Vitrakvi Dosage

Generic name: LAROTRECTINIB 25mg
Dosage form: capsules, oral solution
Drug class: Multikinase inhibitors

Medically reviewed by Drugs.com. Last updated on Nov 3, 2023.

Patient Selection

Select patients for treatment with VITRAKVI based on the presence of a NTRK gene fusion in tumor specimens. Information on FDA-approved tests is available at http://www.fda.gov/companiondiagnostics.

Recommended Dosage

Recommended Dosage in Adult and Pediatric Patients with Body Surface Area of at Least 1 Meter-Squared

The recommended dosage of VITRAKVI is 100 mg orally twice daily, with or without food, until disease progression or until unacceptable toxicity.

Recommended Dosage in Pediatric Patients with Body Surface Area Less Than 1 Meter-Squared

The recommended dosage of VITRAKVI is 100 mg/m2 orally twice daily, with or without food, until disease progression or until unacceptable toxicity.

Dosage Modifications for Adverse Reactions

For Grade 2 and higher liver function test abnormalities, refer to Section 2.4, Table 2, Dosage Modifications for Hepatotoxicity.

For all other Grade 3 or 4 adverse reactions:

•: Withhold VITRAKVI until adverse reaction resolves or improves to baseline or Grade 1. Resume at the next dosage modification if resolution occurs within 4 weeks.
•: Permanently discontinue VITRAKVI if an adverse reaction does not resolve within 4 weeks.

The recommended dosage reductions for VITRAKVI for adverse reactions are provided in Table 1.

Table 1 Recommended Dosage Reductions for VITRAKVI for Adverse Reactions

Dosage Reduction	Adult and Pediatric Patients with Body Surface Area of 1 m2 or Greater	Pediatric Patients with Body Surface Area Less Than 1 m2
First	75 mg orally twice daily	75 mg/m2 orally twice daily
Second	50 mg orally twice daily	50 mg/m2 orally twice daily
Third	100 mg orally once daily	25 mg/m2 orally twice daily a

a Pediatric patients on 25 mg/m2 orally twice daily should remain on this dosage even if body surface area becomes greater than 1 m2 during the treatment. Maximum dose should be 25 mg/m2 orally twice daily at the third dosage modification.

Permanently discontinue VITRAKVI in patients who are unable to tolerate VITRAKVI after three dose modifications.

2.4 Dosage Modifications for Hepatotoxicity

The recommended dosage modifications for VITRAKVI liver function test abnormalities are provided in Table 2.

For CTCAE Grade 2 ALT and/or AST elevation, monitor liver function frequently as clinically indicated, to establish whether a dose interruption or reduction is required.

Table 2 Recommended Dosage Modifications for VITRAKVI for Hepatotoxicity

Severitya

Dosage Modification

AST or ALT ≥ 5 x ULN with bilirubin ≤ 2 x ULN

•: Withhold VITRAKVI until recovery to ≤ Grade 1 or return to baseline.
•: Resume VITRAKVI at the next lower dose level.
•: Permanently discontinue if a Grade 4 AST and/or ALT elevation occurs after resuming VITRAKVI.

AST or ALT > 3 × ULN with total bilirubin > 2 × ULN in the

absence of alternative causes

•: Permanently discontinue VITRAKVI.

ALT = alanine aminotransferase; AST = aspartate aminotransferase; ULN = upper limit of normal

aGrading defined by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE)

version 4.03

Dosage Modifications for Coadministration with Strong CYP3A4 Inhibitors

Avoid coadministration of strong CYP3A4 inhibitors with VITRAKVI. If coadministration of a strong CYP3A4 inhibitor cannot be avoided, reduce the VITRAKVI dose by 50%. After the inhibitor has been discontinued for 3 to 5 elimination half-lives, resume the VITRAKVI dose that was used prior to initiating the CYP3A4 inhibitor.

2.6 Dosage Modifications for Coadministration with Strong or Moderate CYP3A4 Inducers

Avoid coadministration of strong CYP3A4 inducers with VITRAKVI. If coadministration of a strong CYP3A4 inducer cannot be avoided, double the VITRAKVI dose. Additionally, for coadministration with a moderate CYP3A4 inducer, double the VITRAKVI dose. After the inducer has been discontinued for 3 to 5 elimination half-lives, resume the VITRAKVI dose that was used prior to initiating the CYP3A4 inducer.

Dosage Modifications for Patients with Hepatic Impairment

Reduce the starting dose of VITRAKVI by 50% in patients with moderate (Child-Pugh B) to severe (Child-Pugh C) hepatic impairment.

Administration

VITRAKVI capsule or oral solution may be used interchangeably.

Do not make up a missed dose within 6 hours of the next scheduled dose.

If vomiting occurs after taking a dose of VITRAKVI, take the next dose at the scheduled time.

Capsules

Swallow capsules whole with water. Do not chew or crush the capsules.

Oral Solution packaged in one bottle containing 100 mL

•: Store the glass bottle of VITRAKVI oral solution in the refrigerator. Discard any unused VITRAKVI oral solution remaining after 90 days of first opening the bottle.
•: Prior to preparing an oral dose for administration, refer to the Instructions for Use.

Oral Solution packaged in two bottles each containing 50 mL

•: Store the glass bottles of VITRAKVI oral solution in the refrigerator. Discard any unused VITRAKVI oral solution remaining after 31 days of first opening the bottle.
•: Prior to preparing an oral dose for administration, refer to the Instructions for Use.