migalastat (Rx)

Brand and Other Names:Galafold
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 123mg

Fabry Disease

Treatment of adults with a confirmed diagnosis of Fabry disease and an amenable galactosidase alpha gene (GLA) variant based on in vitro assay data

123 mg PO once every other day at same time of day

Also see administration

Dosage Modifications

Renal impairment

  • Mild to moderate (eGFR ≥30 mL/min/1.73 m²): No dosage adjustment required
  • Severe (eGFR<30 mL/min/1.73 m²) or end-stage renal disease: Not recommended

Dosage Considerations

Consultation with a clinical genetics professional is strongly recommended in cases in which amenable GLA variant is of uncertain clinical significance (VUS, variant of uncertain significance) or may be benign (not causing Fabry disease)

Safety and efficacy not established

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Interactions

Interaction Checker

and migalastat

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                    Adverse Effects

                    >10%

                    Headache (35%)

                    Nasopharyngitis (18%)

                    Urinary tract infection (15%)

                    Nausea (12%)

                    Pyrexia (12%)

                    1-10%

                    Abdominal pain (9%)

                    Back pain (9%)

                    Cough (9%)

                    Diarrhea (9%)

                    Epistaxis (9%)

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                    Warnings

                    Contraindications

                    None reported by the manufacturer

                    Cautions

                    This porduct was approved under accelerated approval based on reduction in kidney interstitial capillary cell globotriaosylceramide (KIC GL-3) substrate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

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                    Pregnancy

                    Pregnancy

                    Current study collects data on pregnant women with Fabry disease, either exposed or unexposed to GALAFOLD; healthcare providers are encouraged to register patients or obtain additional information by contacting the Pregnancy Coordinating Center at 1-888-239-0758; email fabrypregnancy@ubc.com, or visit www.fabrypregnancyregistry.com

                    Available data are not sufficient to assess drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes; in animal reproduction studies, no adverse developmental effects were observed

                    Infertility

                    • Effects on fertility in humans not studied; transient and fully reversible infertility in male rats associated with treatment at systemic exposure (AUC) equivalent to human exposure at recommended dose; complete reversibility was seen at 4 weeks after termination of treatment; drug did not affect fertility in female rats

                    Lactation

                    Current study collects data on effects of GALAFOLD on lactation for women with Fabry disease and their neonates and infants up to 1 year of age who are exposed through breast milk; healthcare providers are encouraged to register patients or obtain additional information by contacting Pregnancy Coordinating Center at 1-888-239-0758, email fabrypregnancy@ubc.com, or visit www.fabrypregnancyregistry.com

                    There are no human data available on the presence of the drug in human milk, the effects on breastfed infant, or on milk production; the drug is present in the milk of lactating rats; when a drug is present in animal milk, it is likely that the drug will be present in human milk; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on the breastfed child from drug or from underlying maternal condition

                    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

                    Binds to and stabilizes endogenous alpha-galactosidase A (alpha-Gal A) that is made in the patient’s own cells, with the intention of enabling its trafficking from the endoplasmic reticulum to lysosomes (designed to act as a “pharmacological chaperone”); once delivered to lysosomes, the alpha-Gal A enzyme can degrade the accumulated glycolipid (globotriaosylceramide [GL-3]) and globotriaosylsphingosine (lyso-Gb3)

                    Certain GLA variants (mutations) causing Fabry disease result in production of abnormally folded and less stable forms of alpha-Gal A protein, which, however, retain enzymatic activity; those GLA variants, referred to as amenable variants, produce alpha-Gal A proteins that may be stabilized by migalastat, thereby restoring their trafficking to lysosomes and their intralysosomal activity

                    Absorption

                    Absolute bioavailability: ~ 75%

                    Peak plasma time: 3 hr

                    Plasma exposure (AUC and Cmax): Showed dose-proportional increases at oral doses from 75-1250 mg (doses from 0.5- to 8.3-fold of approved recommended dosage); drug does not accumulate following administration of drug every other day

                    Effects of food

                    • Administration 1 hr before a high-fat (850 calories; 56% from fat) or light meal (507 calories; 30% from fat), or 1 hr after a light meal, reduced the mean migalastat AUC by 37-42% and peak plasma concentration by 15-39% compared to fasting state

                    Distribution

                    Apparent volume of distribution (Vz/F): 89 L (range: 77-133 L) at steady state in Fabry patients

                    Metabolism

                    Based upon in vivo data, drug is a substrate for uridine diphosphate glucuronosyltransferase (UDPGT), a minor elimination pathway

                    Elimination

                    Urine (77%) and feces (20%)

                    Half-life: 4 hr

                    Clearance: 12.5 L/hr

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                    Administration

                    Oral Administration

                    Take on empty stomach; do not consume food at least 2 hr before and 2 hr after taking drug to give a minimum 4-hr fast; clear liquids can be consumed during this 4-hour period

                    Not to be taken on 2 consecutive days

                    Swallow capsules whole; do not cut, crush, or chew

                    Missed dose

                    • If dose missed entirely for the day, take missed dose only if within 12 hours of normal time dose should have been taken; if more than 12 hours passed, resume taking drug at next planned dosing day and time, according to every-other-day dosing schedule

                    Storage

                    Store at USP controlled room temperature of 20-25°C (68-77°F), with excursions permitted between 15° and 30°C (59° and 86°F)

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                    Images

                    BRAND FORM. UNIT PRICE PILL IMAGE
                    Galafold oral
                    -
                    123 mg capsule

                    Copyright © 2010 First DataBank, Inc.

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                    Patient Handout

                    A Patient Handout is not currently available for this monograph.
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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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                    Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the 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.