Gleolan (aminolevulinic acid oral) dosing, indications, interactions, adverse effects, and more

Sections

Sections aminolevulinic acid oral
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
Administration
Images
Patient Handout
Formulary

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

lyophilized powder for oral solution

30mg/mL (after reconstitution)

Glioma Imaging

Indicated in patients with glioma (suspected WHO grades III or IV on preoperative imaging) as an adjunct for the visualization of malignant tissue during surgery

20 mg/kg PO ~3 hr (range 2-4 hr) before anesthesia induction

Imaging instructions

Must be used with a standard surgical operating microscope adapted with a blue light-emitting light source (power density 40-80 mW/cm²) and ancillary excitation and emission filters to visualize fluorescence excitation in the wavelength of 375-440 nm and for observation from 620-710 nm
Filters transmit porphyrin fluorescence as red-violet, as well as a fraction of backscattered blue excitation light necessary for distinguishing nonfluorescing tissue

Dosage Modifications

Renal impairment: Not studied; ~one-third of aminolevulinic acid (ALA) dose excreted in urine as parent drug; unknown if dose adjustments are needed

Hepatic impairment: Not studied; unknown if dose adjustments are needed

Dosing Considerations

Should only be used by neurosurgeons who have completed a training program on use of fluorescence in surgery (provided by the manufacturer)

Safety and efficacy not established

Interaction Checker

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Serious - Use Alternative (77)

acitretin
aminolevulinic acid oral, acitretin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
adapalene
aminolevulinic acid oral, adapalene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
afatinib
aminolevulinic acid oral, afatinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
alitretinoin topical
aminolevulinic acid oral, alitretinoin topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
aminolevulinic acid topical
aminolevulinic acid oral, aminolevulinic acid topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
amiodarone
aminolevulinic acid oral, amiodarone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
bendroflumethiazide
aminolevulinic acid oral, bendroflumethiazide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
bexarotene
aminolevulinic acid oral, bexarotene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
bicalutamide
aminolevulinic acid oral, bicalutamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
calcitriol topical
aminolevulinic acid oral, calcitriol topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
celecoxib
aminolevulinic acid oral, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
chlorothiazide
aminolevulinic acid oral, chlorothiazide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
chlorpromazine
aminolevulinic acid oral, chlorpromazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
chlorpropamide
aminolevulinic acid oral, chlorpropamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
chlorthalidone
aminolevulinic acid oral, chlorthalidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ciprofloxacin
aminolevulinic acid oral, ciprofloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
cobimetinib
aminolevulinic acid oral, cobimetinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
demeclocycline
aminolevulinic acid oral, demeclocycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
diclofenac
aminolevulinic acid oral, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
diclofenac topical
aminolevulinic acid oral, diclofenac topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
diflunisal
aminolevulinic acid oral, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
dong quai
aminolevulinic acid oral, dong quai. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
doxycycline
aminolevulinic acid oral, doxycycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
etodolac
aminolevulinic acid oral, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
fenoprofen
aminolevulinic acid oral, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
fluphenazine
aminolevulinic acid oral, fluphenazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
flurbiprofen
aminolevulinic acid oral, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
gemifloxacin
aminolevulinic acid oral, gemifloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
glimepiride
aminolevulinic acid oral, glimepiride. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
glipizide
aminolevulinic acid oral, glipizide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
glyburide
aminolevulinic acid oral, glyburide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
griseofulvin
aminolevulinic acid oral, griseofulvin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
hydrochlorothiazide
aminolevulinic acid oral, hydrochlorothiazide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ibuprofen
aminolevulinic acid oral, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ibuprofen IV
aminolevulinic acid oral, ibuprofen IV. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
indapamide
aminolevulinic acid oral, indapamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
indomethacin
aminolevulinic acid oral, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
isotretinoin
aminolevulinic acid oral, isotretinoin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ketoprofen
aminolevulinic acid oral, ketoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ketorolac
aminolevulinic acid oral, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ketorolac intranasal
aminolevulinic acid oral, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
levofloxacin
aminolevulinic acid oral, levofloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
meclofenamate
aminolevulinic acid oral, meclofenamate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
mefenamic acid
aminolevulinic acid oral, mefenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
meloxicam
aminolevulinic acid oral, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
methyclothiazide
aminolevulinic acid oral, methyclothiazide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
methyl aminolevulinate
aminolevulinic acid oral, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
metolazone
aminolevulinic acid oral, metolazone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
minocycline
aminolevulinic acid oral, minocycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
moxifloxacin
aminolevulinic acid oral, moxifloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
nabumetone
aminolevulinic acid oral, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
naproxen
aminolevulinic acid oral, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ofloxacin
aminolevulinic acid oral, ofloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
oxaprozin
aminolevulinic acid oral, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
oxytetracycline
aminolevulinic acid oral, oxytetracycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
panitumumab
aminolevulinic acid oral, panitumumab. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
perphenazine
aminolevulinic acid oral, perphenazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
pirfenidone
aminolevulinic acid oral, pirfenidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
piroxicam
aminolevulinic acid oral, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
porfimer
aminolevulinic acid oral, porfimer. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
prochlorperazine
aminolevulinic acid oral, prochlorperazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
St John's Wort
aminolevulinic acid oral, St John's Wort. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
sulfadiazine
aminolevulinic acid oral, sulfadiazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
sulfamethoxazole
aminolevulinic acid oral, sulfamethoxazole. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
sulfisoxazole
aminolevulinic acid oral, sulfisoxazole. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
sulindac
aminolevulinic acid oral, sulindac. Either increases levels of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tetracycline
aminolevulinic acid oral, tetracycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
thioridazine
aminolevulinic acid oral, thioridazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tolazamide
aminolevulinic acid oral, tolazamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tolbutamide
aminolevulinic acid oral, tolbutamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tolmetin
aminolevulinic acid oral, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tretinoin
aminolevulinic acid oral, tretinoin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tretinoin topical
aminolevulinic acid oral, tretinoin topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
trifluoperazine
aminolevulinic acid oral, trifluoperazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
vemurafenib
aminolevulinic acid oral, vemurafenib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
verteporfin
aminolevulinic acid oral, verteporfin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
voriconazole
aminolevulinic acid oral, voriconazole. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.

Monitor Closely (0)

Minor (0)

acitretin
Serious - Use Alternative (1)aminolevulinic acid oral, acitretin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
adapalene
Serious - Use Alternative (1)aminolevulinic acid oral, adapalene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
afatinib
Serious - Use Alternative (1)aminolevulinic acid oral, afatinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
alitretinoin topical
Serious - Use Alternative (1)aminolevulinic acid oral, alitretinoin topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
aminolevulinic acid topical
Serious - Use Alternative (1)aminolevulinic acid oral, aminolevulinic acid topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
amiodarone
Serious - Use Alternative (1)aminolevulinic acid oral, amiodarone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
bendroflumethiazide
Serious - Use Alternative (1)aminolevulinic acid oral, bendroflumethiazide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
bexarotene
Serious - Use Alternative (1)aminolevulinic acid oral, bexarotene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
bicalutamide
Serious - Use Alternative (1)aminolevulinic acid oral, bicalutamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
calcitriol topical
Serious - Use Alternative (1)aminolevulinic acid oral, calcitriol topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
celecoxib
Serious - Use Alternative (1)aminolevulinic acid oral, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
chlorothiazide
Serious - Use Alternative (1)aminolevulinic acid oral, chlorothiazide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
chlorpromazine
Serious - Use Alternative (1)aminolevulinic acid oral, chlorpromazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
chlorpropamide
Serious - Use Alternative (1)aminolevulinic acid oral, chlorpropamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
chlorthalidone
Serious - Use Alternative (1)aminolevulinic acid oral, chlorthalidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ciprofloxacin
Serious - Use Alternative (1)aminolevulinic acid oral, ciprofloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
cobimetinib
Serious - Use Alternative (1)aminolevulinic acid oral, cobimetinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
demeclocycline
Serious - Use Alternative (1)aminolevulinic acid oral, demeclocycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
diclofenac
Serious - Use Alternative (1)aminolevulinic acid oral, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
diclofenac topical
Serious - Use Alternative (1)aminolevulinic acid oral, diclofenac topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
diflunisal
Serious - Use Alternative (1)aminolevulinic acid oral, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
dong quai
Serious - Use Alternative (1)aminolevulinic acid oral, dong quai. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
doxycycline
Serious - Use Alternative (1)aminolevulinic acid oral, doxycycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
etodolac
Serious - Use Alternative (1)aminolevulinic acid oral, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
fenoprofen
Serious - Use Alternative (1)aminolevulinic acid oral, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
fluphenazine
Serious - Use Alternative (1)aminolevulinic acid oral, fluphenazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
flurbiprofen
Serious - Use Alternative (1)aminolevulinic acid oral, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
gemifloxacin
Serious - Use Alternative (1)aminolevulinic acid oral, gemifloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
glimepiride
Serious - Use Alternative (1)aminolevulinic acid oral, glimepiride. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
glipizide
Serious - Use Alternative (1)aminolevulinic acid oral, glipizide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
glyburide
Serious - Use Alternative (1)aminolevulinic acid oral, glyburide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
griseofulvin
Serious - Use Alternative (1)aminolevulinic acid oral, griseofulvin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
hydrochlorothiazide
Serious - Use Alternative (1)aminolevulinic acid oral, hydrochlorothiazide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ibuprofen
Serious - Use Alternative (1)aminolevulinic acid oral, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ibuprofen IV
Serious - Use Alternative (1)aminolevulinic acid oral, ibuprofen IV. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
indapamide
Serious - Use Alternative (1)aminolevulinic acid oral, indapamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
indomethacin
Serious - Use Alternative (1)aminolevulinic acid oral, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
isotretinoin
Serious - Use Alternative (1)aminolevulinic acid oral, isotretinoin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ketoprofen
Serious - Use Alternative (1)aminolevulinic acid oral, ketoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ketorolac
Serious - Use Alternative (1)aminolevulinic acid oral, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ketorolac intranasal
Serious - Use Alternative (1)aminolevulinic acid oral, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
levofloxacin
Serious - Use Alternative (1)aminolevulinic acid oral, levofloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
meclofenamate
Serious - Use Alternative (1)aminolevulinic acid oral, meclofenamate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
mefenamic acid
Serious - Use Alternative (1)aminolevulinic acid oral, mefenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
meloxicam
Serious - Use Alternative (1)aminolevulinic acid oral, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
methyclothiazide
Serious - Use Alternative (1)aminolevulinic acid oral, methyclothiazide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
methyl aminolevulinate
Serious - Use Alternative (1)aminolevulinic acid oral, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
metolazone
Serious - Use Alternative (1)aminolevulinic acid oral, metolazone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
minocycline
Serious - Use Alternative (1)aminolevulinic acid oral, minocycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
moxifloxacin
Serious - Use Alternative (1)aminolevulinic acid oral, moxifloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
nabumetone
Serious - Use Alternative (1)aminolevulinic acid oral, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
naproxen
Serious - Use Alternative (1)aminolevulinic acid oral, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
ofloxacin
Serious - Use Alternative (1)aminolevulinic acid oral, ofloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
oxaprozin
Serious - Use Alternative (1)aminolevulinic acid oral, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
oxytetracycline
Serious - Use Alternative (1)aminolevulinic acid oral, oxytetracycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
panitumumab
Serious - Use Alternative (1)aminolevulinic acid oral, panitumumab. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
perphenazine
Serious - Use Alternative (1)aminolevulinic acid oral, perphenazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
pirfenidone
Serious - Use Alternative (1)aminolevulinic acid oral, pirfenidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
piroxicam
Serious - Use Alternative (1)aminolevulinic acid oral, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
porfimer
Serious - Use Alternative (1)aminolevulinic acid oral, porfimer. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
prochlorperazine
Serious - Use Alternative (1)aminolevulinic acid oral, prochlorperazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
St John's Wort
Serious - Use Alternative (1)aminolevulinic acid oral, St John's Wort. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
sulfadiazine
Serious - Use Alternative (1)aminolevulinic acid oral, sulfadiazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
sulfamethoxazole
Serious - Use Alternative (1)aminolevulinic acid oral, sulfamethoxazole. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
sulfisoxazole
Serious - Use Alternative (1)aminolevulinic acid oral, sulfisoxazole. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
sulindac
Serious - Use Alternative (1)aminolevulinic acid oral, sulindac. Either increases levels of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tetracycline
Serious - Use Alternative (1)aminolevulinic acid oral, tetracycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
thioridazine
Serious - Use Alternative (1)aminolevulinic acid oral, thioridazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tolazamide
Serious - Use Alternative (1)aminolevulinic acid oral, tolazamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tolbutamide
Serious - Use Alternative (1)aminolevulinic acid oral, tolbutamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tolmetin
Serious - Use Alternative (1)aminolevulinic acid oral, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tretinoin
Serious - Use Alternative (1)aminolevulinic acid oral, tretinoin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
tretinoin topical
Serious - Use Alternative (1)aminolevulinic acid oral, tretinoin topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
trifluoperazine
Serious - Use Alternative (1)aminolevulinic acid oral, trifluoperazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
vemurafenib
Serious - Use Alternative (1)aminolevulinic acid oral, vemurafenib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
verteporfin
Serious - Use Alternative (1)aminolevulinic acid oral, verteporfin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
voriconazole
Serious - Use Alternative (1)aminolevulinic acid oral, voriconazole. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.

1-10%

Note: An imbalance was notable for the adverse events of aphasia, ataxia, convulsion, and hemianopsia, and is likely related to the higher amount of brain resection performed in the ALA arm

Aphasia (8%)

Hemiparesis (7.8%)

Hemianopsia (3.2%)

Headache (2.7%)

Seizure (1.9%)

Hemiplegia (1.9%)

Monoparesis (1.3%)

Hypoesthesia (1.1%)

<1%

Cerebral edema

Frequency Not Defined

Transient amnestic episodes

Risk of BF-RhodoLED Lamp

Induced eye injury

Increased photosensitivity

Bleeding in patients with coagulation disorders

Ophthalmic adverse reactions

Mucous membrane irritation

Nausea (following surgery)

Vomiting (following surgery)

Hypotension (following surgery)

Postmarketing Reports

Immune disorders: Anaphylactic shock, angioedema, drug eruption, urticaria, erythema

Metabolism and nutrition disorders: Metabolic acidosis, pyrexia

Skin and subcutaneous tissue disorders: Application site inflammation and/or discoloration

Eye disorders: Eye irritation, diplopia, ocular hyperemia, photophobia, and blurred vision

General disorders and administration site conditions: Fatigue

Nervous system disorders: Dysaesthesia, transient amnestic episodes

Cardiovascular: Hypertension

Gastrointestinal disorders: Nausea, vomiting

Contraindications

Hypersensitivity to ALA or porphyrins

Acute or chronic types of porphyria, owing to potential ineffectiveness of the drug in these patients

Cautions

Risk of phototoxic reactions; do not administer phototoxic drugs for 24 hr during perioperative period; reduce exposure to sunlight or room lights for 48 hours after administration of therapy

Errors may occur, including false negatives and false positives; nonfluorescing tissue in the surgical field does not rule out the presence of tumor in patients with glioma; fluorescence may be seen in areas of inflammation or metastases from other tumor types

Transient amnestic episodes reported during postmarketing use in combination with photodynamic therapy; inform patients and caregivers that combination with photodynamic therapy may cause transient amnestic episodes; advise them to contact healthcare provider if amnesia occurs after treatment

Hypersensitivity reactions, including serious reactions reported; these reactions include anaphylactic shock, swelling, and urticaria; cardiopulmonary resuscitation personnel and equipment must be readily available and monitor all patients for hypersensitivity reactions

Drug interaction overview

Not an inhibitor of CYP1A2, 2B6, 2C8, 2C9, 2C19, 2D6, or 3A
Avoid administering phototoxic drugs (eg, St. John’s wort, griseofulvin, thiazide diuretics, sulfonylureas, phenothiazines, sulfonamides, quinolones, tetracyclines) and topical ALA preparations for 24 hr before and after administering oral ALA
In vitro studies suggest that phenytoin and other anticonvulsants may decrease cellular PpIX (ALA metabolite) accumulation

Pregnancy

No available human data in pregnant women to inform a drug-associated risk of adverse developmental outcomes

In animal reproduction studies, no adverse developmental effects were observed with oral ALA administration to pregnant rabbits during organogenesis at doses 3 times the maximum recommended human oral dose

Lactation

Unknown if distributed in human breast milk

To decrease exposure to the breastfed infant, advise a lactating woman to pump and discard breast milk after ALA administration for 24 hours (ie, 5-6 half-lives)

Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the 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.

Mechanism of Action

ALA occurs endogenously as a metabolite that is formed in the mitochondria from succinyl-CoA and glycine; exogenous administration leads to accumulation of the ALA metabolite PpIX in tumor cells

The reason for the accumulation of PpIX in neoplastic brain tissue is not known

During glioma surgery, an operating microscope adapted with a blue-emitting light source and filters for excitation light of wavelength 375-440 nm, and observation at wavelengths of 620-710 nm is used; this allows tumor tissue to be visualized as red fluorescence; tissue lacking sufficient PpIX concentrations appears blue

Absorption

Absolute bioavailability: 100%

Peak concentration time: 0.8 hr (ALA); 4 hr (PpIX)

Distribution

Protein bound: 12%

Metabolism

Metabolized to PpIX, but the fraction of administered ALA that is metabolized to PpIX is unknown

Average plasma AUC of PpIX is <6% of ALA’s AUC

Elimination

Half-life: 0.9 hr (ALA); 3.6 hr (PpIX)

Excretion: 34% (range 27-57%) in urine

Oral Preparation

Powder must be reconstituted before administration by healthcare personnel

Determine total number of vials needed to achieve intended dose as follows: Number of vials = body weight (kg) divided by 75 kg/vial

Completely remove the white cap and aluminum crimp seal from each vial

Remove and retain the rubber stopper from the vial

Using an appropriate volumetric measuring device (eg, flask, graduated cylinder, dosing syringe), measure 50 mL of drinking water and add to each vial (1500 mg/vial)

Gently swirl vial to completely dissolve powder

Resulting reconstituted solution is 30 mg/mL

Solution should appear clear and colorless to slightly yellowish

If required, replace the stopper and store reconstituted solution for up to 24 hr at room temperature prior to administration

Oral Administration

For oral use only

Calculate administration volume according the following equation: mL = (body weight (kg) x 20 mg/kg) divided by 30 mg/mL

Transfer entire contents of prepared vial(s) into an appropriate dosing container (eg, oral medicine bottle); ensure the entire contents of the vials are transferred

After transfer, discard the empty vial(s)

Using a disposable volumetric syringe, remove the administration volume of reconstituted solution from the dosing container and transfer to a separate oral dosing container

Discard unneeded solution

Administer PO 3 hr (range 2-4 hr) before anesthesia induction

Storage

Unopened vials: Store at room temperature (25°C [77°F]); excursions permitted to 15-30°C (59-86°F)

Reconstituted solution: May be stored for up to 24 hr at room temperature

Images

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Patient Handout

A Patient Handout is not currently available for this monograph.

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.

View explanations for tiers and restrictions

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.

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

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