TEDUGLUTIDE Drug Interactions: What You Need to Know

INTERACTIONS

7.1 Potential for Increased Absorption of Oral Medications Based upon the pharmacodynamic effect of GATTEX, there is a potential for increased absorption of concomitant oral medications. Altered mental status has been observed in patients taking GATTEX and benzodiazepines in the adult clinical studies <span class="opacity-50 text-xs">[see Warnings and Precautions ( 5.5 )]</span> . Monitor patients on concomitant oral drugs requiring titration or with a narrow therapeutic index for adverse reactions related to the concomitant drug while on GATTEX. The concomitant drug may require a reduction in dosage.

None. None. ( 4 )

AND PRECAUTIONS Acceleration of Neoplastic Growth : In case of intestinal malignancy, discontinue GATTEX. The decision to continue GATTEX in patients with non-gastrointestinal malignancy should be made based on benefit risk considerations. ( 5.1 ) In adult patients, colonoscopy and upper GI endoscopy (or alternate imaging) is recommended after 1 year of treatment. Perform subsequent colonoscopies and upper GI endoscopes (or alternate imaging) no less frequently than every 5 years. ( 5.1 ) In pediatric patients, perform fecal occult blood testing annually. Colonoscopy/sigmoidoscopy is recommended after 1 year of treatment and every 5 years thereafter on treatment. Consider upper GI endoscopy (or alternate imaging) during treatment with GATTEX. ( 5.1 )

Intestinal

Obstruction : In patients who develop intestinal or stomal obstruction, temporarily discontinue GATTEX pending further clinical evaluation and management. ( 5.2 ) Biliary and Pancreatic Disease : Obtain bilirubin, alkaline phosphatase, lipase, amylase every 6 months. If clinically meaningful changes are seen, further evaluation is recommended including imaging, and reassess continued GATTEX treatment. ( 5.3 )

Fluid

Overload, Including Congestive Heart Failure : If fluid overload occurs, adjust parenteral support, and reassess continued GATTEX treatment. ( 5.4 ) Potential for Increased Absorption of Oral Medications : Monitor patients on concomitant oral medications (e.g., benzodiazepines) for adverse reactions related to the concomitant drug; dosage reduction of the other drug may be required. ( 5.5 , 7.1 )

5.1 Acceleration of Neoplastic Growth Based on the pharmacologic activity and tumor findings in the rat and mouse carcinogenicity studies, GATTEX has the potential to cause hyperplastic changes including neoplasia <span class="opacity-50 text-xs">[see Clinical Pharmacology ( 12.1 ), Nonclinical Toxicology ( 13.1 )]</span> . In patients at increased risk for malignancy, the clinical decision to use GATTEX should be considered only if the benefits outweigh the risks. In patients who develop active gastrointestinal malignancy (GI tract, hepatobiliary, pancreatic) while on GATTEX, discontinue GATTEX treatment. In patients who develop active non-gastrointestinal malignancy while on GATTEX, the clinical decision to continue GATTEX should be made based on benefit-risk considerations.

Gastrointestinal Polyps

Intestinal polyps were identified during the clinical studies. Postmarketing cases of colorectal, gastric, and small intestinal (duodenum, ileum, and jejunum) polyps have been reported postmarketing [see Adverse Reactions ( 6.1 , 6.2 )] .

Adult Patients Within

6 months prior to starting treatment with GATTEX, perform colonoscopy and upper GI endoscopy with removal of polyps. A follow-up colonoscopy and upper GI endoscopy (or alternate imaging) is recommended at the end of 1 year of GATTEX. Perform subsequent colonoscopies and upper GI endoscopies (or alternate imaging) every 5 years or more often as needed. If a polyp is found, adherence to current polyp follow-up guidelines is recommended. If gastrointestinal cancer is diagnosed, discontinue GATTEX therapy.

Pediatric Patients Within

6 months prior to starting treatment with GATTEX, perform fecal occult blood testing; if there is new or unexplained blood in the stool, perform colonoscopy/sigmoidoscopy and an upper GI endoscopy. Perform subsequent fecal occult blood testing annually in pediatric patients while they are receiving GATTEX. If there is new or unexplained blood in the stool, perform colonoscopy/sigmoidoscopy and an upper GI endoscopy. Colonoscopy/sigmoidoscopy is recommended for all pediatric patients after 1 year of treatment and every 5 years thereafter while on continuous treatment with GATTEX [see Dosage and Administration ( 2.1 )] . Consider upper GI endoscopy (or alternate other imaging) during treatment with GATTEX. If gastrointestinal cancer is diagnosed, discontinue GATTEX therapy.

5.2 Intestinal Obstruction Intestinal obstruction has been reported in clinical studies <span class="opacity-50 text-xs">[see Adverse Reactions ( 6.1 )]</span> and postmarketing. In patients who develop intestinal or stomal obstruction, temporarily discontinue GATTEX while the patient is clinically managed. GATTEX may be restarted when the obstructive presentation resolves, if clinically indicated.

5.3 Biliary and Pancreatic Disease Gallbladder and Biliary Tract Disease Cholecystitis, cholangitis, and cholelithiasis have been reported in clinical studies <span class="opacity-50 text-xs">[see Adverse Reactions ( 6.1 )]</span> and postmarketing. For identification of the onset or worsening of gallbladder/biliary disease, obtain laboratory assessment of bilirubin and alkaline phosphatase within 6 months prior to starting GATTEX, and at least every 6 months while on GATTEX; or more frequently if needed. If clinically meaningful changes are seen, further evaluation including imaging of the gallbladder and/or biliary tract is recommended; and reassess the need for continued GATTEX treatment.

Pancreatic Disease

Pancreatitis has been reported in clinical studies [see Adverse Reactions ( 6.1 )] . For identification of onset or worsening of pancreatic disease, obtain laboratory assessments of lipase and amylase within 6 months prior to starting GATTEX, and at least every 6 months while on GATTEX; or more frequently if needed. If clinically meaningful changes are seen, further evaluation such as imaging of the pancreas is recommended; and reassess the need for continued GATTEX treatment.

5.4 Fluid Imbalance and Fluid Overload Fluid Overload Fluid overload and congestive heart failure have been observed in clinical studies, which were deemed to be related to enhanced fluid absorption associated with GATTEX <span class="opacity-50 text-xs">[see Adverse Reactions ( 6.1 )]</span> . If fluid overload occurs, adjust parenteral support and reassess GATTEX treatment, especially in patients with underlying cardiovascular disease. If significant cardiac deterioration develops while on GATTEX, reassess the need for continued GATTEX treatment. Fluid and Electrolyte Imbalance Discontinuation of treatment with GATTEX may also result in fluid and electrolyte imbalance. Monitor fluid and electrolyte status in patients who discontinue treatment with GATTEX <span class="opacity-50 text-xs">[see Dosage and Administration ( 2.5 )]</span>.

5.5 Increased Absorption of Concomitant Oral Medication In the adult placebo-controlled studies, an analysis of episodes of cognition and attention disturbances was performed for patients on benzodiazepines. One patient receiving prazepam concomitantly with GATTEX 0.05 mg/kg once daily experienced a dramatic deterioration in mental status progressing to coma during the first week of GATTEX therapy. The patient was admitted to the ICU and the prazepam blood concentration was &gt;300 mcg/L. GATTEX and prazepam were discontinued, and coma resolved 5 days later. Monitor patients receiving concomitant oral drugs requiring titration or with a narrow therapeutic index, for adverse reactions due to potential increased absorption of the concomitant drug. The concomitant drug may require a reduction in dosage <span class="opacity-50 text-xs">[see Drug Interactions ( 7.1 )]</span> .