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ambrisentan (Rx)Brand and Other Names:Letairis

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
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Pulmonary Arterial Hypertension (PAH)

Indicated for WHO group 1 PAH to 1) improve exercise ability and delay clinical worsening; and 2) in combination with tadalafil to reduce the risks of disease progression and hospitalization for worsening PAH, and to improve exercise ability

Initiate treatment at 5 mg PO qDay, with or without tadalafil 20 mg PO qDay

At 4-week intervals, either ambrisentan or tadalafil dose can be increased, as needed and tolerated, not to exceed ambrisentan 10 mg/day or tadalafil 40 mg/day

Dosage Modifications

Coadministration with cyclosporine: Limit ambrisentan to 5 mg/day

Renal impairment

  • Mild-to-moderate: No dosage adjustment required
  • Severe: Not studied

Hepatic impairment

  • Pre-existing
    • Mild: No information available
    • Moderate-to-severe: Not recommended
  • Elevated LFTs after initiating
    • LFTs >5 xULN: Discontinue
    • LFTs increased and accompanied by bilirubin >2 xULN (or signs/symptoms of liver dysfunction): Discontinue

Dosing Considerations

Studies establishing effectiveness included predominantly patients with WHO functional Class II–III symptoms and etiologies of idiopathic or heritable PAH (60%) or PAH associated with connective tissue diseases (34%)

Initiate treatment with ambrisentan in females of reproductive potential only after a negative pregnancy test; obtain monthly pregnancy tests during treatment

Safety and efficacy not established

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Interactions

Interaction Checker

ambrisentan and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Peripheral edema (17%)

            Headache (15%)

            1-10%

            Nasal congestion (6%)

            Palpitations (5%)

            Constipation (4%)

            Dyspnea (4%)

            Flushing (4%)

            Abdominal pain (3%)

            Nasopharyngitis (3%)

            Sinusitis (3%)

            Postmarketing Reports

            Anemia

            Dizziness

            Fatigue

            Fluid retention

            Heart failure (associated with fluid retention)

            Nausea

            Vomiting

            Increased liver aminotransferases (ALT, AST)

            Hypersensitivity (eg, angioedema, rash)

            Symptomatic hypotension

            Hepatotoxicity

            Liver failure

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            Warnings

            Black Box Warnings

            Pregnancy Contraindication

            • Likely to produce serious birth defects if used by pregnant women; this effect has been seen consistently when administered to animals
            • Exclude pregnancy before the initiating treatment; obtain monthly pregnancy tests during treatment and 1 month after discontinuing treatment
            • Females of reproductive potential must use acceptable methods of contraception during treatment and for 1 month after treatment
            • Acceptable methods of contraception include: 1 highly effective form of contraception (IUD, contraceptive implant (including progesterone implant), or tubal sterilization), or a combination of methods (hormone method with a barrier method, or 2 barrier methods)
            • If a partner’s vasectomy is the chosen method of contraception, a hormone or barrier method must be used along with this method

            Restricted Distribution Program

            • Because of risk of birth defects, available only through restricted distribution program called the LETAIRIS Education and Access Program (LEAP), by calling 1-866-664-LEAP (5327); only prescribers and pharmacies registered with LEAP may prescribe and distribute ambrisentan
            • May be dispensed only to patients enrolled in and meet all conditions of LEAP

            Contraindications

            Hypersensitivity

            Idiopathic pulmonary fibrosis (IPF) including patients with pulmonary hypertension (WHO Group 3)

            Pregnancy; see Black Box Warnings

            Cautions

            Available only through a special restricted distribution program (see Black Box Warnings)

            Caution with hepatic impairment; may be associated with rare cases of hepatic cirrhosis with prolonged use; not recommended in patients with moderate-to-severe hepatic impairment

            Discontinue in patients with elevated aminotransferases >5x ULN, or if elevations are accompanied by bilirubin >2X ULN, or signs/symptoms of liver dysfunction

            Reports of decreased hemoglobin concentrations from baseline that persisted for up to 4 yr of treatment

            Coadministration with cyclosporine or CYP3A4 or CYP2C19 inhibitors

            Peripheral edema is known class effect of endothelin receptor antagonists, and also a clinical consequence of pulmonary arterial hypertension (PAH) and worsening PAH; fluid retention in patients with pulmonary hypertension, occurring within weeks of initiating therapy reported; if clinically significant fluid retention develops, with or without associated weight gain, further evaluate to determine cause, such as ambrisentan or underlying heart failure, possible need for specific treatment or discontinuation of therapy

            Risk of fluid retention and peripheral edema; more common in combination with tadalafil, than with ambrisentan or tadalafil alone

            Adverse effect on spermatogenesis for endotheling receptor antagonists reported

            Development of acute pulmonary edema during therapy initiation may be associated with pulmonary veno-occlusive disease

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            Pregnancy & Lactation

            Pregnancy Category: X; Consistently shown to have teratogenic effects when administered to animals

            Decreased sperm counts observed in human and animal studies with another endothelin receptor antagonist and in animal fertility studies with ambrisentan; may have an adverse effect on spermatogenesis

            Lactation: Excretion in milk unknown; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            High affinity endothelin (ETa) receptor subtype antagonist, resulting in inhibition of vasoconstriction

            Absorption

            Peak Plasma Time: 2 hr

            Distribution

            Protein Bound: 99%

            Metabolism

            Substrate of hepatic CYP3A4, CYP2C19, UGTs (1A9S, 2B7S, and 1A3S)

            Elimination

            Half-Life: 9 hr

            Excretion: Predominantly nonrenal

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            Administration

            Instructions

            May take with or without food

            Swallow whole, do not split, crush, or chew tablets

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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