Drugs Details

Drugs Info of Zelboraf
Drugs Details
  • Drugs Type  : Multum
  • Date : 13th Jul 2015 07:58 am
  • Brand Name : Zelboraf
  • Generic Name : vemurafenib (Pronunciation: VEM ue RAF e nib)
Descriptions

ZELBORAF (vemurafenib) is a kinase inhibitor available as 240 mg tablets for oral use. Vemurafenib has the chemical name propane-1-sulfonic acid {3-[5-(4-chlorophenyl)-1H-pyrrolo[2,3-b]pyridine-3-carbonyl]-2,4difluoro-phenyl}-amide. It has the molecular formula C23H18ClF2N3O3S and a molecular weight of 489.9. Vemurafenib has the following chemical structure:

 

ZELBORAF® (vemurafenib) Structural Formula Illustration

Vemurafenib is a white to off-white crystalline solid. It is practically insoluble in aqueous media.

Tablets of ZELBORAF are for oral administration. Each tablet contains 240 mg of vemurafenib.

The inactive ingredients of ZELBORAF are: Tablet Core: hypromellose acetate succinate, croscarmellose sodium, colloidal silicon dioxide, magnesium stearate, and hydroxypropyl cellulose. Coating: pinkish white: poly (vinyl alcohol), titanium dioxide, polyethylene glycol 3350, talc, and iron oxide red.

What are the possible side effects of vemurafenib (Zelboraf)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using vemurafenib and call your doctor at once if you have a serious side effect such as:

  • severe dizziness, fainting, fast or pounding heartbeats;
  • white patches on your eyes;
  • new or worsening skin lesions; or
  • severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in...

Read All Potential Side Effects and See Pictures of Zelboraf »

Indications

ZELBORAF® is indicated for the treatment of patients with unresectable or metastatic melanoma with BRAF V600E mutation as detected by an FDA-approved test.

Limitation of Use

ZELBORAF is not indicated for treatment of patients with wild-type BRAF melanoma [see WARNINGS AND PRECAUTIONS].

Dosage Administration

Patient Selection

Confirm the presence of BRAF V600E mutation in tumor specimens prior to initiation of treatment with ZELBORAF [see WARNINGS AND PRECAUTIONS]. Information on FDA approved tests for the detection of BRAF V600 mutations in melanoma is available at http://www.fda.gov/CompanionDiagnostics.

Recommended Dose

The recommended dose of ZELBORAF is 960 mg (four 240 mg tablets) orally every 12 hours with or without a meal. A missed dose can be taken up to 4 hours prior to the next dose.

Treat patients with ZELBORAF until disease progression or unacceptable toxicity occurs.

Do not take an additional dose if vomiting occurs after ZELBORAF administration, but continue with the next scheduled dose.

Do not crush or chew the tablets.

Dose Modifications

For New Primary Cutaneous Malignancies: No dose modifications are recommended.

For Other Adverse Reactions:

Permanently discontinue ZELBORAF for any of the following:

  • Grade 4 adverse reaction, first appearance (if clinically appropriate) or second appearance
  • QTc prolongation > 500 ms and increased by > 60 ms from pre-treatment values [see WARNINGS AND PRECAUTIONS]

Withhold ZELBORAF for NCI CTCAE (v4.0) intolerable Grade 2 or greater adverse reactions.

Upon recovery to Grade 0–1, restart ZELBORAF at a reduced dose as follows:

  • 720 mg twice daily for first appearance of intolerable Grade 2 or Grade 3 adverse reactions
  • 480 mg twice daily for second appearance of Grade 2 (if intolerable) or Grade 3 adverse reactions or for first appearance of Grade 4 adverse reaction (if clinically appropriate)

Do not dose reduce to below 480 mg twice daily.

How Supplied

Dosage Forms And Strengths

Tablet: 240 mg.

Storage And Handling

ZELBORAF (vemurafenib) is supplied as 240 mg film-coated tablets with VEM debossed on one side in single bottle of 120 count. The following packaging configuration is available:

NDC 50242-090-01

Storage and Stability

Store at room temperature 20°C–25°C (68°F–77°F); excursions permitted between 15°C and 30°C (59°F and 86°F), See USP Controlled Room Temperature. Store in the original container with the lid tightly closed.

Disposal of unused/expired medicines

The release of pharmaceuticals in the environment should be minimized. Medicines should not be disposed of via wastewater and disposal through household waste should be avoided. Use established “collection systems,” if available in your location.

Distributed by: Genentech USA, Inc., A Member of the Roche Group, 1 DNA Way, South San Francisco, CA 94080-4990. Revised: November 2014

Side Effects

The following adverse reactions are discussed in greater detail in other sections of the label:

  • New Primary Malignancies [see WARNINGS AND PRECAUTIONS]
  • Hypersensitivity Reactions [see WARNINGS AND PRECAUTIONS]
  • Dermatologic Reactions [see WARNINGS AND PRECAUTIONS]
  • QT Prolongation [see WARNINGS AND PRECAUTIONS]
  • Hepatotoxicity [see WARNINGS AND PRECAUTIONS]
  • Photosensitivity [see WARNINGS AND PRECAUTIONS]
  • Ophthalmologic Reactions [see WARNINGS AND PRECAUTIONS]

Clinical Trials Experience

Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not predict the rates observed in a broader patient population in clinical practice.

This section describes adverse drug reactions (ADRs) identified from analyses of Trial 1 and Trial 2 [see Clinical Studies]. Trial 1 randomized (1:1) 675 treatment-naive patients with unresectable or metastatic melanoma to receive ZELBORAF 960 mg orally twice daily or dacarbazine 1000 mg/m² intravenously every 3 weeks. In Trial 2, 132 patients with metastatic melanoma and failure of at least one prior systemic therapy received treatment with ZELBORAF 960 mg orally twice daily.

Table 1 presents adverse reactions reported in at least 10% of patients treated with ZELBORAF. The most common adverse reactions of any grade ( ≥ 30% in either study) in ZELBORAF-treated patients were arthralgia, rash, alopecia, fatigue, photosensitivity reaction, nausea, pruritus, and skin papilloma. The most common ( ≥ 5%) Grade 3 adverse reactions were cuSCC and rash. The incidence of Grade 4 adverse reactions was ≤ 4% in both studies.

The incidence of adverse events resulting in permanent discontinuation of study medication in Trial 1 was 7% for the ZELBORAF arm and 4% for the dacarbazine arm. In Trial 2, the incidence of adverse events resulting in permanent discontinuation of study medication was 3% in ZELBORAF-treated patients. The median duration of study treatment was 4.2 months for ZELBORAF and 0.8 months for dacarbazine in Trial 1, and 5.7 months for ZELBORAF in Trial 2.

Table 1 : Adverse Reactions Reported in ≥ 10% of Patients Treated with ZELBORAF*

ADRs Trial 1: Treatment Naïve Patients Trial 2: Patients with Failure of at Least One Prior Systemic Therapy
ZELBORAF
n=336
Dacarbazine
n=287
ZELBORAF
n=132
All Grades (%) Grade 3a (%) All Grades (%) Grade 3 (%) All Grades (%) Grade 3a (%)
Skin and subcutaneous tissue disorders
Rash 37 8 2 0 52 7
Photosensitivity reaction 33 3 4 0 49 3
Alopecia 45 < 1 2 0 36 0
Pruritus 23 1 1 0 30 2
Hyperkeratosis 24 1 < 1 0 28 0
Rash maculo-papular 9 2 < 1 0 21 6
Actinic keratosis 8 0 3 0 17 0
Dry skin 19 0 1 0 16 0
Rash papular 5 < 1 0 0 13 0
Erythema 14 0 2 0 8 0
Musculoskeletal and connective tissue disorders
Arthralgia 53 4 3 < 1 67 8
Myalgia 13 < 1 1 0 24 < 1
Pain in extremity 18 < 1 6 2 9 0
Musculoskeletal pain 8 0 4 < 1 11 0
Back pain 8 < 1 5 < 1 11 < 1
General disorders and administration site conditions
Fatigue 38 2 33 2 54 4
Edema peripheral 17 < 1 5 0 23 0
Pyrexia 19 < 1 9 < 1 17 2
Asthenia 11 < 1 9 < 1 2 0
Gastrointestinal disorders
Nausea 35 2 43 2 37 2
Diarrhea 28 < 1 13 < 1 29 < 1
Vomiting 18 1 26 1 26 2
Constipation 12 < 1 24 0 16 0
Nervous system disorders
Headache 23 < 1 10 0 27 0
Dysgeusia 14 0 3 0 11 0
Neoplasms benign, malignant and unspecified (includes cysts and polyps)
Skin papilloma 21 < 1 0 0 30 0
Cutaneous SCC†# 24 22 < 1 < 1 24 24
             
Seborrheic keratosis 10 < 1 1 0 14 0
Investigations
Gamma-glutamyltransferase increased 5 3 1 0 15 6
Metabolism and nutrition disorders
Decreased appetite 18 0 8 < 1 21 0
Respiratory, thoracic and mediastinal disorders
Cough 8 0 7 0 12 0
Injury, poisoning and procedural complications Sunburn 10 0 0 0 14 0
*Adverse drug reactions, reported using MedDRA and graded using NCI-CTC-AE v 4.0 (NCI common toxicity criteria) for assessment of toxicity.
aGrade 4 adverse reactions limited to gamma-glutamyltransferase increased ( < 1% in Trial 1 and 4% in Trial 2).
† Includes both squamous cell carcinoma of the skin and keratoacanthoma.
#Cases of cutaneous squamous cell carcinoma were required to be reported as Grade 3 per protocol.

Clinically relevant adverse reactions reported in < 10% of patients treated with ZELBORAF in the Phase 2 and Phase 3 studies include:

Skin and subcutaneous tissue disorders: palmar-plantar erythrodysesthesia syndrome, keratosis pilaris, panniculitis, erythema nodosum, Stevens-Johnson syndrome, toxic epidermal necrolysis

Musculoskeletal and connective tissue disorders: arthritis

Nervous system disorders: neuropathy peripheral, VIIth nerve paralysis

Neoplasms benign, malignant and unspecified (includes cysts and polyps): basal cell carcinoma, oropharyngeal squamous cell carcinoma

Infections and infestations: folliculitis

Eye disorders: retinal vein occlusion

Vascular disorders: vasculitis

Cardiac disorders: atrial fibrillation Table 2 shows the incidence of worsening liver laboratory abnormalities in Trial 1 summarized as the proportion of patients who experienced a shift from baseline to Grade 3 or 4.

Table 2 : Change From Baseline to Grade 3/4 Liver Laboratory Abnormalities*

Parameter Change From Baseline to Grade 3/4
ZELBORAF (%) Dacarbazine (%)
GGT 11.5 8.6
AST 0.9 0.4
ALT 2.8 1.9
Alkaline phosphatase 2.9 0.4
Bilirubin 1.9 0
* For ALT, alkaline phosphatase, and bilirubin, there were no patients with a change to Grade 4 in either treatment arm.

Postmarketing Experience

The following adverse reactions have been identified during postapproval use of ZELBORAF. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Neoplasms benign, malignant and unspecified (incl. cysts and polyps): Progression of pre-existing chronic myelomonocytic leukemia with NRAS mutation [see WARNINGS AND PRECAUTIONS].

Skin and Subcutaneous Tissue Disorders: Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) [see WARNINGS AND PRECAUTIONS].

Blood and lymphatic systems disorder: Neutropenia

Interactions

Effect Of Strong CYP3A4 Inhibitors Or Inducers On Vemurafenib

Vemurafenib is a substrate of CYP3A4 based on in vitro data; therefore, coadministration of strong CYP3A4 inhibitors or inducers may alter vemurafenib concentrations [see CLINICAL PHARMACOLOGY]. Avoid coadministration of ZELBORAF with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, atazanavir, nefazodone, saquinavir, telithromycin, ritonavir, indinavir, nelfinavir, voriconazole) or strong inducers (e.g., phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital), and replace these drugs with alternative drugs when possible.

Effect Of Vemurafenib On CYP1A2 Substrates

Concomitant use of ZELBORAF with drugs with a narrow therapeutic window that are predominantly metabolized by CYP1A2 is not recommended as ZELBORAF may increase concentrations of CYP1A2 substrates [see CLINICAL PHARMACOLOGY]. If coadministration cannot be avoided, monitor closely for toxicities and consider a dose reduction of concomitant CYP1A2 substrates.

Ipilimumab

Increases in transaminases and bilirubin occurred in a majority of patients who received concurrent ipilimumab and ZELBORAF [see WARNINGS AND PRECAUTIONS].

Warnings

Included as part of the PRECAUTIONS section.

Precautions

New Primary Malignancies

Cutaneous Malignancies

Cutaneous squamous cell carcinoma, keratoacanthoma, and melanoma occurred at a higher incidence in patients receiving ZELBORAF compared to those in the control arm in Trial 1. The incidence of cutaneous squamous cell carcinomas (cuSCC) and keratoacanthomas in the ZELBORAF arm was 24% compared to < 1% in the dacarbazine arm [see ADVERSE REACTIONS]. The median time to the first appearance of cuSCC was 7 to 8 weeks; approximately 33% of patients who developed a cuSCC while receiving ZELBORAF experienced at least one additional occurrence with median time between occurrences of 6 weeks. Potential risk factors associated with cuSCC observed in clinical studies using ZELBORAF included age ( ≥ 65 years), prior skin cancer, and chronic sun exposure.

In Trial 1, new primary malignant melanoma occurred in 2.1% (7/336) of patients receiving ZELBORAF compared to none of the patients receiving dacarbazine.

Perform dermatologic evaluations prior to initiation of therapy and every 2 months while on therapy. Manage suspicious skin lesions with excision and dermatopathologic evaluation. Consider dermatologic monitoring for 6 months following discontinuation of ZELBORAF.

Non-Cutaneous Squamous Cell Carcinoma

Non-cutaneous squamous cell carcinomas (SCC) of the head and neck can occur in patients receiving ZELBORAF [see ADVERSE REACTIONS]. Monitor patients receiving ZELBORAF closely for signs or symptoms of new non-cutaneous SCC.

Other Malignancies

Based on mechanism of action, ZELBORAF may promote malignancies associated with activation of RAS through mutation or other mechanisms [see Tumor Promotion in BRAF Wild-Type Melanoma]. Monitor patients receiving ZELBORAF closely for signs or symptoms of other malignancies.

Tumor Promotion In BRAF Wild-Type Melanoma

In vitro experiments have demonstrated paradoxical activation of MAP-kinase signaling and increased cell proliferation in BRAF wild-type cells that are exposed to BRAF inhibitors. Confirm evidence of BRAF V600E mutation in tumor specimens prior to initiation of ZELBORAF [see INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION].

Hypersensitivity Reactions

Anaphylaxis and other serious hypersensitivity reactions can occur during treatment and upon re-initiation of treatment with ZELBORAF. Severe hypersensitivity reactions included generalized rash and erythema, hypotension, and drug reaction with eosinophilia and systemic symptoms (DRESS syndrome). Permanently discontinue ZELBORAF in patients who experience a severe hypersensitivity reaction [see ADVERSE REACTIONS].

Dermatologic Reactions

Severe dermatologic reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, can occur in patients receiving ZELBORAF. Permanently discontinue ZELBORAF in patients who experience a severe dermatologic reaction [see ADVERSE REACTIONS].

QT Prolongation

Concentration-dependent QT prolongation occurred in an uncontrolled, open-label QT sub-study in previously treated patients with BRAF V600E mutation-positive metastatic melanoma [see CLINICAL PHARMACOLOGY]. QT prolongation may lead to an increased risk of ventricular arrhythmias, including Torsade de Pointes.

Do not start treatment in patients with uncorrectable electrolyte abnormalities, QTc > 500 ms, or long QT syndrome, or in patients who are taking medicinal products known to prolong the QT interval. Prior to and following treatment initiation or after dose modification of ZELBORAF for QTc prolongation, evaluate ECG and electrolytes (including potassium, magnesium, and calcium) after 15 days, monthly during the first 3 months, and then every 3 months thereafter or more often as clinically indicated.

Withhold ZELBORAF in patients who develop QTc > 500 ms (Grade 3). Upon recovery to QTc ≤ 500 ms (Grade ≤ 2), restart at a reduced dose. Permanently discontinue ZELBORAF treatment if the QTc interval remains > 500 ms and increased > 60 ms from pre-treatment values after controlling cardiac risk factors for QT prolongation (e.g., electrolyte abnormalities, congestive heart failure, and bradyarrhythmias) [see DOSAGE AND ADMINISTRATION].

Hepatotoxicity

Liver injury leading to functional hepatic impairment, including coagulopathy or other organ dysfunction, can occur with ZELBORAF [see ADVERSE REACTIONS]. Monitor transaminases, alkaline phosphatase, and bilirubin before initiation of treatment and monthly during treatment, or as clinically indicated. Manage laboratory abnormalities with dose reduction, treatment interruption, or treatment discontinuation [see DOSAGE AND ADMINISTRATION].

Concurrent Administration with Ipilimumab

The safety and effectiveness of ZELBORAF in combination with ipilimumab have not been established [see INDICATIONS AND USAGE]. In a dose-finding trial, Grade 3 increases in transaminases and bilirubin occurred in a majority of patients who received concurrent ipilimumab (3 mg/kg) and vemurafenib (960 mg BID or 720 mg BID) [see DRUG INTERACTIONS].

Photosensitivity

Mild to severe photosensitivity can occur in patients treated with ZELBORAF [see ADVERSE REACTIONS]. Advise patients to avoid sun exposure, wear protective clothing and use a broad spectrum UVA/UVB sunscreen and lip balm (SPF ≥ 30) when outdoors.

Institute dose modifications for intolerable Grade 2 or greater photosensitivity [see DOSAGE AND ADMINISTRATION].

Ophthalmologic Reactions

Uveitis, blurry vision, and photophobia can occur in patients treated with ZELBORAF. In Trial 1, uveitis, including iritis, occurred in 2.1% (7/336) of patients receiving ZELBORAF compared to no patients in the dacarbazine arm. Treatment with steroid and mydriatic ophthalmic drops may be required to manage uveitis. Monitor patients for signs and symptoms of uveitis.

Embryo-Fetal Toxicity

ZELBORAF can cause fetal harm when administered to a pregnant woman based on its mechanism of action. There are no adequate and well-controlled studies in pregnant women. If this drug is used during pregnancy or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus [see Use in Specific Populations].

Patient Counseling Information

See FDA-approved patient labeling (Medication Guide). Health care providers should advise patients of the potential benefits and risks of ZELBORAF and instruct their patients to read the Medication Guide before starting ZELBORAF therapy. Inform patients of the following:

  • Evidence of BRAF V600E mutation in the tumor specimen with an FDA approved test is necessary to identify patients for whom treatment with ZELBORAF is indicated [see DOSAGE AND ADMINISTRATION].
  • ZELBORAF increases the risk of developing new primary cutaneous malignancies. Advise patients of the importance of contacting their health care provider immediately for any changes in their skin [see WARNINGS AND PRECAUTIONS].
  • Anaphylaxis and other serious hypersensitivity reactions can occur during treatment and upon reinitiation of treatment with ZELBORAF. Advise patients to stop taking ZELBORAF and to seek immediate medical attention for symptoms of anaphylaxis or hypersensitivity [see WARNINGS AND PRECAUTIONS].
  • Severe dermatologic reactions can occur in patients receiving ZELBORAF. Advise patients to stop taking ZELBORAF and to contact their health care provider for severe dermatologic reactions [see WARNINGS AND PRECAUTIONS].
  • ZELBORAF can prolong QT interval, which may result in ventricular arrhythmias. Advise patients of the importance of monitoring of their electrolytes and the electrical activity of their heart (via an ECG) during ZELBORAF treatment [see WARNINGS AND PRECAUTIONS].
  • Liver injury leading to functional hepatic impairment, including coagulopathy or other organ dysfunction, can occur with ZELBORAF. Advise patients of the importance of laboratory monitoring of their liver during ZELBORAF treatment and to contact their health care provider for relevant symptoms [see WARNINGS AND PRECAUTIONS].
  • ZELBORAF can cause mild to severe photosensitivity. Advise patients to avoid sun exposure, wear protective clothing, and use a broad spectrum UVA/UVB sunscreen and lip balm (SPF ≥ 30) when outdoors to help protect against sunburn [see WARNINGS AND PRECAUTIONS].
  • Ophthalmologic reactions can occur in patients treated with ZELBORAF. Advise patients to contact their health care provider immediately for ophthalmologic symptoms [see WARNINGS AND PRECAUTIONS].
  • ZELBORAF can cause fetal harm when administered to a pregnant woman based on its mechanism of action. Advise women of childbearing potential and men to use appropriate contraceptive measures during ZELBORAF therapy and for at least 2 months after discontinuation of ZELBORAF. Advise patients to contact their health care provider immediately if they become pregnant [see WARNINGS AND PRECAUTIONS and Use in Special Populations].

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment Of Fertility

There have been no formal studies conducted assessing the carcinogenic potential of vemurafenib. ZELBORAF increased the development of cutaneous squamous cell carcinomas in patients in clinical trials.

Vemurafenib did not cause genetic damage when tested in in vitro assays (bacterial mutation [AMES Assay], human lymphocyte chromosome aberration) or in the in vivo rat bone marrow micronucleus test.

No specific studies with vemurafenib have been conducted in animals to evaluate the effect on fertility; nevertheless, no histopathological findings were noted in reproductive organs in males and females in repeat-dose toxicology studies in rats at doses up to 450 mg/kg/day (approximately 0.6 and 1.6 times the human exposure based on AUC in males and females, respectively) and dogs at doses up to 450 mg/kg/day (approximately 0.3 times the human clinical exposure based on AUC in both males and females, respectively).

Use In Specific Populations

Pregnancy

Pregnancy Category D [see WARNINGS AND PRECAUTIONS].

ZELBORAF can cause fetal harm when administered to a pregnant woman based on its mechanism of action.

Vemurafenib revealed no evidence of teratogenicity in rat embryo/fetuses at doses up to 250 mg/kg/day (approximately 1.3 times the human clinical exposure based on AUC) or rabbit embryo/fetuses at doses up to 450 mg/kg/day (approximately 0.6 times the human clinical exposure based on AUC). Fetal drug levels were 3– 5% of maternal levels, indicating that vemurafenib has the potential to be transmitted from the mother to the developing fetus. There are no adequate and well controlled studies in pregnant women. Women of childbearing potential and men should be advised to use appropriate contraceptive measures during ZELBORAF therapy and for at least 2 months after discontinuation of ZELBORAF. If this drug is used during pregnancy or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus.

Nursing Mothers

It is not known whether vemurafenib is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions from ZELBORAF in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Safety and efficacy in pediatric patients below the age of 18 have not been established.

Geriatric Use

Clinical studies of ZELBORAF did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Hepatic Impairment

No formal clinical study has been conducted to evaluate the effect of hepatic impairment on the pharmacokinetics of vemurafenib. No dose adjustment is recommended for patients with mild and moderate hepatic impairment based on a population pharmacokinetic analysis [see CLINICAL PHARMACOLOGY]. The appropriate dose of ZELBORAF has not been established in patients with severe hepatic impairment.

Renal Impairment

No formal clinical study has been conducted to evaluate the effect of renal impairment on the pharmacokinetics of vemurafenib. No dose adjustment is recommended for patients with mild and moderate renal impairment based on a population pharmacokinetic analysis [see CLINICAL PHARMACOLOGY]. The appropriate dose of ZELBORAF has not been established in patients with severe renal impairment.

OverDose

There is no information on overdosage of ZELBORAF.

ContrainDications

None.

Clinical Pharamacology

Mechanism Of Action

Vemurafenib is a low molecular weight, orally available inhibitor of some mutated forms of BRAF serine-threonine kinase, including BRAF V600E. Vemurafenib also inhibits other kinases in vitro such as CRAF, ARAF, wild-type BRAF, SRMS, ACK1, MAP4K5, and FGR at similar concentrations. Some mutations in the BRAF gene including V600E result in constitutively activated BRAF proteins, which can cause cell proliferation in the absence of growth factors that would normally be required for proliferation. Vemurafenib has anti-tumor effects in cellular and animal models of melanomas with mutated BRAF V600E.

Pharmacodynamics

Cardiac Electrophysiology

In a multi-center, open-label, single-arm study in 132 patients with BRAF V600E mutation-positive metastatic melanoma, patients administered vemurafenib 960 mg orally twice daily did not experience large changes in mean QTc interval (i.e., > 20 ms) from baseline. Vemurafenib is associated with concentration-dependent QTc interval prolongation. The largest mean change from baseline in the first month of treatment occurred at 2 hours post-dose on Day 15—an increase of 12.8 ms (upper boundary of the two-sided 90% confidence interval of 14.9 ms). In the first 6 months of treatment, the largest observed mean change from baseline occurred at a pre-dose time point—an increase of 15.1 ms (upper boundary of the two-sided 90% confidence interval of 17.7 ms).

Pharmacokinetics

The pharmacokinetics of vemurafenib were determined in patients with BRAF mutation-positive metastatic melanoma following 15 days of 960 mg twice daily with dosing approximately 12 hours apart. The population pharmacokinetic analysis pooled data from 458 patients. At steady-state, vemurafenib exhibits linear pharmacokinetics within the 240 mg to 960 mg dose range.

Absorption

The bioavailability of vemurafenib has not been determined. The median Tmax was approximately 3 hours following multiple doses.

The mean (± SD) Cmax and AUC0-12 were 62 ± 17 μg/mL and 601 ± 170 μg*h/mL, respectively. The median accumulation ratio estimate from the population pharmacokinetic analysis for the twice daily regimen is 7.4, with steady-state achieved at approximately 15 to 22 days.

In clinical trials, vemurafenib was administered without regard to food. A food effect study has demonstrated that a single dose of vemurafenib administered with a high-fat meal increased AUC by approximately 5-fold, increased Cmax by 2.5-fold, and delayed Tmax by approximately 4 hours as compared to the fasted state.

QTc prolongation may occur with increased exposures as vemurafenib is associated with concentration-dependent QTc interval prolongation.

Distribution

Vemurafenib is highly bound ( > 99%) to human albumin and alpha-1 acid glycoprotein plasma proteins. The population apparent volume of distribution is estimated to be 106 L (with 66% inter-patient variability).

Metabolism

Following oral administration of 960 mg of 14C-vemurafenib, mean data showed that vemurafenib and its metabolites represented 95% and 5% of the components in plasma over 48 hours, respectively.

Elimination

Following oral administration of 960 mg of 14C-vemurafenib, approximately 94% of the radioactive dose was recovered in feces and approximately 1% was recovered in the urine. The population apparent clearance is estimated to be 31 L/day (with 32% inter-patient variability). The median elimination half-life estimate for vemurafenib is 57 hours (the 5th and 95th percentile range is 30 to 120 hours).

Pharmacokinetics in Special Populations

Hepatic Impairment

The pharmacokinetics of vemurafenib were examined in patients with metastatic melanoma enrolled in the clinical trials with normal hepatic function (n=158, total bilirubin ≤ ULN) and mild (n=58, total bilirubin 1.0–1.5 x ULN), moderate (n=27, total bilirubin 1.5–3 x ULN), or severe (n=3, total bilirubin > 3 x ULN) hepatic impairment. Patients received vemurafenib 960 mg orally twice daily. The apparent clearance of vemurafenib in patients with mild and moderate hepatic impairment was similar to that in patients with normal hepatic function. The appropriate dose for patients with severe hepatic impairment cannot be determined as clinical and pharmacokinetic data were available for only three patients [see Use In Specific Populations].

Renal Impairment

The pharmacokinetics of vemurafenib were examined in patients with metastatic melanoma enrolled in the clinical trials with normal renal function (CLcr ≥ 90 mL/min) and mild (n=94, CLcr > 60 to 89 mL/min), moderate (n=11, CLcr 30 to 59 mL/min) or severe (n=1, CLcr < 29 mL/min) renal impairment. Patients received vemurafenib 960 mg orally twice daily. The apparent clearance of vemurafenib in patients with mild and moderate renal impairment was similar to that in patients with normal renal function. The appropriate dose for patients with severe renal impairment cannot be determined as clinical and pharmacokinetic data were available for only one patient [see Use in Specific Populations].

Age, Body Weight, Gender, and Race

Based on the population pharmacokinetic analysis, age, body weight, and gender do not have a clinically important effect on the exposure of vemurafenib. There are insufficient data to evaluate potential differences in the pharmacokinetics of vemurafenib by race.

Pediatrics

No studies have been conducted to investigate the pharmacokinetics of vemurafenib in pediatric patients.

Drug Interactions

In vitro studies have demonstrated that vemurafenib is a CYP3A4 substrate. The effect of strong CYP3A4 inhibitors or strong CYP3A4 inducers on the systemic exposure of vemurafenib has not been evaluated in vivo [see DRUG INTERACTIONS].

In vitro studies suggest that vemurafenib is an inhibitor of CYP1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, and 3A4/5.

In an in vivo phenotypic cocktail drug-drug interaction study in patients with cancer, a single dose of the CYP probe substrate cocktail (for CYP1A2, 2D6, 3A4, 2C19 and 2C9) was administered before and concomitantly with vemurafenib (following 15 days of dosing at 960 mg twice daily). Coadministration of vemurafenib increased the mean AUC of caffeine (CYP1A2 substrate) by 2.6-fold [see DRUG INTERACTIONS]. Coadministration of vemurafenib increased the mean AUC of dextromethorphan (CYP2D6 substrate) by 47% and the AUC of S-warfarin (CYP2C9 substrate) by 18%, while it decreased the mean AUC of midazolam (CYP3A4 substrate) by 39%. Coadministration of vemurafenib did not change the mean systemic exposure to omeprazole (CYP2C19 substrate).

In vitro studies suggest that vemurafenib is both a substrate and an inhibitor of the efflux transporters P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP).

Animal Toxicology And/Or Pharmacology

Consistent with the increased incidence of cutaneous squamous cell carcinomas in patients treated with vemurafenib, the treatment of mice implanted with human cuSCC cells with vemurafenib caused a dose dependent acceleration of the growth of the implanted tumors.

Clinical Studies

Treatment Naive Patients

Trial 1, an international, open-label, randomized controlled trial, equally allocated 675 patients with treatment-naive, BRAF V600E mutation-positive unresectable or metastatic melanoma, as detected by the cobas® 4800 BRAF V600 Mutation Test, to receive ZELBORAF 960 mg by mouth twice daily (n=337) or dacarbazine 1000 mg/m² intravenously on Day 1 every 3 weeks (n=338). Randomization stratification factors were disease stage, lactate dehydrogenase (LDH), ECOG performance status, and geographic region. Treatment continued until disease progression, unacceptable toxicity, and/or consent withdrawal. The major efficacy outcome measures of the trial were overall survival (OS) and investigator-assessed progression-free survival (PFS). Other outcome measures included confirmed investigator-assessed best overall response rate.

Baseline characteristics were balanced between treatment groups. Most patients were male (56%) and caucasian (99%), the median age was 54 years (24% were ≥ 65 years), all patients had ECOG performance status of 0 or 1, and the majority of patients had metastatic disease (95%).

Trial 1 demonstrated statistically significant increases in overall survival and progression-free survival in the ZELBORAF arm compared to the dacarbazine control arm. Table 3 and Figure 1 summarize the efficacy results.

Table 3 :Efficacy of ZELBORAF in Treatment Naive Patients with BRAF V600E Mutation-Positive Melanomaa

  ZELBORAF
(n=337)
Dacarbazine
(n=338)
p-valuef
Overall Survival
  Number of Deathsb 78 (23%) 122 (36%)  
  Hazard Ratio(95% CI)c 0 47 (0.35, 0.62) < 0.0001
  Updated Median Survival (months) (95 % CI) d, e 13.6 (12.0, 15.3) 10.3 (9.1, 12.8)  
Progression-free survival 
  Hazard Ratio (95% CI)c   0.26 (0.20, 0.33) < 0.0001
  Median PFS (months)(95% CI)d 5.3 (4.9, 6.6) 1.6 (1.6, 1.7) -
aAs detected by the cobas® 4800 BRAF V600 Mutation Test
bTotal of 200 deaths (Zelboraf median follow-up 6.2 months)
cHazard ratio estimated using Cox model; a hazard ratio of < 1 favors ZELBORAF
dKaplan-Meier estimate
eUpdated based on 478 deaths (Zelboraf median follow-up 13.4 months)
fUnstratified log-rank test

Figure 1 : Kaplan-Meier Curves of Overall Survival – Treatment Naive Patients

Kaplan-Meier Curves of Overall Survival – Treatment Naive Patients - Illustration

The confirmed, investigator-assessed best overall response rate was 48.4% (95% CI: 41.6%, 55.2%) in the ZELBORAF arm compared to 5.5% (95% CI: 2.8%, 9.3%) in the dacarbazine arm. There were 2 complete responses (0.9%) and 104 partial responses (47.4%) in the ZELBORAF arm and all 12 responses were partial responses (5.5%) in the dacarbazine arm.

Patients Who Received Prior Systemic Therapy

In a single-arm, multicenter, multinational trial (Trial 2), 132 patients with BRAF V600E mutation-positive metastatic melanoma, as detected by the cobas® 4800 BRAF V600 Mutation Test, who had received at least one prior systemic therapy, received ZELBORAF 960 mg by mouth twice daily. The median age was 52 years with 19% of patients being older than 65 years. The majority of patients were male (61%) and Caucasian (99%). Forty-nine percent of patients received ≥ 2 prior therapies. The median duration of follow-up was 6.87 months (range, 0.6 to 11.3).

The confirmed best overall response rate as assessed by an independent review committee (IRC) was 52% (95% CI: 43%, 61%). There were 3 complete responses (2.3%) and 66 partial responses (50.0%). The median time to response was 1.4 months with 75% of responses occurring by month 1.6 of treatment. The median duration of response by IRC was 6.5 months (95% CI: 5.6, not reached).

Patients with Wild-Type BRAF Melanoma

ZELBORAF has not been studied in patients with wild-type BRAF melanoma [see WARNINGS AND PRECAUTIONS].

Patient Information

ZELBORAF®
(ZEL-bor-raf)
(vemurafenib) Tablets for Oral Administration

What is the most important information I should know about ZELBORAF?

ZELBORAF can cause serious side effects, including:

Risk of cancers. ZELBORAF may cause a type of skin cancer called cutaneous squamous cell carcinoma (cuSCC). New melanoma lesions have occurred in people who take ZELBORAF. ZELBORAF may also cause another type of cancer called non-cutaneous squamous cell carcinoma (SCC). Talk with your healthcare provider about your risk for these cancers.

Check your skin and tell your healthcare provider right away about any skin changes including a:

  • new wart
  • skin sore or reddish bump that bleeds or does not heal
  • change in size or color of a mole

Your healthcare provider should check your skin before you start taking ZELBORAF, and every 2 months while taking ZELBORAF, to look for any new skin cancers. Your healthcare provider may continue to check your skin for 6 months after you stop taking ZELBORAF.

Your healthcare provider should also check for cancers that may not occur on the skin. Tell your healthcare provider about any new symptoms that you get while taking ZELBORAF.

See “What are the possible side effects of ZELBORAF?” for more information about side effects.

What is ZELBORAF?

ZELBORAF is a prescription medicine used to treat a type of skin cancer called melanoma,

  • that has spread to other parts of the body or cannot be removed by surgery, and
  • that has a certain type of abnormal “BRAF” gene

Your healthcare provider will perform a test to make sure that ZELBORAF is right for you.

  • ZELBORAF is not used to treat melanoma with a normal BRAF gene.

It is not known if ZELBORAF is safe and effective in children under 18 years of age.

What should I tell my healthcare provider before taking ZELBORAF?

Before you take ZELBORAF, tell your healthcare provider if you:

  • have any heart problems, including a condition called long QT syndrome
  • have liver or kidney problems
  • have been told that you have low blood levels of potassium, calcium, or magnesium
  • have any other medical conditions
  • are pregnant or plan to become pregnant. ZELBORAF can harm your unborn baby.
    • Females who are able to become pregnant, and males who take ZELBORAF, should use birth control during treatment and for at least 2 months after stopping ZELBORAF.
    • Talk to your healthcare provider about birth control methods that may be right for you.
    • Tell your healthcare provider right away if you become pregnant during treatment with ZELBORAF.
  • are breastfeeding or plan to breastfeed. It is not known if ZELBORAF passes into your breast milk. You and your healthcare provider should decide if you will take ZELBORAF or breastfeed. You should not do both.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How should I take ZELBORAF?

  • Take ZELBORAF exactly as your healthcare provider tells you. Do not change your dose or stop taking ZELBORAF unless your healthcare provider tells you to.
  • Take ZELBORAF every 12 hours with or without a meal.
  • Do not crush or chew ZELBORAF tablets.
  • Do not take an additional dose of ZELBORAF if you vomit after taking your scheduled dose. Take your next dose at your regular time.
  • If you miss a dose of ZELBORAF, take it as soon as you remember. If it is within 4 hours of your next scheduled dose, just take your next dose at your regular time. Do not make up for the missed dose.
  • If you take too much ZELBORAF, call your healthcare provider or go the nearest hospital emergency room right away.

What should I avoid while taking ZELBORAF?

Avoid sunlight while you are taking ZELBORAF. ZELBORAF can make your skin sensitive to sunlight. You may burn more easily and get severe sunburns. To help protect against sunburn:

  • When you go outside, wear clothes that protect your skin, including your head, face, hands, arms, and legs.
  • Use lip balm and a broad-spectrum sunscreen with SPF 30 or higher.

What are the possible side effects of ZELBORAF?

ZELBORAF may cause serious side effects, including:

  • See “What is the most important information I should know about ZELBORAF?”
  • Allergic reactions can happen while taking ZELBORAF, and can be severe. Stop taking ZELBORAF and get medical help right away if you have any of these symptoms of an allergic reaction:
    • get a rash or redness all over your body
    • have throat tightness or hoarseness
    • have trouble breathing or swallowing
    • have swelling of the face, lips, or tongue
    • feel faint
    • have a fast heartbeat
  • Severe skin reactions. Stop taking ZELBORAF and call your healthcare provider right away if you get a skin rash with any of the following symptoms, because you may have a severe skin reaction:
    • blisters on your skin
    • fever
    • blisters or sores in your mouth
    • redness or swelling of your face, hands, or soles of your feet
    • peeling of your skin
  • Changes in the electrical activity of your heart called QT prolongation. QT prolongation can cause irregular heartbeats that can be life-threatening. Your healthcare provider should do tests before you start taking ZELBORAF and during your treatment with ZELBORAF to check the electrical activity of your heart.
    Tell your healthcare provider right away if you feel faint, lightheaded, dizzy, or feel your heart beating irregularly or fast while taking ZELBORAF. These may be symptoms related to QT prolongation.
  • Liver injury. Your healthcare provider should do blood tests to check your liver function before you start taking ZELBORAF and during treatment. Tell your healthcare provider right away if you get any of these symptoms of a liver problem during treatment:
    • yellowing of your skin or the white part of your eyes
    • dark or brown (tea color) urine
    • nausea or vomiting
    • loss of appetite
    • pain on the right side of your stomach
  • Eye problems. Tell your healthcare provider right away if you get any of these symptoms during treatment with ZELBORAF:
    • eye pain, swelling, or redness
    • blurred vision or other vision changes

The most common side effects of ZELBORAF include:

  • joint pain
  • sunburn or sun sensitivity
  • rash (see “Severe skin reactions” above)
  • nausea
  • hair loss
  • itching
  • tiredness
  • warts

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of ZELBORAF. For more information about side effects, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

You may also report side effects to Genentech at 1-888-835-2555.

How should I store ZELBORAF?

  • Store ZELBORAF at room temperature between 68°F to 77°F (20°C to 25°C).
  • Store ZELBORAF in the original container with the lid tightly closed.
  • Ask your healthcare provider or pharmacist how to safely throw away (dispose of) any unused or expired ZELBORAF.

Keep ZELBORAF and all medicine out of the reach of children.

General information about ZELBORAF

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use ZELBORAF for a condition for which it was not prescribed. Do not give ZELBORAF to other people, even if they have the same symptoms that you have. It may harm them.

If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about ZELBORAF that is written for health professionals.

For more information, call Genentech at 1-888-835-2555.

What are the ingredients in ZELBORAF?

Active ingredient: vemurafenib

Inactive ingredients:Tablet Core: hypromellose acetate succinate, croscarmellose sodium, colloidal silicon dioxide, magnesium stearate, hydroxypropyl cellulose. Coating: pinkish white: poly (vinyl alcohol), titanium dioxide, polyethylene glycol 3350, talc, and iron oxide red.

Consumer Overview Uses

No Information Available!

Consumer Overview Side Effect

No Information Available!

Consumer Overview Missed Dose

No Information Available!

Patient Detailed Side Effect

Brand Names: Zelboraf

Generic Name: vemurafenib (Pronunciation: VEM ue RAF e nib)

  • What is vemurafenib (Zelboraf)?
  • What are the possible side effects of vemurafenib (Zelboraf)?
  • What is the most important information I should know about vemurafenib (Zelboraf)?
  • What should I discuss with my healthcare provider before taking vemurafenib (Zelboraf)?
  • How should I take vemurafenib (Zelboraf)?
  • What happens if I miss a dose (Zelboraf)?
  • What happens if I overdose (Zelboraf)?
  • What should I avoid while taking vemurafenib (Zelboraf)?
  • What other drugs will affect vemurafenib (Zelboraf)?
  • Where can I get more information?

What is vemurafenib (Zelboraf)?

Vemurafenib is a cancer medication that interferes with the growth and spread of cancer cells in the body.

Vemurafenib is used to treat metastatic melanoma (skin cancer).

Vemurafenib may also be used for purposes not listed in this medication guide.

What are the possible side effects of vemurafenib (Zelboraf)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using vemurafenib and call your doctor at once if you have a serious side effect such as:

  • severe dizziness, fainting, fast or pounding heartbeats;
  • white patches on your eyes;
  • new or worsening skin lesions; or
  • severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious side effects may include:

  • joint pain;
  • tired feeling;
  • nausea;
  • hair loss;
  • mild rash or itching;
  • skin growths; or
  • blurred vision, increased sensitivity of your eyes to light.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the Zelboraf (vemurafenib) Side Effects Center for a complete guide to possible side effects

Learn More »

What is the most important information I should know about vemurafenib (Zelboraf)?

Do not use vemurafenib if you are pregnant. It could harm the unborn baby.

Before you take vemurafenib, tell your doctor if you have liver disease, an electrolyte imbalance (such as low levels of potassium or magnesium in your blood), or a personal or family history of Long QT syndrome.

Using vemurafenib may increase your risk of developing other types of skin cancer. Report any new or worsening skin lesions to your doctor right away.

There are many other drugs that can interact with vemurafenib. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Patient Detailed How Take

What should I discuss with my healthcare provider before taking vemurafenib (Zelboraf)?

You should not use vemurafenib if you are allergic to it.

To make sure you can safely use vemurafenib, tell your doctor if you have any of these other conditions:

  • liver disease;
  • a heart rhythm disorder;
  • a personal or family history of Long QT syndrome; or
  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood).

Using vemurafenib may increase your risk of developing other types of skin cancer. Report any new or worsening skin lesions to your doctor right away.

FDA pregnancy category D. Do not use vemurafenib if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.

It is not known whether vemurafenib passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using vemurafenib.

How should I take vemurafenib (Zelboraf)?

Before you start treatment, your doctor may perform tests to make sure vemurafenib is the best treatment for your type of skin cancer.

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Vemurafenib is usually taken twice per day, as 2 tablets in the morning and 2 tablets in the evening. Follow your doctor's instructions.

Take this medicine with a full glass of water. You may take vemurafenib with or without food.

Do not crush, chew, or break a vemurafenib tablet. Swallow it whole.

To make sure this medication is helping your condition and not causing harmful effects, your skin condition will need to be checked often. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. You may also need eye exams. Your cancer treatments may be delayed based on the results of these tests. Do not miss any follow-up visits to your doctor.

Your doctor may want to check your skin for several months after you stop using vemurafenib. Visit your doctor regularly.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Patient Detailed Avoid Taking

What happens if I miss a dose (Zelboraf)?

Take the missed dose as soon as you remember. Skip the missed dose if your next dose is less than 4 hours away. Do not take extra medicine to make up the missed dose.

What happens if I overdose (Zelboraf)?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking vemurafenib (Zelboraf)?

Avoid exposure to sunlight or tanning beds. Vemurafenib can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

What other drugs will affect vemurafenib (Zelboraf)?

Many drugs can interact with vemurafenib. Below is just a partial list. Tell your doctor if you are using:

  • a blood thinner such as warfarin (Coumadin, Jantoven);
  • cyclosporine (Gengraf, Neoral, Sandimmune), sirolimus (Rapamune) or tacrolimus (Prograf);
  • digoxin (digitalis, Lanoxin, Lanoxicaps);
  • theophylline (Elixophyllin, Theo-24, Theochron, Uniphyl);
  • ADHD medication such as Adderall, Concerta, Daytrana, Metadate, Ritalin, Strattera;
  • an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), rifampin (Rifater, Rifadin, Rifamate), rifabutin (Mycobutin), rifapentine (Priftin), or telithromycin (Ketek);
  • an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), desipramine (Norpramin), doxepin (Sinequan, Silenor), duloxetine (Cymbalta), fluoxetine (Prozac, Sarafem, Symbyax), nefazodone, nortriptyline (Pamelor), paroxetine (Paxil, Pexeva), sertraline (Zoloft), venlafaxine (Effexor), and others;
  • antifungal medication such as itraconazole (Sporanox), ketoconazole (Nizoral), miconazole (Oravig), or voriconazole (Vfend);
  • cancer medicine such as doxorubicin (Adriamycin, Doxil), lomustine (CeeNU), tamoxifen (Soltamox);
  • ergot medicine such as ergotamine (Ergomar, Cafergot) or dihydroergotamine (D.H.E. 45, Migranal Nasal Spray);
  • cough medicine such as dextromethorphan (Delsym, Robitussin Maximum Strength, Vicks 44, and others) or dihydrocodeine (Alahist DHC, J-Max DHC, Pancof-PD, Panlor, Trezix, Welltuss EXP, and others);
  • pain medication such as codeine (Tylenol #3), hydrocodone (Lortab, Vicodin, Vicoprofen), oxycodone (OxyContin, Combunox, Roxicodone, Percocet), or tramadol (Ultram, Ultracet);
  • heart or blood pressure medication such as betaxolol (Kerlone), captopril (Capoten), carvedilol (Coreg), labetalol (Normodyne), metoprolol (Dutoprol, Lopressor, Toprol), nicardipine (Cardene), pindolol (Visken), propranolol (Inderal), timolol (Blocadren);
  • a heart rhythm medication such as disopyramide (Norpace), flecainide (Tambocor), mexilitene (Mexitil), procainamide (Procan, Pronestyl), propafenone (Rythmol), or quinidine (Quin-G);
  • HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase), or ritonavir (Norvir, Kaletra);
  • medicine to treat psychiatric disorders, such as chlorpromazine (Thorazine), fluphenazine (Permitil), haloperidol (Haldol), pimozide (Orap), perphenazine (Trilafon), promethazine (Phenergan), risperidone (Risperdal), or thioridazine (Mellaril); or
  • seizure medication such as carbamazepine (Carbatrol, Equetro, Tegretol), divalproex (Depakote), phenobarbital (Solfoton), phenytoin (Dilantin), or valproic acid (Depakene, Stavzor).

This list is not complete and there are many other drugs that can interact with vemurafenib. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Where can I get more information?

Your pharmacist can provide more information about vemurafenib.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

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