Votrient Tablet 200 mg

NOVARTIS (SINGAPORE) PTE LTD

NOVARTIS (SINGAPORE) PTE LTD

Therapeutic

Prescription Only

TABLET, FILM COATED

**Dosage Regimen and Administration** **Dosage Regimen** **General target population** The recommended dose of VOTRIENT is 800 mg orally once daily. (see Method of administration) **Dose Modifications** Initial dose reduction should be from 800 mg to 400 mg daily. Subsequent dose modification, either an increase or decrease in dose, should be in 200 mg increments in a stepwise fashion based on individual tolerability in order to manage adverse reactions. The daily dose of VOTRIENT should not exceed 800 mg. _CYP3A4 inhibitor_: The concomitant use of strong CYP3A4 inhibitors may increase pazopanib concentrations and should be avoided (e.g. ketoconazole, itraconazole, clarithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole). If co-administration of a strong CYP3A4 inhibitor is warranted a dose reduction to 400 mg of VOTRIENT is recommended based on pharmacokinetic studies. This dose is predicted to adjust the pazopanib AUC to the range observed without inhibitors ( _see Interactions_ – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). However, there are no clinical data with this dose adjustment in patients receiving strong CYP3A4 inhibitors. **Special populations** - **Pediatric patients (below 18 years)** Votrient is not recommended for use in children and adolescents under 18 years ( _see Warnings and Precautions, Pre-Clinical Safety Data_ – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). - **Geriatric patients (above 65 years)** Clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. No alteration of dosage, dosing frequency or route of administration is required in patients over 65 years. - **Renal impairment** Renal impairment is not expected to have a clinically relevant effect on Votrient pharmacokinetics given the low renal excretion of pazopanib and metabolites (see section CLINICAL PHARMACOLOGY, Pharmacokinetics, Elimination – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). Renal impairment is not expected to influence pazopanib exposure, and dose adjustment is not necessary in patients with creatine clearance ≥ 30 mL/min. There is no experience of VOTRIENT in patients with severe renal impairment or in patients undergoing peritoneal dialysis or hemodialysis; therefore, use of VOTRIENT is not recommended in these patients. - **Hepatic impairment** The safety and pharmacokinetics of VOTRIENT in patients with pre-existing hepatic impairment have not been fully established ( _see Warnings and Precautions_ – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). No dose adjustment is required in patients with mild hepatic impairment as defined by alanine aminotransferase (ALT) and bilirubin ( _see Clinical Pharmacology_ – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). The dose of VOTRIENT should be reduced to 200 mg per day in patients with moderate hepatic impairment. (see section Clinical pharmacology – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_) Administration of VOTRIENT to patients with mild or moderate hepatic impairment should be undertaken with caution and close monitoring due to potentially increased exposure to the medicinal product. There are insufficient data in patients with severe hepatic impairment (total bilirubin > 3 times the upper limit of normal \[X ULN\] regardless of the ALT value), therefore, use of VOTRIENT is not recommended in these patients. **Method of administration** Votrient should be taken without food (at least one hour before or two hours after a meal) (see sections Interactions and Clinical Pharmacology – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). Votrient should be taken whole with water and must not be broken or crushed (see section CLINICAL PHARMACOLOGY, Pharmacokinetics – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). If a dose is missed, it should not be taken if it is less than 12 hours until the next dose.