eribulin (Rx)

Brand and Other Names:Halaven
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

intravenous solution

  • 1mg/2mL (0.5mg/mL)

Breast Cancer, Metastatic

Indicated for metastatic breast cancer in patients who have previously received at least 2 chemotherapeutic regimens for the treatment of metastatic disease; prior therapy should have included an anthracycline and a taxane in either the adjuvant or metastatic setting

1.4 mg/m² IV infused over 2-5 min on days 1 and 8 of 21-day cycle  

Liposarcoma

Indicated for unresectable or metastatic liposarcoma in patients who have received a prior anthracycline-containing regimen

1.4 mg/m² IV infused over 2-5 min on days 1 and 8 of 21-day cycle  

Dosage Modifications

Assess for peripheral neuropathy and obtain CBC counts prior to each dose

Recommended dose delays

  • Do not administer on Day 1 or Day 8 for any of the following
    • ANC <1,000/mm³
    • Platelets <75,000/mm³
    • Grade 3 or 4 nonhematological toxicities
  • The Day 8 dose may be delayed for a maximum of 1 week:
    • If toxicities do not resolve or improve to ≤Grade 2 severity by Day 15, omit the dose
    • If toxicities resolve or improved to ≤Grade 2 severity by Day 15, administer at a reduced dose and initiate the next cycle no sooner than 2 weeks later

Recommended dose reductions

  • If a dose has been delayed for toxicity and then recovered to ≤Grade 2 severity, resume at reduced doses (see below)
  • Do not re-escalate once dose has been reduced
  • Permanently reduce the 1.4 mg/m² dose to 1.1 mg/m² for any of the following:
    • ANC <500/mm³ for >7 days
    • ANC <1,000/mm³ with fever or infection
    • Platelets <25,000/mm³
    • Platelets <50,000/mm³ requiring transfusion
    • Nonhematologic Grade 3 or 4 toxicities
    • Omission or delay of Day 8 dose in previous cycle for toxicity
  • Permanently reduce dose to 0.7 mg/m² for any of the following:
    • Occurrence of any event requiring permanent dose reduction while receiving 1.1 mg/m²
  • Discontinue
    • Occurrence of any event requiring permanent dose reduction while receiving 0.7 mg/m²

Renal impairment

  • Moderate-to-severe (CrCl 15-49 mL/min): 1.1 mg/m² IV

Hepatic impairment

  • Mild (Child-Pugh A): 1.1 mg/m² IV
  • Moderate (Child-Pugh B): 0.7 mg/m² IV

Safety and efficacy not established

No overall differences in safety were observed between elderly and younger patients

See Adult Dosing section

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Interactions

Interaction Checker

and eribulin

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (70)

              • alfuzosin

                alfuzosin and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • amiodarone

                eribulin and amiodarone both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • apomorphine

                apomorphine and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • aripiprazole

                aripiprazole and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • arsenic trioxide

                eribulin and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • artemether

                eribulin and artemether both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • artemether/lumefantrine

                eribulin and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • asenapine

                eribulin and asenapine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • bedaquiline

                bedaquiline and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • ceritinib

                ceritinib and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • chloroquine

                eribulin and chloroquine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • chlorpromazine

                eribulin and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • citalopram

                citalopram and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • clarithromycin

                eribulin and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • clozapine

                clozapine and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • crizotinib

                crizotinib and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • dasatinib

                dasatinib and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • degarelix

                eribulin and degarelix both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • desflurane

                desflurane and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • disopyramide

                eribulin and disopyramide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • dofetilide

                eribulin and dofetilide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

                dofetilide increases toxicity of eribulin by QTc interval. Avoid or Use Alternate Drug.

              • dolasetron

                eribulin and dolasetron both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • dronedarone

                eribulin and dronedarone both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • droperidol

                eribulin and droperidol both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • entrectinib

                eribulin and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

              • erythromycin base

                eribulin and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • erythromycin ethylsuccinate

                eribulin and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • erythromycin lactobionate

                eribulin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • erythromycin stearate

                eribulin and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • escitalopram

                escitalopram increases toxicity of eribulin by QTc interval. Avoid or Use Alternate Drug.

              • fexinidazole

                fexinidazole and eribulin both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

              • flecainide

                eribulin and flecainide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • glasdegib

                eribulin and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

              • haloperidol

                eribulin and haloperidol both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • hydroxychloroquine sulfate

                hydroxychloroquine sulfate and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • ibutilide

                eribulin and ibutilide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • iloperidone

                eribulin and iloperidone both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • inotuzumab

                inotuzumab and eribulin both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

              • ivosidenib

                ivosidenib and eribulin both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

              • lefamulin

                lefamulin and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

              • lumefantrine

                eribulin and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • macimorelin

                macimorelin and eribulin both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

              • mefloquine

                eribulin and mefloquine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • methadone

                eribulin and methadone both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • mobocertinib

                mobocertinib and eribulin both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

              • moxifloxacin

                eribulin and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • nilotinib

                eribulin and nilotinib both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • palifermin

                palifermin increases toxicity of eribulin by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hrbefore, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

              • paliperidone

                eribulin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • panobinostat

                eribulin and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

              • pentamidine

                eribulin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • pimozide

                eribulin and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • pitolisant

                eribulin and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

              • pomalidomide

                eribulin increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • procainamide

                eribulin and procainamide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • quinidine

                eribulin and quinidine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • quinine

                eribulin and quinine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • ranolazine

                eribulin and ranolazine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • ribociclib

                ribociclib increases toxicity of eribulin by QTc interval. Avoid or Use Alternate Drug.

              • saquinavir

                eribulin and saquinavir both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • selinexor

                selinexor, eribulin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sotalol

                eribulin and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • sunitinib

                eribulin and sunitinib both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • telavancin

                eribulin and telavancin both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • tetrabenazine

                eribulin and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • thioridazine

                eribulin and thioridazine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • toremifene

                eribulin and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              • umeclidinium bromide/vilanterol inhaled

                eribulin increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

              • vilanterol/fluticasone furoate inhaled

                eribulin increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

              • ziprasidone

                eribulin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

              Monitor Closely (24)

              • albuterol

                albuterol and eribulin both increase QTc interval. Use Caution/Monitor.

              • alfuzosin

                eribulin and alfuzosin both increase QTc interval. Use Caution/Monitor.

              • arformoterol

                arformoterol and eribulin both increase QTc interval. Use Caution/Monitor.

              • cholera vaccine

                eribulin decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

              • dengue vaccine

                eribulin decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

              • dichlorphenamide

                dichlorphenamide and eribulin both decrease serum potassium. Use Caution/Monitor.

              • digoxin

                eribulin will decrease the level or effect of digoxin by Other (see comment). Use Caution/Monitor. Antineoplastic agents may decrease absorption of digoxin; monitor patients for therapeutic efficacy.

              • fingolimod

                eribulin increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

              • fostemsavir

                eribulin and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

              • gemtuzumab

                eribulin and gemtuzumab both increase QTc interval. Use Caution/Monitor.

              • goserelin

                goserelin increases toxicity of eribulin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

              • histrelin

                histrelin increases toxicity of eribulin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

              • lenvatinib

                eribulin and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

              • leuprolide

                leuprolide increases toxicity of eribulin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

              • osilodrostat

                osilodrostat and eribulin both increase QTc interval. Use Caution/Monitor.

              • osimertinib

                osimertinib and eribulin both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

              • oxaliplatin

                oxaliplatin will increase the level or effect of eribulin by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

              • ozanimod

                ozanimod and eribulin both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

              • ponesimod

                ponesimod and eribulin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • selpercatinib

                selpercatinib increases toxicity of eribulin by QTc interval. Use Caution/Monitor.

              • siponimod

                siponimod and eribulin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • sipuleucel-T

                eribulin decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

              • triptorelin

                triptorelin increases toxicity of eribulin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

              • voclosporin

                voclosporin, eribulin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

              Minor (2)

              • azithromycin

                azithromycin increases toxicity of eribulin by QTc interval. Minor/Significance Unknown.

              • chloroquine

                chloroquine increases toxicity of eribulin by QTc interval. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Neutropenia (82%)

              Anemia (58%)

              Asthenia/fatigue (54%)

              Alopecia (45%)

              Peripheral neuropathy (35%)

              Nausea (35%)

              Constipation (25%)

              Arthralgia/myalgia (22%)

              Pyrexia (21%)

              Weight loss (21%)

              Anorexia (20%)

              Headache (19%)

              Vomiting (18%)

              Diarrhea (18%)

              Back pain (16%)

              Dyspnea (16%)

              Cough (14%)

              Bone pain (12%)

              Extremity pain (11%)

              Urinary tract infection (10%)

              1-10%

              Increased lacrimation

              Dyspepsia

              Abdominal pain

              Stomatitis

              Xerostomia

              URI

              Hypokalemia

              Muscle spasm/weakness

              Dysgeusia

              Dizziness

              Insomnia

              Depression

              Rash

              Postmarketing Reports

              Gastrointestinal disorders: Pancreatitis

              Blood and lymphatic system disorders: Lymphopenia

              Hepatobiliary disorders: Hepatotoxicity

              Immune system disorders: Drug hypersensitivity

              Infections and infestations: Pneumonia, sepsis/neutropenic sepsis

              Metabolism and nutrition disorders: Hypomagnesemia, dehydration

              Respiratory, thoracic and mediastinal disorders: Interstitial lung disease

              Skin and subcutaneous tissue disorders: Pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis

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              Warnings

              Contraindications

              None known

              Cautions

              Monitor for peripheral neuropathy before each dose (see Dosage Modifications)

              Severe neutropenia reported; monitor complete blood counts prior to each dose (see Dosage Modifications); increase frequency of monitoring in patients who develop Grade 3 or 4 cytopenias; delay therapy and reduce subsequent doses in patients who experience febrile neutropenia or Grade 4 neutropenia lasting longer than 7 days

              Delay administration and/or reduce dose if ANC <1,000/m³, platelets <75,000/m³, or for grade 3-4 nonhematological toxicities (see Dosage Modifications)

              Caution with CHF, bradyarrhythmias, and congenital long QT syndrome (monitor for QT prolongation); correct hypokalemia or hypomagnesemia before administering drug

              May cause additive effects when coadministration with other drugs that prolong QT interval (eg, class Ia or III antiarrhythmics, thioridazine, erythromycin)

              Based on animal studies and its mechanism of action, can cause fetal harm when administered to pregnant women or males with female partners of reproductive potential

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              Pregnancy & Lactation

              Pregnancy

              Based on findings from an animal reproduction study and its mechanism of action, can cause fetal harm when administered to a pregnant woman

              There are no available data on the use during pregnancy

              Animal studies

              • In an animal reproduction study, eribulin mesylate caused embryo-fetal toxicity when administered to pregnant rats during organogenesis at doses below the recommended human

              Contraception

              • Females: Advise females of reproductive potential to use effective contraception during treatment and for at least 2 weeks following the final dose
              • Males: Advise males with female partners of reproductive potential to use effective contraception during treatment and for 3.5 months following the final dose

              Infertility

              • Based on animal data, may result in damage to male reproductive tissues leading to impaired fertility of unknown duration

              Lactation

              Unknown whether distributed in breast milk, caution advised; because of the potential for serious adverse reactions in human milk fed infants, a decision should be made whether to discontinue nursing or to discontinue eribulin, taking into account the importance of the drug to the mother

              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

              Microtubule inhibitor; inhibits growth phase of microtubules, leading to G2/M cell-cycle block, disruption of mitotic spindles, and, ultimately, apoptotic cell death

              Pharmacokinetics

              Half-life elimination: 40 hr

              Vd: 43-115 L/m²

              Protein Bound: 49-65%

              Metabolism: Negligible

              Clearance: 1.16-2.42 L/hr

              Excretion: Mostly unchanged in feces (82%), urine (9%)

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              Administration

              IV Incompatibilities

              Additive: Dextrose

              Y-site: Dextrose

              IV Compatibilities

              Solution: 0.9% NaCl

              IV Preparation

              Clear, colorless, sterile solution for IV administration

              Each vial contains 1 mg of eribulin mesylate as a 0.5 mg/mL solution in ethanol:water (5:95)

              IV infusion: Aseptically withdraw dose; may be administered undiluted or diluted (in 0.9% NaCl 100 mL)

              Discard unused portion of vial

              IV Administration

              May be administered undiluted or diluted (in 0.9% NaCl 100 mL)

              Administer over 2-5 minutes

              Do not dilute in or administer through IV line contain solutions with dextrose

              Do not administer in same IV line concurrent with other medical products

              Storage

              Store undiluted eribulin in syringe for up to 4 hr at room temperature or for up to 24 hr under refrigeration (40°F or/ 4°C)

              Store diluted solutions of eribulin for up to 4 hr at room temperature or up to 24 hr under refrigeration (40°F or/ 4°C)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Halaven intravenous
              -
              1 mg/2 mL (0.5 mg/mL) vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              eribulin intravenous

              ERIBULIN - INJECTION

              (ER-i-BUE-lin)

              COMMON BRAND NAME(S): Halaven

              USES: Eribulin is used to treat certain types of cancer (breast, liposarcoma). It works by slowing or stopping the growth of cancer cells.

              HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start using eribulin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication is given by injection into a vein by a health care professional. It is given on a schedule as directed by your doctor. Dosage is based on your medical condition, body size, and response to treatment.

              SIDE EFFECTS: Nausea, constipation, watering eyes, loss of appetite, dry mouth, changes in taste, trouble sleeping, muscle/joint pain, dizziness, tiredness, or weakness may occur. If any of these effects persist or worsen, tell your doctor promptly.Temporary hair loss may occur. Normal hair growth should return after treatment has ended.People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, numbness/tingling/burning in the hands/feet, signs of anemia (such as unusual tiredness, pale skin).This medication can lower the body's ability to fight an infection. Tell your doctor right away if you develop any signs of an infection such as fever, chills, cough, or burning/pain when you urinate.Get medical help right away if you have any very serious side effects, including: fainting, fast/irregular heartbeat, severe dizziness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using eribulin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood/bone marrow problems (such as low red/white blood cells and platelets), kidney problems, liver problems.Eribulin may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using eribulin, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using eribulin safely.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Eribulin can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).This medication is not recommended for use during pregnancy. It may harm an unborn baby. Consult your doctor for more details and to discuss reliable forms of birth control. Females should use reliable forms of birth control during and for 2 weeks after treatment with eribulin. Males and their female partner should use reliable forms of birth control during and for 14 weeks after treatment with eribulin. If you or your partner become pregnant or may be pregnant, tell your doctor right away.It is unknown if this medication passes into breast milk. Because of possible risk to the infant, breast-feeding while using this drug and for 2 weeks after treatment is not recommended. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Laboratory and/or medical tests (such as complete blood counts) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule.

              STORAGE: Not applicable. This medication is given in a hospital or clinic and will not be stored at home.

              Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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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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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.