galsulfase (Rx)

Brand and Other Names:Naglazyme
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 1mg/mL
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Mucopolysaccharidosis VI

1 mg/kg IV infusion qWeek 

Pretreat with antihistamines with or without antipyretics 30-60 minutes before infusion

Dosage Forms & Strengths

injectable solution

  • 1mg/mL
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Mucopolysaccharidosis VI

<5 years: Safety & efficacy not established

>5 years: 1 mg/kg IV infusion qWeek 

Pretreat with antihistamines with or without antipyretics 30-60 minutes before infusion

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Adverse Effects

>10%

Abdominal pain (53%)

Ear pain (42%)

Conjunctivitis (21%)

Dyspnea (21%)

Rigors (21%)

Chest pain (16%)

Pharyngitis (16%)

Areflexia (11%)

Face edema (11%)

Gastroenteritis (11%)

HTN (11%)

Increased corneal opacification (11%)

Malaise (11%)

Nasal congestion (11%)

Umbilical hernia (11%)

Frequency Not Defined

Bronchospasm

Erythema

Tachycardia

Thrombocytopenia

Tachypnea

Shock

Cyanosis

Hypoxia

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Warnings

Contraindications

None listed in the manufacturer's label

Cautions

Anaphylaxis and severe allergic reactions have been observed during and up to 24 hr after infusion; some reactions were life-threatening and included anaphylaxis, shock, respiratory distress, dyspnea, bronchospasm, laryngeal edema, and hypotension

Type III immune complex-mediated reactions, including membranous glomerulonephritis, observed with enzyme replacement therapies

Caution in patients susceptible to fluid volume overload (eg, weight ≤20 kg, acute underlying respiratory illness, compromised cardiac and/or respiratory function) because CHF may result

Because of the potential for infusion reactions, patients should receive antihistamines with or without antipyretics prior to infusion; infusion reactions may still occur despite of premedication; decrease rate of infusion if it occurs or discontinue immediately if reaction is severe; use caution with readministration

Sleep apnea is common in patients with MPS VI and antihistamine pretreatment may increase the risk of apneic episodes

Spinal or cervical cord compression (SCC) with resultant myelopathy is a known and serious complication of MPS VI; SCC is expected to occur in the natural history of the disease, including in patients on galsulfase; there are postmarketing reports of onset or worsening of SCC requiring decompression surgery

Consider postponing treatment in patients with acute febrile or respiratory illness

Excess agitation of solutioni prior to or after dilution may denature and inactivate galsulfase

A registry has been created to track adverse effects, and monitor therapeutic responses during long-term treatment; may contact 1-800-983-4587 or at www.naglazyme.com/en/clinical-resources/surveillance-program.aspx

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Pregnancy & Lactation

Pregnancy Category: B

Lactation: Excretion in milk unknown; use with caution

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

Recombinant N-acetylgalactosamine-4-sulfatase enzyme replacement that prevents the accumulation of the glycosaminoglycan dermatan sulfate in various tissues that could cause progressive disease including decreased growth, skeletal deformities, clouding of the cornea, upper airway obstruction, coarse facial features, and heart disease

Pharmacokinetics

Peak Plasma (mean): Week 1: 0.8 mcg/mL; Week 24: 1.5 mcg/mL

Half-Life: 6-21 min (Week 1); 8-40 min (Week 24)

Vd: 56-323 mL/kg (week 1); 59-2799 mL/kg (week 24)

Clearance: Week 1: 4.7-10.5 mL/kg/min; Week 24: 1.1-55.9 mL/kg/min

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Administration

IV Preparation

Reconstitute total amount to be infused in 250 mL NS (calculate total volume of galsulfase, remove that volume from a 250 mL bag of NS, add galsulfase to obatin 250 mL infusion soln).

Consider reducing infusion volume to 100 mL for pt <20 kg & susceptible to fluid overload (no need to remove NS from bag to accomodate galsulfase volme)

Use immediately (or within a 48-hr time from dilution to end of administration if refrigerated at 2-8 C)

IV Administration

Infused over no less than 4 hr using infusion pump (reduce infusion rate if <250 mL used to maintain at least 4 hr infusion time)

Initial rate 6 mL/hr, may be incr to 80 mL/hr if well-tolerated

Infusion time may be incr up to 20 hr if infusion reactions occur

Storage

2-8 C

Do not freeze or overshake

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Formulary

FormularyPatient Discounts

Adding plans allows you to compare formulary status to other drugs in the same class.

To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

Adding plans allows you to:

  • View the formulary and any restrictions for each plan.
  • Manage and view all your plans together – even plans in different states.
  • Compare formulary status to other drugs in the same class.
  • Access your plan list on any device – mobile or desktop.

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.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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