Active substanceLetrozoleLetrozole
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  • Dosage form: & nbspfilm coated tablets
    Composition:

    1 tablet, film-coated, contains:

    active substance: letrozole 2.5 mg;

    Excipients: lactose monohydrate 61.5 mg, corn starch 6.0 mg, sodium carboxymethyl starch (type A) 4.0 mg, microcrystalline cellulose 25.0 mg, magnesium stearate 1.0 mg;

    film coating: Opadrai II 85F32410 yellow (polyvinyl alcohol partially hydrolyzed 40%, titanium, dioxide (E 171) 23.50%, macrogol 3350 20.20%, talc 14.80%, iron dye oxide yellow (E 172) 1.50%) - 3, 5 mg.

    Description:

    Round biconvex tablets, covered with a film coating of yellow color.

    Pharmacotherapeutic group:Antitumor agent, estrogen synthesis inhibitor
    ATX: & nbsp

    L.02.B.G.04   Letrozole

    L.02.B.G   Enzyme Inhibitors

    Pharmacodynamics:

    Letrozole has an anti-estrogenic effect, selectively inhibits aromatase (an enzyme for the synthesis of estrogens) by highly specific competitive binding with subunit of this enzyme is the heme cytochrome P450. It blocks the synthesis of estrogens in both peripheral and tumor tissues.

    In postmenopausal women, estrogens are formed predominantly with the participation of the aromatase enzyme, which turns the androgen synthesized in the adrenal gland (primarily androstenedione and testosterone) into estrone and estradiol. Daily intake of letrozole in a daily dose of 0.1-5 mg leads to a decrease in the concentration of estradiol, estrone and estrone sulfate in blood plasma by 75-95% of the original content. Suppression of the synthesis of estrogens is maintained throughout the treatment period.

    When letrozole is used in the dose range from 0.1 to 5 mg, there is no disturbance in the synthesis of steroid hormones in the adrenal glands, the test with ACTH does not reveal violations of the synthesis of aldosterone or cortisol. Additional appointment: glucocorticoids and mineralocorticoids is not required.

    The blockade of the biosynthesis of estrogens does not lead to the accumulation of androgens, which are precursors of estrogens. Against the background of the use of letrozole, there were no changes in the concentrations of luteinizing and follicle-stimulating hormones in the blood plasma, changes in the thyroid function, changes in the lipid profile, an increase in the frequency of myocardial infarction and strokes.

    Against the background of treatment with letrozole, the incidence of osteoporosis is slightly increased (6.9% compared with 5.5% on placebo). However, the incidence of bone fractures in patients receiving letrozole, does not differ from that of healthy people of the same age.

    Adjuvant therapy with letrozole early stages of breast cancer reduces the risk of relapse, increases the disease-free survival for 5 years, reduces the risk of developing secondary tumors.

    Extended adjuvant therapy letrozol reduces the risk of recurrence by 42%.A significant advantage over the disease-free survival in the letrozole group was noted regardless of the involvement of the lymph nodes. Treatment with letrozole reduces the mortality of patients with lymph node involvement by 40%.

    Pharmacokinetics:

    Letrozole is quickly and completely absorbed from the gastrointestinal tract (GIT), the average bioavailability is 99.9%. Food intake slightly reduces the absorption rate. The mean time to reach the maximum concentration of letrozole in the blood (TSmOh) is 1 hour when taking letrozole on an empty stomach and 2 hours - when taking with food; average value1 maximum concentration (CmOh) is 129 + 20.3 nmol / l when taken on an empty stomach and 98.7 ± 18.6 nmol / L - when taken with food, but the degree suction of letrozole (when estimating the area under the curve "concentration-time" (AUC)) does not change.

    Small changes in the rate of absorption are regarded as not having clinical meaning, therefore letrozole can be taken regardless of food intake. The connection between letrozole and plasma proteins is approximately 60% (mainly with albumin - 55%). Concentration letrozole in erythrocytes is about 80% of that in blood plasma. The apparent volume of distribution in the equilibrium state is about 1.87 + 0.47 l / kg. The equilibrium concentration is achieved during 2-6 weeks of daily intake of a daily dose of 2.5 mg. Pharmacokinetics is nonlinear. Cumulation with long-term use is not noted. Letrozole is largely exposed to metabolism under the action of isoenzymes CYP3A4 and CYP2A6 cytochrome P450 to form a pharmacologically inactive carbinol compound.

    It is excreted mainly by kidneys in the form of metabolites, to a lesser extent - through the intestine. The final half-life (T1 / 2) is 48 hours.

    The pharmacokinetic parameters of letrozole do not depend on the age of the patient.


    In renal failure pharmacokinetic parameters do not change.

    With a moderate violation of liver function (class B on the Child-Pugh scale), the average values AUC although higher by 37%, but remain within that range values ​​that are noted in individuals without violations of the liver. In patients with cirrhosis of the liver and severe impairment of its function (class C on the Child-Pugh scale) AUC increases by 95% and T1 / 2 by 187%. However, given the good tolerability of high doses of the drug (5-10 mg / day) in these cases, there is no need to change the dose of letrozole.

    Indications:

    Early stages of breast cancer, whose cells have receptors to hormones, in postmenopausal women, as adjuvant therapy.

    Early stages of breast cancer in postmenopausal women after completion standard adjuvant therapy with tamoxifen as an extended adjuvant therapy.

    Common hormone-dependent forms of breast cancer in women in postmenopause (first-line therapy).

    Common forms of breast cancer in postmenopausal women (natural or induced artificially) who received previous therapy with antiestrogens.

    Contraindications:

    Hypersensitivity to active substance or to any auxiliary substance of the preparation;

    endocrine status characteristic of the reproductive period;

    pregnancy, lactation;

    children's age till 18 years (effectiveness and safety for children not established).

    Carefully:Pronounced hepatic (class C on the Child-Pugh scale) and renal failure (creatinine clearance less than 10 ml / min), lactase insufficiency, lactose intolerance,glucose-galactose malabsorption.
    Pregnancy and lactation:

    The drug Lestrodeks is contraindicated for use in pregnancy and lactation.

    During therapy with Lestrodex, given the potential for pregnancy, women in the perimenopausal and early postmenopausal period should use reliable contraceptive methods before establishing a stable postmenopausal hormone level.

    Dosing and Administration:

    Inside, regardless of food intake.

    The recommended dose of Lestrodex is 2.5 mg once a day.

    As an extended adjuvant therapy, treatment should continue for 5 years or until signs of disease progression appear.

    In patients with advanced or metastatic cancer, treatment with Lestrodex should be continued until the tumor progresses clearly.

    No dose adjustment is required for elderly patients.

    Patients with impaired hepatic and / or renal function: with violations of the liver or kidneys (CC more than 10 ml / min), dose adjustment is not required.

    Not enough data for the use of the drug in patients with CC less than 10 ml / min or patients with severe impaired liver function (class C on the Child-Pugh scale) (see sections Precautions for Use and Pharmacokinetics). With Lestrodeks, this group of patients requires constant monitoring of their condition.

    Side effects:

    As a rule, adverse reactions were mild or moderate and mainly related to suppression of the synthesis of estrogens (eg, flushing of the face, alopecia and vaginal bleeding).

    The incidence of adverse reactions is distributed as follows:

    Often (> 1/10), often (> 1/100, <1/10), sometimes (> 1/1000, <1/100), rarely (> 1/10000, <1/1000), rarely (<1/10000), frequency is not known.

    Infectious and parasitic diseases

    Sometimes - urinary tract infections

    Benign, malignant and unspecified neoplasms, (including cysts and polyps)

    Sometimes - pain in tumor foci (not applicable with adjuvant and prolonged adjuvant treatment).

    Violations of the blood and lymphatic system

    Sometimes - leukopenia.

    Disorders from the metabolism and nutrition

    Often - anorexia, increased appetite, hypercholesterolemia;

    sometimes - generalized edema.

    Disorders of the psyche

    Often - depression;

    sometimes - anxiety, including nervousness and irritability.

    Disturbances from the nervous system

    Often - headache, dizziness;

    sometimes - drowsiness, insomnia, memory impairment; Sensitivity disorder (dysesthesia), including paresthesia; hypoesthesia, violation of taste sensations, episodes of cerebral circulation disorders.

    Disturbances on the part of the organ of sight

    Sometimes - cataract, eye irritation, blurred vision.

    Heart Disease

    Sometimes - palpitation, tachycardia.

    Vascular disorders

    Sometimes - thrombophlebitis, including thrombophlebitis of the superficial and deep veins, arterial hypertension, ischemic heart disease;

    rarely - pulmonary embolism, arterial thrombosis, stroke.

    Disturbances from the respiratory system, chest and mediastinal organs

    Sometimes - shortness of breath, cough.

    Disorders from the gastrointestinal tract

    Often - nausea, vomiting, indigestion, constipation, diarrhea;

    sometimes - abdominal pain, stomatitis, dry mouth.

    Disturbances from the liver and bile ducts

    Sometimes - increased activity of hepatic enzymes.

    Disturbances from the skin and subcutaneous tissues

    Often - increased sweating;

    often - alopecia; rash, including erythematous, maculopapular, vesicular rash; psoriasis-like rashes,

    sometimes - itching, dry skin, urticaria;

    frequency not known - angioedema - edema, anaphylactic reactions.

    Disturbances from musculoskeletal and connective tissue

    Often - arthralgia;

    often - myalgia, bone pain, osteoporosis, fractures of bones;

    sometimes - arthritis.

    Disorders from the kidneys and urinary tract

    Sometimes - Frequent urination.

    Violation of the genitals and mammary gland

    Sometimes - vaginal bleeding, discharge from the vagina, dryness of the vagina, pain in the mammary glands.

    General disorders and disorders at the site of administration

    Often - flushes of blood, fatigue, including asthenia;

    often - malaise, peripheral edema;

    sometimes - hyperthermia, dryness of the mucous membrane, thirst.

    Impact on the results of laboratory and instrumental studies

    Often - increase in body weight;

    sometimes - decrease in body weight.

    Overdose:

    There are separate reports of cases of dozethozin overdose.

    Treatment: no specific methods of treatment of overdose are known. Symptomatic and supportive therapy is indicated. Letrozole is excreted from the plasma during hemodialysis.
    Interaction:

    With simultaneous prescription of letrozole with cimetidine and warfarin clinically significant interactions are not observed.

    Clinical experience The use of letrozole in combination with other antitumour agents is currently not available.

    According to the research results in vitro letrozole suppresses activity of cytochrome P450 isoenzymes CYP2A6 and to a moderate extent - CYP2C19. Caution should be exercised in the combined use of letrozole and drugs metabolized predominantly with the abovementioned isoenzymes and having a narrow therapeutic index.
    Special instructions:

    Patients who do not understand the status of postmenopausal women before the start of treatment are recommended to determine the concentration of luteinizing hormone, follicle stimulating hormone and / or estradiol for confirming the status of menopause.

    Impaired renal function

    There is insufficient data on the use of letrozole in patients with SC less than 10 ml / min. In patients with SC less than 10 ml / min, the ratio of potential risk to expected benefit should be assessed.

    Impaired liver function

    The drug Lestrodeks should be used with caution,only after a careful assessment of the ratio of potential benefit and possible risk in patients with severe impairment / liver function (class FROM on the Child-Pugh scale) (see section Pharmacokinetics).

    Effect on bone tissue

    Letrozole strongly affects the decrease in the concentration of estrogens. In patients with osteoporosis and / or fractures in the history of the disease or with an increased risk of osteoporosis, bone mineral density should be assessed by densitometry at the beginning of treatment and regularly throughout its duration. If necessary should be prescribed treatment or prevention of osteoporosis and carefully monitor the patient's condition (see section Side effect).

    Other precautions

    Since each film-coated tablet of Listerdex contains 58.4 mg of lactose in the form of lactose monohydrate, it is not recommended for patients with rare hereditary diseases of galactose intolerance, with severe lactase deficiency or glucose-galactose malabsorption.

    Effect on the ability to drive transp. cf. and fur:

    Since during the therapy with Lestrodeks it is possible to develop fatigue and dizziness, as well as drowsiness,with caution perform work that requires increased attention, speed of motor and mental reactions (including driving or controlling machinery).

    Form release / dosage:Tablets, film-coated 2.5 mg.
    Packaging:10 tablets per blister PVC / Aluminum foil. For 3 or 10 blisters together with instructions for use in a cardboard box.
    Storage conditions:At a temperature of no higher than 25 ° C. Keep out of the reach of children!
    Shelf life:5 years.

    Do not use after the expiration date printed on the package.

    Terms of leave from pharmacies:On prescription
    Registration number:LP-001469
    Date of registration:02.02.2012
    The owner of the registration certificate:Actavis PTS ehf GroupActavis PTS ehf Group Iceland
    Manufacturer: & nbsp
    Representation: & nbspAktavis, Open Company Aktavis, Open Company
    Information update date: & nbsp20.10.2015
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