Apo-Erlotinib: Uses, Side Effects and Dosage

ABOUT THIS MEDICATION

What the medication is used for:

APO-ERLOTINIB is prescribed to you because you have non-small cell lung cancer at an advanced stage and;

• chemotherapy has not helped to stop your disease or

• your cancer cells have certain changes in the gene

  for a protein called epidermal growth factor receptor (EGFR) and your disease has not worsened after 4 cycles of first line chemotherapy, or

• your cancer cells have certain changes in the EGFR gene.

What it does:

APO-ERLOTINIB belongs to a group of medicines called epidermal growth factor receptor tyrosine kinase inhibitors which are used to treat cancer. APO-ERLOTINIB prevents the activity of a protein called epidermal growth factor receptor. This protein is known to be involved in the growth and spread of cancer cells.

When it should not be used:

Do not take APO-ERLOTINIB if you are hypersensitive (allergic) to erlotinib or any of the other ingredients of APO-ERLOTINIB. See What the nonmedicinal ingredients are.

What the medicinal ingredient is:

Erlotinib (as erlotinib hydrochloride)

What the nonmedicinal ingredients are:

Tablet core:

Anhydrous lactose, colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, and microcrystalline cellulose.

Tablet coating:

Hydroxypropyl cellulose, hypromellose, titanium dioxide, and triethyl citrate.

What dosage forms it comes in:

• Tablets
• Each tablet contains 25, 100 or 150 mg erlotinib as erlotinib hydrochloride.

APO-ERLOTINIB is a white to off-white, round, biconvex coated tablet and is available in bottle of 100 and 500 tablets and blister of 30 tablets.

WARNINGS AND PRECAUTIONS

Serious Warnings and Precautions

APO-ERLOTINIB should be prescribed and managed only by a doctor who is experienced with anticancer drugs.

You must have a confirmed activating mutation of the EGFR-TK prior to starting of first-line APO-ERLOTINIB monotherapy.

Erlotinib has not been studied in patients with severely reduced liver function.

Erlotinib has not been studied in patients with severely reduced kidney function

Serious side effects that have been reported with erlotinib include:

• liver failure, including fatal cases.
• gastrointestinal perforation (a hole through the wall of the stomach, small intestine, or large bowel) including fatal cases.

BEFORE you use APO-ERLOTINIB talk to your doctor or pharmacist if:

• you have liver problems
• you have kidney problems
• you have gastrointestinal ulcers (bleeding of the stomach or intestines) or diverticular disease
• you have cataracts, have had cataract surgery, or wear contact lenses
• you have lung disease
• you smoke tobacco

• you plan to become pregnant

• you plan to breastfeed. Breastfeeding should be avoided while being treated with APO-ERLOTINIB and for at least 2 weeks after the final dose.
• you have been told by your doctor that you cannot tolerate some sugars

Avoid pregnancy while being treated with APO-ERLOTINIB. If you are a woman who could become pregnant, use adequate contraception during treatment and for at least 2 weeks after taking the last tablet. If you become pregnant while you are being treated with APO-ERLOTINIB, immediately inform your doctor who will decide if the treatment should be continued.

Smoking tobacco may reduce erlotinib blood level.

INTERACTIONS WITH THIS MEDICATION

Tell your doctor if you are taking other drugs, including non- prescription and natural health products, because they may speed up or slow down the breakdown of APO-ERLOTINIB. For example:

• Antifungals (such as ketoconazole, fluconazole)
• Calcium channel blockers (such as diltiazem, verapamil)

• Macrolide antibiotics (such as erythromycin,

  clarithromycin)

• Fluoroquinolone antibiotics (such as ciprofloxacin,

  norfloxacin)

• Other antibiotics such as rifampin
• Some antivirals (such as ritonavir, indinavir)

• Grapefruit juice

• St. John’s Wort
• Anticonvulsants such as carbamezapine and phenytoin
• Blood thinners such as warfarin

• Medications which reduce acid in the stomach (such as

  omeprazole, ranitidine)

• Statin drugs to treat high cholesterol

PROPER USE OF THIS MEDICATION

Usual dose:

The usual dose is one 150 mg tablet each day. Take your APO-ERLOTINIB tablet:

• at least 1 hour before you eat or
• at least 2 hours after you have eaten

If you are taking medications which reduce acid in the stomach (such as ranitidine 150 mg twice a day), take your APO-ERLOTINIB tablet:

• 2 hours before your morning dose of the medication and
• 10 hours after your evening dose of the medication

Swallow your tablet with a glass of plain water.

Always take APO-ERLOTINIB exactly as your doctor has instructed you. Check with your doctor or pharmacist if you are unsure.

This medicine has been prescribed for you personally and should not be passed on to others. It may harm them even if their symptoms are the same as yours.

Overdose:

If you think you have taken too much APO-ERLOTINIB, contact your healthcare professional, hospital emergency department or regional poison control centre immediately, even if there are no symptoms.

Missed Dose:

If you miss one or more doses of APO-ERLOTINIB, contact your doctor or pharmacist as soon as possible.

Do not take a double dose to make up for forgotten individual doses.

SIDE EFFECTS AND WHAT TO DO ABOUT THEM

Like all medicines, APO-ERLOTINIB can have side effects.

The most common side effects (more than 5 out of 10 patients):

• rash
• diarrhea

If diarrhea occurs, drink plenty of water throughout the day to reduce the risk of dehydration. If you are having difficulty drinking liquid due to severe nausea/vomiting, please call your doctor immediately to be assessed for possible dehydration, low potassium levels and kidney failure.

Very common side effects (more than 1 out of 10 patients): tiredness, loss of appetite, difficulty in breathing, cough, infection, nausea, vomiting, mouth irritation, stomach pain, itching, dry skin, eye irritation.

Common side effects (less than 1 out of 10 patients):

• Bleeding from the stomach or the intestines
• Abnormal blood tests for the liver function.
• Headaches and dizziness
• Hair and nail changes. They included inflammatory reactions around the fingernail (common), excess body and facial hair of a male distribution pattern (uncommon), eyelash and eyebrow changes (uncommon), and brittle and lose nails (uncommon)
• Acne or other red or pink little bumps at hair follicles

Contact your doctor as soon as possible if you suffer from any of the above side effects.

Uncommon serious side effects (less than 1 out of 100 patients):

• Interstitial lung disease, a rare form of lung inflammation and can have a fatal outcome in some cases. If you develop symptoms such as sudden difficulty of breathing associated with cough or fever contact your doctor immediately
• Gastrointestinal bleeding or perforation (a hole through the entire wall of stomach, intestine, or bowel)
• Corneal perforation, the risk is higher in patients who have had cataract surgery or wear contact lenses
• severe skin reactions (Stevens-Johnson Syndrome)

If you notice any side effects not mentioned in this leaflet, please inform your doctor or pharmacist.

This is not a complete list of side effects. For any unexpected effects while taking APO-ERLOTINIB, contact your doctor or pharmacist.

HOW TO STORE IT

• Store APO-ERLOTINIB at room temperature 15°C to

  30°C.

• Keep out of the reach and sight of children.
• Do not use after the expiry date stated on the carton or on the bottle.

Reporting Side Effects

You can report any suspected side effects associated with the use of health products to Health Canada by:

• Visiting the Web page on Adverse Reaction

  Reporting (https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/adverse-reaction-reporting.html) for information on how to report online, by mail or by fax; or

• Calling toll-free at 1-866-234-2345.

NOTE: Contact your health professional if you need information about how to manage your side effects. The Canada Vigilance Program does not provide medical advice.

MORE INFORMATION

If you want more information about APO-ERLOTINIB:

• Talk to your healthcare professional
• Find the full product monograph that is prepared for healthcare professionals and includes this patient medication information by visiting the Health Canada website (https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database.html); the manufacturer’s website http://www.apotex.ca/products, or by calling 1-800-667-4708.

Last revised: December 5, 2018