ONUREG FILM-COATED TABLETS 200 MG

BRISTOL-MYERS SQUIBB (SINGAPORE) PTE. LTD.

BRISTOL-MYERS SQUIBB (SINGAPORE) PTE. LTD.

Therapeutic

Prescription Only

TABLET, FILM COATED

**4 DOSAGE AND ADMINISTRATION** **4.1 Dosing Considerations** - No specific dose adjustments are recommended for elderly patients (≥ 65 years of age), see **INDICATIONS**. - Administer an antiemetic 30 minutes prior to each dose of ONUREG for the first 2 cycles. Antiemetic prophylaxis may be omitted after 2 cycles if there has been no nausea and vomiting. - ONUREGTM can be administered to patients with renal impairment without initial dose adjustment, see **DOSAGE AND ADMINISTRATION, Recommended Dose and Dosage Adjustment** and **CLINICAL PHARMACOLOGY, Pharmacokinetics** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_. **4.2 Recommended Dose and Dosage Adjustment** **Recommended Starting Dosage:** The recommended starting dose of ONUREGTM is 300 mg orally once daily on Day 1 through Day 14 of repeated 28-day treatment cycles. If the absolute neutrophil count (ANC) is less than 500/mcL on Day 1 of a cycle, do not administer ONUREGTM. Delay the start of the cycle until the ANC is 500/mcL or more. ONUREGTM maintenance therapy should be initiated after achievement of a CR/CRi following completion of induction and consolidation therapy or following induction if consolidation therapy is not planned. **Dose Modifications During Treatment:** Dose Adjustment for Renal Impairment: No dose adjustment is required for patients with mild to moderate renal impairment. ONUREGTM can be administered to patients with severe renal impairment without initial dose adjustment. Monitor patients with severe renal impairment (creatinine clearance \[CLcr\] 15 to 29 mL/min calculated by Cockcroft-Gault formula) more frequently for adverse reactions and modify the ONUREG dosage for adverse reactions, see **WARNINGS AND PRECAUTIONS, Monitoring and Laboratory Tests** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_. Dose Adjustment for Hepatic Impairment: ONUREGTM has not been studied in patients with pre-existing severe hepatic impairment (total bilirubin > 3 × ULN). A recommended dosage of ONUREGTM has not been established for patients with moderate hepatic impairment (total bilirubin > 1.5 to 3 × ULN). No dose adjustment of ONUREGTM is recommended for patients with mild hepatic impairment (total bilirubin ≤ ULN and AST > ULN, or total bilirubin 1 to 1.5 × ULN and any AST). Dose Adjustment for Adverse Reactions: Dose modification guidelines for hematologic and non-hematologic adverse reactions are recommended based on clinical and laboratory findings if toxicities are judged related to ONUREGTM (see Table 1).  **Continuation and Discontinuation Recommendations:** ONUREGTM, given Day 1 through Day 14 of repeated 28-day treatment cycles, is intended for continuous use. ONUREGTM treatment should be continued until more than 15% blasts are observed in peripheral blood or bone marrow or until unacceptable toxicity occurs. Discontinue ONUREGTM if more than 15% blasts are observed in either the peripheral blood or bone marrow or at the physician’s discretion. **4.3 Administration** ONUREGTM can be taken with or without food. Do not split, crush, dissolve or chew ONUREGTM tablets. Administer a dose at about the same time each day. Consider providing prophylactic anti-emetic therapy during ONUREGTM treatment. ONUREGTM is not interchangeable with, and should not be substituted with or for, azacitidine for injection. Due to differences in exposure, the dose and schedule recommendations for ONUREGTM are different from those for injectable azacitidine. Verify drug name, dose, and administration route. See **INDICATIONS, Limitation of Use**. **4.5 Missed Dose** If a dose of ONUREGTM is missed, or not taken at the usual time, administer the dose as soon as possible on the same day, and return to the normal time of dose administration the following day. Do not take 2 doses on the same day. If a dose is vomited, do not take another dose on the same day, but return to the normal time of dose administration the following day.