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

    Each film-coated tablet contains:

    Active substance: letrozole 2.5 mg;

    Excipients: lactose monohydrate 62 mg, corn starch 9.5 mg, microcrystalline cellulose 20 mg, talc 1.3 mg, sodium carboxymethyl starch (type A) 5 mg, magnesium stearate 1 mg.

    Composition of the film shell: hypromellose 1.431 mg, giprolose 0.189 mg, talc 0.27 mg, cotton seed oil 0.135 mg, iron oxide oxide yellow 0.0532 mg, iron oxide red oxide 0.0008 mg, titanium dioxide 0.621 mg.

    Description:Round biconvex tablets, film-coated, yellow. Color at the break is white.
    Pharmacotherapeutic group:Antitumor agent, estrogen synthesis inhibitor
    ATX: & nbsp

    L.02.B.G.04   Letrozole

    L.02.B.G   Enzyme Inhibitors

    Pharmacodynamics:

    An antineoplastic agent, a non-steroidal selective aromatase inhibitor, an enzyme for the synthesis of estrogens. Has antiestrogenic effect. The activity of aromatase is reduced due to competitive binding to the prosthetic part (heme) of cytochrome P450 (a subunit of this enzyme). In postmenopausal women, estrogens are formed predominantly with the participation of the aromatase enzyme, which turns androgens synthesized in the adrenal glands (primarily androstenedione and testosterone), into estrone and estradiol.

    Daily administration of letrozole to postmenopausal patients at a dose 0,1-5 mg / day leads to a decrease in the concentration of estradiol, estrone and estrone sulfate in blood plasma by 75 - 95% of the initial concentration; a low concentration of estrogen is maintained throughout treatment in all patients.In women with estrogen-dependent malignant breast tumors that developed during menopause, the drug, reducing the concentration of circulating estrogens and suppressing their synthesis in tumor tissue, leads to regression of tumors (in 23% of cases) and a decrease in the number of relapses and deaths. Possessing high specificity with respect to the enzyme aromatase, letrozole does not interfere with the synthesis of steroid hormones in the adrenal glands.

    Letrozole can be used when tamoxifen is ineffective in postmenopausal women.

    Pharmacokinetics:

    Suction

    Letrozole is rapidly and completely absorbed in the gastrointestinal tract. At reception on an empty stomach the maximum concentration (Сmax) after 1 hour is 129 ± 20.3 nmol / l, and at reception in 2 hours after meal Withmax is 98.7 ± 18.6 nmol / l; the area under the concentration-time curve (AUC) does not change, so the drug is taken regardless of the intake of food. Bioavailability is 99.9%.

    Distribution

    The connection with plasma proteins is 60%, mainly with albumin (55%). The concentration of letrozole erythrocytes is 80% from drug concentration at blood plasma. Apparent volume of distribution when the equilibrium concentration is reached (Vss) -1.87 l / kg.After daily intake at a dose of 2.5 mg / day, the concentration in the blood, corresponding to the state of stable equilibrium, is reached within 2-6 weeks. The measured equilibrium concentration of letrozole in plasma is approximately 7 times higher than when taken single dose of 2.5 mg, and in 1,5-2 times higher than calculated, which indicates a slight non-linearity of letrozole when taken in a dose of 2.5 mg. With prolonged treatment, cumulation does not occur.

    Metabolism and excretion

    Metabolism occurs mainly in the liver with the participation of cytochrome P450 isoenzymes ZA4 and 2A6 with the formation of a pharmacologically inactive carbinol derivative.

    The drug is excreted mainly by the kidneys in the form of metabolites, and also through the intestine. The half-life (T1/2) is 48 hours. In renal and hepatic insufficiency, the pharmacokinetic parameters do not change. It is excreted from the plasma by means of hemodialysis. The pharmacokinetics of the drug does not change with age.

    Indications:

    Early stages of breast cancer, cells of which have receptors for hormones, as adjuvant therapy in postmenopausal women;

    Early stages of breast cancer in postmenopausal women after completion of standard adjuvant tamoxifen therapy, for 5 years;

    Common hormone-dependent forms of breast cancer in postmenopausal women (first-line therapy);

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

    Contraindications:

    Hypersensitivity to the components of the drug;

    Endocrine status characteristic of reproductive age;

    Premenopause;

    Pregnancy and lactation;

    Childhood.

    Carefully:

    Moderate and severe hepatic insufficiency (degree of severity of "B" and "C" by Child-Pugh), renal failure (creatinine clearance less than 10 ml / min);

    Simultaneous use of letrozole with drugs that have a low therapeutic index;

    Insufficiency of lactase, lactose intolerance, glucose-galactose malabsorption, as in the drug form of the drug contains lactose.

    Pregnancy and lactation:

    NEXZAZOL® is contraindicated in premenopausal women, during pregnancy and during lactation.

    Women of childbearing age

    The attending physician should carefully discuss the methods of adequate contraception with a woman of childbearing age,and also if it is in premenopausal or if menopause has occurred recently. In this postmenopause must be confirmed medically.

    Lactation

    NEXZAZOL® is contraindicated during lactation.

    Dosing and Administration:

    Adults and elderly patients:

    NEXZOLE® is taken orally by 1 tablet, coated with a coating, 2.5 mg once a day. Correction of dose in elderly patients is not required.

    As an adjuvant therapy, NEKSAZOL® should be used for 5 years, if the signs of disease progression appear, the drug should be discontinued.

    No dose adjustment is required in patients with impaired renal function with creatinine clearance above 30 mL / min.

    Due to a lack of data, there are no recommendations for dose changes in patients with renal insufficiency with a creatinine clearance below 30 ml / min or in patients with severe impairment of liver function.

    Children and teens

    Indications for use in children and adolescents of NEXZOL® are absent.
    Side effects:

    The adverse reactions listed below are presented in accordance with the classification of the medical vocabulary for regulatory activities MedDra and with the frequency of occurrence: very often (≥1 / 10); often (from ≥1 / 100 to <1/10); infrequently (from ≥1 / 1000 to <1/100); rarely (from ≥1 / 10000 to <1/1000); very rarely (<1/10000), an unknown frequency (based on the available data - it is impossible to assess). Within each group, side effects are listed in descending order of severity.

    Surveys

    Often: weight gain;

    Infrequently: weight loss.

    From the side of the heart and vascular system

    Infrequent: heart failure, angina pectoris, myocardial infarction, tachycardia, palpitation, thromboembolism; thrombophlebitis, including thrombophlebitis of superficial and deep veins, arterial hypertension;

    Rarely: cerebral infarction, thromboembolism of the pulmonary artery, thrombosis of the arteries.

    On the part of the blood and lymphatic system

    Infrequent: leukopenia.

    From the nervous system

    Often: headache, dizziness;

    Infrequent: acute disturbance of cerebral circulation; sensitivity disorders, including paresthesia and hypoesthesia; drowsiness, insomnia, memory disorder, taste disorders.

    From the side of the organ of vision

    Infrequent: cataract, eye irritation, blurred vision.

    On the part of the respiratory system, the chest and mediastinal organs

    Infrequently: dyspnoea, cough.

    From the digestive system

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

    Infrequent: abdominal pain, stomatitis, dry mouth.

    From the urinary system

    Infrequent: frequent urination.

    From the skin and subcutaneous tissue

    Very often: increased sweating;

    Often: alopecia, rash, including erythematous, maculopapular, psoriiform, vesicular;

    Infrequent: itchy skin, dry skin, urticaria rash.

    From the musculoskeletal system and connective tissue

    Very often: arthralgia;

    Often: osteoporosis, fractures, bone pain, myalgia;

    Infrequent: arthritis.

    Metabolic and nutritional disorders

    Often: anorexia, hypercholesterolemia, increased appetite;

    Unclean: total swelling.

    Infectious and parasitic diseases

    Infrequently: an infection.

    Neoplasms are benign, malignant, unspecified (including cysts and polyps)

    Infrequent: pain in the area of ​​the tumor (not with adjuvant or neoadjuvant).

    Systemic disorders and complications at the site of administration

    Very often: hot flashes, fatigue, including asthenia;

    Often: peripheral edema, malaise;

    Infrequently: hyperthermia, dryness of mucous membranes, thirst.

    From the hepatobiliary system

    Infrequently: increased activity of "hepatic" enzymes.

    From the side of the reproductive system and mammary glands

    Infrequent: bleeding from the vagina, discharge from the vagina, dryness of the vagina, soreness of the mammary glands.

    Disorders of the psyche

    Often: depression.

    Infrequently: anxiety, including nervousness, irritability.

    Overdose:

    Single cases of overdose are known. Specific treatment is not available, symptomatic and supportive therapy should be provided.

    Interaction:

    Clinically significant interactions with cimetidine and warfarin when combined with letrozole were not found.

    There was no interaction with frequently prescribed drugs.

    Currently, there is no data on the combined use of letrozole with other antitumor drugs.

    In vitro Letrozole inhibits cytochrome P450 - 2A6 isoenzymes and moderately 2S19. CYP2A6 does not play a significant role in the metabolism of drugs. Thus, caution should be given simultaneously to drugs with a low therapeutic index, the distribution of which depends mainly on these isoenzymes.

    Special instructions:

    Before the beginning of treatment it is recommended to study the estrogen receptor status of the organism. In women with unclear postmenopausal status, concentrations of LH, FSH and / or estradilol should be determined and only after confirmation of the status of prescribing treatment.

    The use of letrozole has not been investigated in a sufficient number of patients with creatinine clearance below 30 ml / min.

    The use of letrozole has been studied in a small number of patients with a nonmetastatic tumor and various degrees of liver damage: from moderate to severe. In volunteer men with severe impairment of the function of baking (cirrhosis, degree of severity of "C" by Child-Pugh) and the absence of a tumor, the systemic exposure and the final half-life were 2 and 3 times higher, respectively, than in healthy volunteers. Thus, in these patients NEXZAZOL® should be used with caution and only after a thorough assessment of the risk-benefit ratio.

    Nexazole causes a significant decrease in the concentration of estrogens. Women with osteoporosis and / or fractures in anamnesis are at risk of developing osteoporosis with prolonged use.Bone density in such patients should be investigated before adjuvant or extended adjuvant treatment with letrozole is prescribed. Due to the risk of developing osteoporosis, these patients should be observed during and after treatment with letrozole.

    NEXZOLE® contains lactose, therefore, it should not be taken to patients with such rare hereditary diseases as galactose intolerance, lactase Lappa deficiency, or glucose-galactose malabsorption syndrome.

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

    During treatment, it is necessary to refrain from engaging in potentially dangerous activities that require increased attention, speed of motor and mental reactions (including from driving or controlling machinery).

    Form release / dosage:Film coated tablets 2.5 mg.
    Packaging:

    For 10 tablets covered with a film sheath in a blister of PVC - aluminum foil. For 3 blisters in a cardboard box together with instructions for use.

    Storage conditions:

    Store at a temperature not exceeding 30 ° C.

    Keep out of the reach of children!

    Shelf life:

    3 years.

    Do not use the drug after the expiration date.

    Terms of leave from pharmacies:On prescription
    Registration number:LP-001497
    Date of registration:13.02.2012
    Expiration Date:13.02.2017
    The owner of the registration certificate:GEDEON RICHTER, OJSC GEDEON RICHTER, OJSC Hungary
    Manufacturer: & nbsp
    Representation: & nbspGEDEON RICHTER OJSC GEDEON RICHTER OJSC Hungary
    Information update date: & nbsp28.06.2018
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