Patients resistant or intolerant to prior treatment that included imatinib with confirmed loss of MR4.0 (2 consecutive measures separated by at least 4 weeks showing loss of MR4.0) or loss of MMR must reinitiate treatment within 4 weeks at the dose level prior to discontinuation of therapy [see Warnings and Precautions (5.16)]. Patients who reinitiate Tasigna therapy should have their BCR-ABL transcript levels monitored monthly until previous major molecular response or MR4.0 is re-established and every 12 weeks thereafter.

Dosage Modification for QT Interval Prolongation

See Table 2 for dose adjustments for QT interval prolongation [see Warnings and Precautions (5.2), Clinical Pharmacology (12.2)].

Table 2: Dosage Adjustments for Adult and Pediatric Patients With QT Prolongation
Abbreviation: ECG, electrocardiogram.
Degree of QTc prolongation	Dosage adjustment
ECGs with a QTc greater than 480 msec	1. Withhold Tasigna, and perform an analysis of serum potassium and magnesium, and if below lower limit of normal, correct with supplements to within normal limits. Concomitant medication usage must be reviewed. 2. Resume within 2 weeks at prior dose if QTcF returns to less than 450 msec and to within 20 msec of baseline. 3. If QTcF is between 450 msec and 480 msec after 2 weeks, reduce the dose to 400 mg once daily in adults and 230 mg/m2 once daily in pediatric patients. 4. Discontinue Tasigna if, following dose-reduction to 400 mg once daily in adults and 230 mg/m2 once daily in pediatric patients, QTcF returns to greater than 480 msec. 5. An ECG should be repeated approximately 7 days after any dose adjustment.

Dosage Modifications for Myelosuppression

Withhold or reduce Tasigna dosage for hematological toxicities (neutropenia, thrombocytopenia) that are not related to underlying leukemia (Table 3) [see Warnings and Precautions (5.1)].

Table 3: Dosage Adjustments for Neutropenia and Thrombocytopenia
Abbreviations: ANC, absolute neutrophil count; Ph+ CML, Philadelphia chromosome positive chronic myeloid leukemia.
Diagnosis	Degree of myelosuppression	Dosage adjustment
Adult patients with: Newly diagnosed Ph+ CML in chronic phase at 300 mg twice daily Resistant or intolerant Ph+ CML in chronic phase or accelerated phase at 400 mg twice daily	ANC less than 1.0 x 109/L and/or platelet counts less than 50 x 109/L	1. Stop Tasigna, and monitor blood counts. 2. Resume within 2 weeks at prior dose if ANC greater than 1.0 x 109/L and platelets greater than 50 x 109/L. 3. If blood counts remain low for greater than 2 weeks, reduce the dose to 400 mg once daily.
Pediatric patients with: Newly diagnosed Ph+ CML in chronic phase at 230 mg/m2 twice daily Resistant or intolerant Ph+ CML in chronic phase at 230 mg/m2 twice daily	ANC less than 1.0 x 109/L and/or platelet counts less than 50 x 109/L	1. Stop Tasigna and monitor blood counts. 2. Resume within 2 weeks at prior dose if ANC greater than 1.5 x 109/L and/or platelets greater than 75 x 109/L. 3. If blood counts remain low for greater than 2 weeks, a dose reduction to 230 mg/m2 once daily may be required. 4. If event occurs after dose reduction, consider discontinuing treatment.

Dosage Modifications for Selected Non-Hematologic Laboratory Abnormalities and Other Toxicities

See Table 4 for dosage adjustments for elevations of lipase, amylase, bilirubin, and/or hepatic transaminases [see Warnings and Precautions (5.5, 5.6), Adverse Reactions (6.1)].

Table 4: Dosage Adjustments for Selected Non-Hematologic Laboratory Abnormalities
Degree of non-hematologic laboratory abnormality	Dosage adjustment
Elevated serum lipase or amylase greater than or equal to Grade 3	Adult patients: 1. Withhold Tasigna, and monitor serum lipase or amylase. 2. Resume treatment at 400 mg once daily if serum lipase or amylase returns to less than or equal to Grade 1.
	Pediatric patients: 1. Interrupt Tasigna until the event returns to less than or equal to Grade 1. 2. Resume treatment at 230 mg/m2 once daily if prior dose was 230 mg/m2 twice daily; discontinue treatment if prior dose was 230 mg/m2 once daily.
Elevated bilirubin greater than or equal to Grade 3 in adult patients and greater than or equal to Grade 2 in pediatric patients	Adult patients: 1. Withhold Tasigna, and monitor bilirubin. 2. Resume treatment at 400 mg once daily if bilirubin returns to less than or equal to Grade 1.
	Pediatric patients: 1. Interrupt Tasigna until the event returns to less than or equal to Grade 1. 2. Resume treatment at 230 mg/m2 once daily if prior dose was 230 mg/m2 twice daily; discontinue treatment if prior dose was 230 mg/m2 once daily, and recovery to less than or equal to Grade 1 takes longer than 28 days.
Elevated hepatic transaminases greater than or equal to Grade 3	Adult patients: 1. Withhold Tasigna, and monitor hepatic transaminases. 2. Resume treatment at 400 mg once daily if hepatic transaminases returns to less than or equal to Grade 1.
	Pediatric patients: 1. Interrupt Tasigna until the event returns to less than or equal to Grade 1. 2. Resume treatment at 230 mg/m2 once daily if prior dose was 230 mg/m2 twice daily; discontinue treatment if prior dose was 230 mg/m2 once daily, and recovery to less than or equal to Grade 1 takes longer than 28 days.

If clinically significant moderate or severe non-hematologic toxicity develops (including medically severe fluid retention), see Table 5 for dosage adjustments [see Adverse Reactions (6.1)].

Table 5: Dosage Adjustments for Other Non-Hematologic Toxicities
Abbreviations: CML-AP, chronic myeloid leukemia-accelerated phase; CML-CP, chronic myeloid leukemia-chronic phase; Ph+, Philadelphia chromosome positive.
Degree of “other Non-hematologic toxicity”	Dosage adjustment
Other clinically moderate or severe non-hematologic toxicity	Adult patients: 1. Withhold Tasigna until toxicity has resolved. 2. Resume treatment at 400 mg once daily if previous dose was 300 mg twice daily in adult patients newly diagnosed with CML-CP or 400 mg twice daily in adult patients with resistant or intolerant CML-CP and CML-AP. 3. Discontinue treatment if the prior dose was 400 mg once daily in adult patients. 4. If clinically appropriate, consider re-escalation of the dose to 300 mg (newly diagnosed Ph+ CML-CP) or 400 mg (resistant or intolerant Ph+ CML-CP and CML-AP) twice daily.
	Pediatric patients: 1. Interrupt Tasigna until toxicity has resolved. 2. Resume treatment at 230 mg/m2 once daily if previous dose was 230 mg/m2 twice daily; discontinue treatment if prior dose was 230 mg/m2 once daily. 3. If clinically appropriate, consider re-escalation of the dose to 230 mg/m2 twice daily.

Dosage Modification for Hepatic Impairment

If possible, consider alternative therapies. If Tasigna must be administered to patients with hepatic impairment, consider the following dose reduction [see Use in Specific Populations (8.7)]:

Table 6: Dose Adjustments for Adult Patients With Hepatic Impairment
Diagnosis	Degree of hepatic impairment	Dosage adjustment
Newly diagnosed Ph+ CML in chronic phase	Mild (Child-Pugh A), Moderate (Child-Pugh B), or Severe (Child-Pugh C)	Reduce dosage to 200 mg twice daily. Increase dosage to 300 mg twice daily based on tolerability.
Resistant or intolerant Ph+ CML in chronic phase or accelerated phase	Mild or Moderate	Reduce dosage to 300 mg twice daily. Increase dosage to 400 mg twice daily based on tolerability.
	Severe	Reduce dosage to 200 mg twice daily. Increase dosage to 300 mg twice daily and then to 400 mg twice daily based on tolerability.

Dosage Modification With Concomitant Strong CYP3A4 Inhibitors

Avoid the concomitant use of strong CYP3A4 inhibitors. Should treatment with any of these agents be required, interrupt therapy with Tasigna. If patients must be coadministered a strong CYP3A4 inhibitor, reduce dosage to 300 mg once daily in patients with resistant or intolerant Ph+ CML or to 200 mg once daily in patients with newly diagnosed Ph+ CML-CP. However, there are no clinical data with this dose adjustment in patients receiving strong CYP3A4 inhibitors. If the strong inhibitor is discontinued, allow a washout period before adjusting Tasigna dose upward to the indicated dose. For patients who cannot avoid use of strong CYP3A4 inhibitors, monitor closely for prolongation of the QT interval [see Boxed Warning, Warnings and Precautions (5.2), Drug Interactions (7.1, 7.2), Clinical Pharmacology (12.3)].