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

    One tablet, film-coated, contains:

    Active substance:

    Letrozole 2.5 mg

    Excipients:

    Sodium carboxymethyl starch 3.0 mg

    Pregelatinized starch 5.0 mg

    Silicon dioxide colloid 2.0 mg

    Lactose monohydrate 54.5 mg

    Magnesium stearate 1.0 mg

    Microcrystalline cellulose 32.0

    Composition of the film shell:

    Aquarius Prime VAR214000 yellow 3.0 mg [Hypromellose (69%), titanium dioxide (20%), macrogol (10%), ferric oxide yellow oxide (1%)]


    Description:

    The tablets are round biconvex, covered with a film coating of light yellow with a cream shade of color, a thin film membrane and a white or almost white core are visible on the cross section.

    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 antiestrogenic effect, selectively inhibits aromatase, an enzyme for the synthesis of estrogens, due to highly specific competitive binding to the subunit of this enzyme, the heme cytochrome P450. It blocks the synthesis of estrogens, both in peripheral and in tumor tissues.

    In postmenopausal women, estrogens are formed predominantly with the participation of the aromatase enzyme, which converts hormones synthesized in the adrenal glands (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 concentrations of estradiol, estrone and estrone sulfate in blood plasma by 75-95% of of the original content. Suppression of the synthesis of estrogens is maintained throughout the treatment period.

    When letrozole is administered in doses of 0.1 to 5 mg, steroid synthesis disorders hormones in the adrenal glands are not observed, the test with adrenocorticotropic hormone (ACTH) does not reveal violations of the synthesis of aldosterone or cortisol. Additional appointment of glucocorticosteroids and mineralocorticosteroids is not required. Blocking the synthesis of estrogens does not lead to the accumulation of androgens, which are precursors of estrogens. Against the background of taking letrozole, changes in the concentrations of luteinizing and follicle-stimulating hormones in the blood plasma, thyroid function, changes in the lipid profile, increased frequency of myocardial infarction and stroke were not noted.

    Pharmacokinetics:

    Letrozole is quickly and completely absorbed from the gastrointestinal tract (GIT), bioavailability is about 9.9%. Food intake slightly reduces the absorption rate. The time to reach the maximum concentration of letrozole in the blood (TSmah) - approximately 1 hour with the intake of letrozole on an empty stomach and about 2 hours when taken with food. The equilibrium concentration is achieved after 2-6 weeks of daily intake in a daily dose of 2.5 mg. The connection with plasma proteins (mainly with albumin) is about 60%. The concentration of letrozole in erythrocytes is about 80% of that in blood plasma. The apparent volume of distribution in the equilibrium state is about 1.5-2 l / kg.

    With prolonged use of cumulation is not observed.

    Much of it is metabolized by isozymes

    CYP3A4 and CYP2A6 with the formation of a pharmacologically inactive carbinol compound.

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

    With moderately expressed hepatic insufficiency (class B according to the Child-Pugh classification) there was an increase in the area under the concentration-time curve (AUC) by 37%, but this increase remains within the range of values ​​that are discarded in persons without impaired liver function. In patients with cirrhosis of the liver and with severe hepatic insufficiency (class C according to the Child-Pugh classification) AUC increases by 95% and T1 / 2 by 187%.

    Indications:

    Breast cancer with positive hormonal receptors in early steels in postmenopausal women, as adjuvant therapy.

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

    Common hormone-dependent breast cancer in postmenopausal women as 1st line therapy.

    A common breast cancer that progresses against the background of anti-estrogen therapy in postmenopausal women.

    Contraindications:

    Hypersensitivity to letrozole or any other component preparation.

    Endocrine status characteristic of the reproductive period.

    Pregnancy, the period of breastfeeding.

    Children under 18 years.

    Carefully:

    Chronic renal failure with creatinine clearance less than 10 ml / min.

    Dosing and Administration:

    Inside, regardless of food intake.

    The recommended dose is 2.5 mg once daily, daily. Treatment is long. As a prolonged adjuvant therapy treatment should continue for 5 years (but not more than 5 years).

    If signs of disease progression appear, the drug should be discontinued.

    In case of violations of the liver or kidney function (creatinine clearance> 10 ml / min), dose adjustment is not required, however, patients with severe hepatic (class FROM according to the Child-Pugh classification) and severe renal failure should be under constant supervision.

    Side effects:

    Undesirable reactions are listed according to the frequency of their registration in accordance with the following gradation highly often (> 10%); often (> 1% and <10%); infrequently (> 0.1% and <1%); rarely (> 0.01% and <0.1%); very rarely (<0.01%), including individual messages

    From the digestive system: often - nausea, vomiting, indigestion, constipation, diarrhea, anorexia, infrequently - abdominal pain, stomatitis, dry mouth, increased activity of "liver" enzymes; very rarely - hepatitis.

    From the nervous system: often - headache, dizziness, depression; infrequently - a sense of anxiety, nervousness, irritability, drowsiness, insomnia, memory impairment, dysesthesia, paresthesia, hypoesthesia, eating disorders, episodes of cerebral circulation disorders.

    From the hematopoiesis: infrequently, leukopenia.

    From the side of the cardiovascular system: infrequent - palpitation, tachycardia, thrombophlebitis of superficial and deep veins, increased blood pressure, ischemic cardiovascular disorders (angina pectoris, myocardial infarction, heart failure); rarely - thromboembolism, pulmonary embolism, thrombosis of the arteries, stroke.

    From the side respiratory system: infrequently - shortness of breath, cough.

    From the skin and subcutaneous fat: often - alopecia, excessive sweating, skin rash (including erythematous, maculopapular, vesicular rashes, psoriasis-like rashes); infrequently - itching of the skin, dry skin, urticaria; very rarely - angioedema, anaphylactic reactions, Lyell's syndrome (toxic epidermal necrolysis), (malignant exudative erythema).

    From the musculoskeletal system: very often - arthralgia; often - myalgia, ossalgia, osteoporosis, fractures of bones; infrequently - arthritis.

    From the sense organs: infrequently - cataract, eye irritation, blurred vision, violation of taste sensations.

    From the genitourinary system: infrequent - frequent urination, urinary tract infections, vaginal bleeding, vaginal discharge, vaginal dryness, pain in the mammary gland.

    Other: very often - the "tides" of blood; often - increased fatigue, asthenia, malaise, peripheral edema, weight gain, increased appetite; infrequently - weight loss, hypercholesterolemia, thirst, hyperthermia, dry mucous membranes, generalized edema, pain in tumor foci.

    Overdose:

    There are separate reports of cases of dozethozin overdose. Specific symptoms of an overdose were absent. Specific treatments for overdose are unknown because of limited data. In case of an overdose vomiting and symptomatic and supportive therapy. Letrozole is removed from the plasma by hemodialysis.

    Interaction:

    Clinical experience in the application of letrozole in combination with other antitumour agents is currently not available. With the simultaneous use of letrozole and tamoxifen in a dose of 20 mg per day, a decrease in the concentration of letrozole was observed to decrease by 38%.

    Clinically significant interaction letrozola with warfarin and cimetidine is not it was noted.

    Letrozole suppresses the activity of isoenzymes CYP2A6 and CYP2C19. Since the isoenzyme CYP2A6 does not play an important role in the metabolism of drugs, clinically significant interactions with drugs, in the metabolism of which isoenzyme participates CYP2A6, not expected. In vitro it was shown that letrozole in concentrations 100 times greater than equilibrium, did not significantly inhibit the metabolism of diazepam (substrate isoenzyme CYP2C19). Thus, clinically significant interactions with drugs, in the metabolism of which isoenzyme participates CYP2C19, unlikely. Nevertheless, caution should be exercised in the combined use of letrozole and drugs metabolized predominantly with the abovementioned isozymes and having narrow therapeutic range.

    Special instructions:

    Patients with severe hepatic insufficiency during treatment with the drug should be under constant supervision.

    Given the possibility of pregnancy, women in the perimenopausal and early postmenopausal period during the treatment with the drug should use reliable contraceptive methods to establish a stable postmenopausal hormone level.

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

    Some side effects of the drug, such as general weakness and dizziness, can affect the ability to drive vehicles and perform potentially hazardous activities requiring increased concentration attention and speed of psychomotor reactions. In this respect, caution when driving vehicles and working with machinery.

    Form release / dosage:

    Tablets, film-coated, 2.5 mg.

    Packaging:

    For 10 tablets in a contour mesh box made of polyvinylchloride film and aluminum foil printed lacquered. For 30 tablets in cans of polymeric for medicines.

    Free space in the bank is filled with cotton hygroscopic cotton. Each jar or 3 contour mesh packages together with the instruction for use are placed in a pack of cardboard box.

    Storage conditions:

    In dry, dark place at a temperature of 5 to 25 ° C.Keep out of the reach of children.

    Shelf life:

    2 years.

    Do not use after expiry date.

    Terms of leave from pharmacies:On prescription
    Registration number:LSR-005770/10
    Date of registration:23.06.2010
    The owner of the registration certificate:TECHNOLOGY OF DRUGS, LTD. TECHNOLOGY OF DRUGS, LTD. Russia
    Manufacturer: & nbsp
    Information update date: & nbsp21.10.2015
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