trastuzumab (Rx)

Brand and Other Names:Herceptin, Ogivri, more...Herzuma, Ontruzant, Trazimera, Kanjinti, trastuzumab-dkst, trastuzumab-pkrb, trastuzumab-dttb, trastuzumab-qyyp, trastuzumab-anns
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injection, powder for reconstitution

  • 150mg/single-dose vial (Herceptin, Ontruzant)
  • 420mg/multidose vial (Herceptin, Ogivri, Herzuma, Trazimera, Kanjinti, Ontruzant)

Biosimilars to Herceptin

  • Ogivri (trastuzumab-dkst)
  • Herzuma (trastuzumab-pkrb)
  • Ontruzant (trastuzumab-dttb)
  • Trazimera (trastuzumab-qyyp)
  • Kanjinti (trastuzumab-anns)

Breast Cancer

Adjuvant treatment

  • Indicated for adjuvant treatment of HER-2 overexpressing breast cancer
  • In combination with doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
    • Herceptin, Ogivri, Herzuma, Ontruzant, Trazimera, Kanjinti
    • 4 mg/kg IV over 90 min, THEN  
    • 2 mg/kg IV over 30 min qWeek during chemotherapy for the first 12 weeks (paclitaxel or docetaxel)
    • One week following the last weekly dose, initiate 6 mg/kg IV q3Weeks; infuse over 30-90 min
    • Administer for a total of 52 weeks
  • In combination with docetaxel and carboplatin
    • Herceptin, Ogivri, Herzuma, Ontruzant, Trazimera, Kanjinti
    • 4 mg/kg IV over 90 min, THEN  
    • 2 mg/kg IV over 30 min qWeek during chemotherapy for the first 18 weeks (docetaxel/carboplatin)
    • One week following the last weekly dose, initiate 6 mg/kg IV q3Weeks; infuse over 30-90 min
    • Administer for a total of 52 weeks
  • As a single agent following completion of multi-modality, anthracycline-based chemotherapy
    • Herceptin, Ogivri, Ontruzant, Trazimera, Kanjinti
    • 8 mg/kg IV over 90 min, THEN  
    • 6 mg/kg as an IV over 30−90 min q3Weeks
    • Administer for a total of 52 weeks
    • Extending adjuvant treatment beyond one year not recommended

Metastatic breast cancer

  • Herceptin, Ogivri, Herzuma, Ontruzant, Trazimera, Kanjinti
  • Indicated for HER2-overexpressing metastatic breast cancer as first-line treatment in combination with paclitaxel OR as a single agent for patients who have received 1 or more chemotherapy regimens for metastatic disease
  • 4 mg/kg IV over 90 min, THEN  
  • 2 mg/kg IV over 30 min qWeek, continue until disease progression

Gastric Cancer

Herceptin, Ogivri, Ontruzant, Trazimera, Kanjinti

Indicated, in combination with cisplatin and capecitabine or 5-fluorouracil, for patients with HER2-overexpressing metastatic gastric or gastroesophageal junction adenocarcinoma who have not received prior treatment for metastatic disease

8 mg/kg IV over 90 min, THEN  

6 mg/kg IV q3wk; infuse IV over 30-90 min, continue until disease progression

Dosage Modifications

Modifications required for serious adverse events, including hypersensitivity reaction (anaphylaxis), infusion reactions (fatalities), decreased left ventricular function, and pulmonary events (ARDS)

Infusion reactions

  • Decrease infusion rate for mild-moderate infusion reactions
  • Interrupt infusion if dyspnea or clinically significant hypotension
  • Strongly consider permanent discontinuation if severe and life-threatening infusion reactions

Cardiomyopathy

  • Assess LVEF prior to initiation and frequently during treatment
  • Withhold for at least 4 weeks
    • ≥16% absolute decrease in LVEF from pretreatment values
    • LVEF below institutional limits of normal and ≥10% absolute decrease in LVEF from pretreatment values
    • Resume drug if, within 4-8 weeks, the LVEF returns to normal and absolute decrease from baseline is ≤15%
    • Permanently discontinue for a persistent (>8 weeks) LVEF decline or for suspension of drug on >3 occasions for cardiomyopathy

Dosing Considerations

Do not substitute ado-trastuzumab emtansine (Kadcyla) for or with trastuzumab; see Black Box Warnings

Patient selection is based on HER2 protein overexpression or HER2 gene amplification; assessment of HER2 protein overexpression and gene amplification should be performed using FDA-approved tests specific for breast or gastric cancers by laboratories with demonstrated proficiency; FDA-approved tests for detection of HER2 protein overexpression and HER2 gene amplification is available at: http://www.fda.gov/CompanionDiagnostics

Pancreatic Cancer (Orphan)

Herceptin only

Indicated for the treatment of patients with pancreatic cancer that overexpress p185HER2

Orphan indication sponsor

  • Genentech, Inc; 1 DNA Way; South San Francisco, CA 94080-4990

Safety and efficacy not established

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Interactions

Interaction Checker

and trastuzumab

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              Serious - Use Alternative (5)

              • daunorubicin

                trastuzumab, daunorubicin. Either increases toxicity of the other by unknown mechanism. Avoid or Use Alternate Drug. Trastuzumab may cause cardiomyopathy. Incidence and severity was highest when used with anthracycline-containing chemotherapy regimens. If possible, avoid anthracycline-based therapy for 7 months after last trastuzumab/hyaluronidase dose. If anthracyclines are used, carefully monitor cardiac function.

              • doxorubicin

                trastuzumab, doxorubicin. Either increases toxicity of the other by unknown mechanism. Avoid or Use Alternate Drug. Trastuzumab may cause cardiomyopathy. Incidence and severity was highest when used with anthracycline-containing chemotherapy regimens. If possible, avoid anthracycline-based therapy for 7 months after last trastuzumab/hyaluronidase dose. If anthracyclines are used, carefully monitor cardiac function.

              • doxorubicin liposomal

                trastuzumab, doxorubicin liposomal. Either increases toxicity of the other by unknown mechanism. Avoid or Use Alternate Drug. Trastuzumab may cause cardiomyopathy. Incidence and severity was highest when used with anthracycline-containing chemotherapy regimens. If possible, avoid anthracycline-based therapy for 7 months after last trastuzumab/hyaluronidase dose. If anthracyclines are used, carefully monitor cardiac function.

              • epirubicin

                trastuzumab, epirubicin. Either increases toxicity of the other by unknown mechanism. Avoid or Use Alternate Drug. Trastuzumab may cause cardiomyopathy. Incidence and severity was highest when used with anthracycline-containing chemotherapy regimens. If possible, avoid anthracycline-based therapy for 7 months after last trastuzumab/hyaluronidase dose. If anthracyclines are used, carefully monitor cardiac function.

              • idarubicin

                trastuzumab, idarubicin. Either increases toxicity of the other by unknown mechanism. Avoid or Use Alternate Drug. Trastuzumab may cause cardiomyopathy. Incidence and severity was highest when used with anthracycline-containing chemotherapy regimens. If possible, avoid anthracycline-based therapy for 7 months after last trastuzumab/hyaluronidase dose. If anthracyclines are used, carefully monitor cardiac function.

              Monitor Closely (153)

              • abatacept

                trastuzumab, abatacept. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • abemaciclib

                trastuzumab, abemaciclib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • acalabrutinib

                trastuzumab, acalabrutinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • ado-trastuzumab emtansine

                trastuzumab, ado-trastuzumab emtansine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • alemtuzumab

                trastuzumab, alemtuzumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • anakinra

                trastuzumab, anakinra. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • antithymocyte globulin equine

                trastuzumab, antithymocyte globulin equine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • antithymocyte globulin rabbit

                trastuzumab, antithymocyte globulin rabbit. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • azacitidine

                trastuzumab, azacitidine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • azathioprine

                trastuzumab, azathioprine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • baricitinib

                trastuzumab, baricitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • basiliximab

                trastuzumab, basiliximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • beclomethasone, inhaled

                trastuzumab, beclomethasone, inhaled. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • beclomethasone, intranasal

                trastuzumab, beclomethasone, intranasal. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • belatacept

                trastuzumab, belatacept. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • belimumab

                trastuzumab, belimumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • betamethasone

                trastuzumab, betamethasone. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • bleomycin

                trastuzumab, bleomycin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • blinatumomab

                trastuzumab, blinatumomab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • brentuximab vedotin

                trastuzumab, brentuximab vedotin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • brodalumab

                trastuzumab, brodalumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • budesonide

                trastuzumab, budesonide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • busulfan

                trastuzumab, busulfan. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • cabazitaxel

                trastuzumab, cabazitaxel. Either increases levels of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • canakinumab

                trastuzumab, canakinumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • capecitabine

                trastuzumab, capecitabine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • carboplatin

                trastuzumab, carboplatin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • carmustine

                trastuzumab, carmustine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • certolizumab pegol

                trastuzumab, certolizumab pegol. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • chlorambucil

                trastuzumab, chlorambucil. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • cisplatin

                trastuzumab, cisplatin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • cladribine

                trastuzumab, cladribine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • clofarabine

                trastuzumab, clofarabine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • copanlisib

                trastuzumab, copanlisib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • corticotropin

                trastuzumab, corticotropin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • cortisone

                trastuzumab, cortisone. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • cyclophosphamide

                trastuzumab, cyclophosphamide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • cyclosporine

                trastuzumab, cyclosporine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • cytarabine

                trastuzumab, cytarabine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • dacarbazine

                trastuzumab, dacarbazine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • dactinomycin

                trastuzumab, dactinomycin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • dasatinib

                trastuzumab, dasatinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • daunorubicin

                trastuzumab, daunorubicin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • deflazacort

                trastuzumab, deflazacort. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • dengue vaccine

                trastuzumab 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.

              • dexamethasone

                trastuzumab, dexamethasone. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • dinutuximab

                trastuzumab, dinutuximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • docetaxel

                trastuzumab, docetaxel. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • doxorubicin

                trastuzumab, doxorubicin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • doxorubicin liposomal

                trastuzumab, doxorubicin liposomal. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • duvelisib

                trastuzumab, duvelisib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • eculizumab

                trastuzumab, eculizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • elotuzumab

                trastuzumab, elotuzumab. Either increases levels of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • emapalumab

                trastuzumab, emapalumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • epirubicin

                trastuzumab, epirubicin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • estramustine

                trastuzumab, estramustine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • etanercept

                trastuzumab, etanercept. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • etoposide

                trastuzumab, etoposide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • everolimus

                trastuzumab, everolimus. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • fludarabine

                trastuzumab, fludarabine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • fludrocortisone

                trastuzumab, fludrocortisone. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • fluorouracil

                trastuzumab, fluorouracil. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • fluticasone inhaled

                trastuzumab, fluticasone inhaled. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • gemcitabine

                trastuzumab, gemcitabine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • gemtuzumab

                trastuzumab, gemtuzumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • glatiramer

                trastuzumab, glatiramer. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • golimumab

                trastuzumab, golimumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • guselkumab

                trastuzumab, guselkumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • hydrocortisone

                trastuzumab, hydrocortisone. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • hydroxyurea

                trastuzumab, hydroxyurea. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • ibritumomab tiuxetan

                trastuzumab, ibritumomab tiuxetan. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • ibrutinib

                trastuzumab, ibrutinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • idarubicin

                trastuzumab, idarubicin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • idelalisib

                trastuzumab, idelalisib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • ifosfamide

                trastuzumab, ifosfamide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • imatinib

                trastuzumab, imatinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • imiquimod

                trastuzumab, imiquimod. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • infliximab

                trastuzumab, infliximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • inotuzumab

                trastuzumab, inotuzumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • irinotecan

                trastuzumab, irinotecan. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • irinotecan liposomal

                trastuzumab, irinotecan liposomal. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • ixekizumab

                trastuzumab, ixekizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • leflunomide

                trastuzumab, leflunomide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • lenalidomide

                trastuzumab, lenalidomide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • lomustine

                trastuzumab, lomustine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • mechlorethamine

                trastuzumab, mechlorethamine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • melphalan

                trastuzumab, melphalan. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • mercaptopurine

                trastuzumab, mercaptopurine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • methotrexate

                trastuzumab, methotrexate. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • methylprednisolone

                trastuzumab, methylprednisolone. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • mitomycin

                trastuzumab, mitomycin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • mitoxantrone

                trastuzumab, mitoxantrone. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • mogamulizumab

                trastuzumab, mogamulizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • mycophenolate

                trastuzumab, mycophenolate. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • natalizumab

                trastuzumab, natalizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • nelarabine

                trastuzumab, nelarabine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • nilotinib

                trastuzumab, nilotinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • obinutuzumab

                trastuzumab, obinutuzumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • ocrelizumab

                trastuzumab, ocrelizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • ofatumumab

                trastuzumab, ofatumumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • omacetaxine

                trastuzumab, omacetaxine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • osimertinib

                trastuzumab, osimertinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • oxaliplatin

                trastuzumab, oxaliplatin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • paclitaxel

                trastuzumab, paclitaxel. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • paclitaxel protein bound

                trastuzumab, paclitaxel protein bound. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • palbociclib

                trastuzumab, palbociclib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • panobinostat

                trastuzumab, panobinostat. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • pazopanib

                trastuzumab, pazopanib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • pemetrexed

                trastuzumab, pemetrexed. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • pentostatin

                trastuzumab, pentostatin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • pomalidomide

                trastuzumab, pomalidomide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • ponesimod

                ponesimod and trastuzumab 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.

              • pralatrexate

                trastuzumab, pralatrexate. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • prednisolone

                trastuzumab, prednisolone. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • prednisone

                trastuzumab, prednisone. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • procarbazine

                trastuzumab, procarbazine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • ravulizumab

                trastuzumab, ravulizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • ribociclib

                trastuzumab, ribociclib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • rilonacept

                trastuzumab, rilonacept. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • rituximab

                trastuzumab, rituximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • rituximab-hyaluronidase

                trastuzumab, rituximab-hyaluronidase. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • romidepsin

                trastuzumab, romidepsin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • ruxolitinib

                trastuzumab, ruxolitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • sarilumab

                trastuzumab, sarilumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • secukinumab

                trastuzumab, secukinumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • siltuximab

                trastuzumab, siltuximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • siponimod

                siponimod and trastuzumab 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.

              • sirolimus

                trastuzumab, sirolimus. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • sorafenib

                trastuzumab, sorafenib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • streptozocin

                trastuzumab, streptozocin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • sunitinib

                trastuzumab, sunitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • tacrolimus

                trastuzumab, tacrolimus. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • temozolomide

                trastuzumab, temozolomide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • temsirolimus

                trastuzumab, temsirolimus. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • teniposide

                trastuzumab, teniposide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • teriflunomide

                trastuzumab, teriflunomide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • thalidomide

                trastuzumab, thalidomide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • thioguanine

                trastuzumab, thioguanine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • thiotepa

                trastuzumab, thiotepa. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • tocilizumab

                trastuzumab, tocilizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • tofacitinib

                trastuzumab, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • topotecan

                trastuzumab, topotecan. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • trabectedin

                trastuzumab, trabectedin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • tretinoin

                trastuzumab, tretinoin. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • triamcinolone acetonide extended-release injectable suspension

                trastuzumab, triamcinolone acetonide extended-release injectable suspension. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • triamcinolone acetonide injectable suspension

                trastuzumab, triamcinolone acetonide injectable suspension. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • trifluridine/tipiracil

                trastuzumab, trifluridine/tipiracil. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • ustekinumab

                trastuzumab, ustekinumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • vedolizumab

                trastuzumab, vedolizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • vinblastine

                trastuzumab, vinblastine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • vincristine

                trastuzumab, vincristine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • vincristine liposomal

                trastuzumab, vincristine liposomal. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              • vinorelbine

                trastuzumab, vinorelbine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

              Minor (0)

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                Adverse Effects

                >10% (Metastatic Breast Cancer)

                Pain (47%)

                Asthenia (42%)

                Fever (36%)

                Nausea (33%)

                Chills (32%)

                Cough (26%)

                Headache (26%)

                Diarrhea (25%)

                Vomiting (23%)

                Abdominal pain (22%)

                Back pain (22%)

                Dyspnea (22%)

                Infection (20%)

                Rash (18%)

                Anorexia (14%)

                Insomnia (14%)

                Dizziness (13%)

                1-10% (Adjuvant Breast Cancer Treatment)

                Headache (10%)

                Nasopharyngitis (8%)

                Diarrhea (7%)

                Nausea (6%)

                Pyrexia (6%)

                Peripheral edema (5%)

                Back pain (5%)

                Chills (5%)

                Asthenia (4.5%)

                Myalgia (4%)

                Hypertension (4%)

                Dizziness (4%)

                Influenza (4%)

                Rash (4%)

                Vomiting (3.5%)

                Bone pain (3%)

                UTI (3%)

                Influenza-like illness (2%)

                Nail disorders (2%)

                Pruritus (2%)

                Paresthesia (2%)

                1-10% (Metastatic Breast Cancer)

                Flu-like syndrome (10%)

                Peripheral edema (10%)

                CHF (7%)

                Depression (6%)

                Tachycardia (5%)

                UTI (5%)

                Anemia (4%)

                Hypersensitivity (3%)

                Leukopenia (3%)

                <1% (Adjuvant Breast Cancer Treatment)

                Cardiac failure (0.5%)

                Cardiac disorder (0.3%)

                Hypersensitivity (0.6%)

                Autoimmune thyroiditis (0.3%)

                Ventricular dysfunction (0.2%)

                Sudden death (0.06%)

                Postmarketing Reports

                Infusion reaction

                Oligohydramnios or oligohydramnios sequence, including pulmonary hypoplasia, skeletal abnormalities, and neonatal death

                Glomerulopathy

                Immune thrombocytopenia

                Tumor lysis syndrome

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                Warnings

                Black Box Warnings

                Do not substitute ado-trastuzumab emtansine (Kadcyla) for or with trastuzumab (Herceptin); dosing and treatment schedules for Kadcyla and Herceptin are quite different, so confusion between these products could lead to dosing errors and potential harm to patients

                Cardiomyopathy

                • Administration can result in subclinical and clinical cardiac failure manifesting as CHF and decreased left ventricular ejection fraction (LVEF)
                • Evaluate LVEF in all patients prior to and during treatment with trastuzumab
                • Incidence and severity of left ventricular cardiac dysfunction is highest in patients who receive the drug concurrently with anthracycline-containing chemotherapy regimens
                • Discontinue if receiving adjuvant therapy for breast cancer, and strongly consider discontinuation with metastatic breast cancer who develop a clinically significant decrease in left ventricular function

                Infusion reactions, pulmonary toxicity

                • Can result in serious pulmonary toxicity and sometimes fatal infusion reactions
                • In most cases, symptoms occurred during or within 24 hr of administration
                • Interrupt infusion in patients experiencing dyspnea or clinically significant hypotension
                • Monitor until signs and symptoms completely resolve
                • Discontinue for infusion reactions manifesting as anaphylaxis, angioedema, interstitial pneumonitis, or acute respiratory distress syndrome

                Embryo-fetal toxicity

                • Exposure during pregnancy can result in oligohydramnios, in some cases complicated by pulmonary hypoplasia, skeletal abnormalities, and neonatal death

                Contraindications

                Hypersensitivity to drug/class/component or hamster protein

                Cautions

                Use extreme caution in cardiac disease, cardiotoxic agent history, ejection fraction decrease, pulmonary disease, elderly (see Black Box Warnings)

                Verify pregnancy status of females of reproductive potential prior to the initiation of therapy (see Pregnancy)

                CHF: At a median follow-up duration of 8 yr, the incidence of severe CHF (NYHA III and IV) was 0.8%, and the rate of mild symptomatic and asymptomatic left ventricular dysfunction was 4.6%

                Exposure to trastuzumab during pregnancy or within 7 months prior to conception can result in fetal harm; females of reproductive potential should use effective contraception during treatment and for 7 months following last dose of trastuzumab

                Tumor lysis syndrome (TLS) reported; patients with significant tumor burden (eg, bulky metastases) may be at a higher risk; patients could present with hyperuricemia, hyperphosphatemia, and acute renal failure which may represent possible TLS; providers should consider additional monitoring and/or treatment as clinically indicated

                Cardiomyopathy

                • Therapy can cause left ventricular cardiac dysfunction, arrhythmias, hypertension, disabling cardiac failure, cardiomyopathy, and cardiac death
                • Can also cause asymptomatic decline in left ventricular ejection fraction (LVEF); there is a 4−6 fold increase in the incidence of symptomatic myocardial dysfunction among patients receiving drug as a single agent; the highest absolute incidence occurs when drug is administered with an anthracycline; withhold therapy for ≥16% absolute decrease in LVEF from pre-treatment values or an LVEF value below institutional limits of normal and ≥10% absolute decrease in LVEF from pretreatment values
                • The safety of continuation or resumption of therapy in patients with therapy-induced left ventricular cardiac dysfunction has not been studied
                • Patients who receive anthracycline after stopping Herceptin may also be at increased risk of cardiac dysfunction

                Cardiac monitoring

                • Conduct thorough cardiac assessment, including history, physical examination, and determination of LVEF by echocardiogram or MUGA scan; the following schedule is recommended
                • Baseline LVEF measurement immediately prior to initiation of therapy
                • LVEF measurements every 3 months during and upon completion of therapy
                • Repeat LVEF measurement at 4 week intervals if drug is withheld for significant left ventricular cardiac dysfunction
                • LVEF measurements every 6 months for at least 2 years following completion of therapy as a component of adjuvant therapy

                Infusion reactions

                • Infusion reactions consist of a symptom complex characterized by fever and chills, and on occasion included nausea, vomiting, pain (in some cases at tumor sites), headache, dizziness, dyspnea, hypotension, rash, and asthenia
                • Interrupt infusion in all patients experiencing dyspnea, clinically significant hypotension, and intervention of medical therapy administered (which may include epinephrine, corticosteroids, diphenhydramine, bronchodilators, and oxygen)
                • Patients should be evaluated and carefully monitored until complete resolution of signs and symptoms; permanent discontinuation should be strongly considered in all patients with severe infusion reactions
                • There are no data regarding the most appropriate method of identification of patients who may safely be retreated after experiencing a severe infusion reaction
                • Prior to resumption of infusion, the majority of patients who experience a severe infusion reaction may be pre-medicated with antihistamines and/or corticosteroids; while some patients may tolerate the infusions, others may have severe infusion reactions despite pre-medications

                Pulmonary toxicity

                • Therapy can result in serious and fatal pulmonary toxicity; toxicity includes dyspnea, interstitial pneumonitis, pulmonary infiltrates, pleural effusions, non-cardiogenic pulmonary edema, pulmonary insufficiency and hypoxia, acute respiratory distress syndrome, and pulmonary fibrosis
                • Such events can occur as sequelae of infusion reactions; patients with symptomatic intrinsic lung disease or with extensive tumor involvement of the lungs, resulting in dyspnea at rest, appear to have more severe toxicity

                Exacerbation of chemotherapy-induced neutropenia

                • In randomized, controlled clinical trials, the per-patient incidences of NCI-CTC Grade 3−4 neutropenia and of febrile neutropenia were higher in patients receiving therapy in combination with myelosuppressive chemotherapy as compared to those who received chemotherapy alone; incidence of septic death was similar among patients who received therapy and those who did not

                Preinfusion treatment

                • Symptoms such as chills and/or fever observed in ~40% of patients
                • Usually mild-to-moderate severity
                • Pretreat with acetaminophen, diphenhydramine, and meperidine (with or without reduction in infusion rate)
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                Pregnancy & Lactation

                Pregnancy

                May cause fetal harm when administered to a pregnant woman

                In postmarketing reports, use of trastuzumab during pregnancy resulted in cases of oligohydramnios and of oligohydramnios sequence, manifesting as pulmonary hypoplasia, skeletal abnormalities, and neonatal death

                Advise patient of the potential risks to a fetus

                Herceptin pregnancy registry

                • If administered during pregnancy, or if a patient becomes pregnant while receiving trastuzumab or within 7 months following last dose, health care providers and patients should immediately report exposure to Genentech at 1-888-835-2555

                Contraception

                • Verify pregnancy status of females of reproductive potential prior to initiating
                • Advise pregnant women and females of reproductive potential that exposure during pregnancy or within 7 months prior to conception can result in fetal harm
                • Advise females of reproductive potential to use effective contraception during treatment and for 7 months following last dose

                Lactation

                No information regarding the presence of trastuzumab in human milk, the effects on breastfed infants, or the effects on milk production

                Published data suggest human IgG is present in human milk but does not enter neonatal and infant circulation in substantial amounts

                Trastuzumab was present in the milk of lactating cynomolgus monkeys but not associated with neonatal toxicity

                Assess the developmental and health benefits of breastfeeding along with the mother’s clinical need for treatment and any potential adverse effects on the breastfed child from the drug or from the underlying maternal condition (unwrap)

                Consider trastuzumab wash out period of 7 months

                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

                Monoclonal antibody, inhibits growth of tumor cells that overexpress HER2

                Absorption

                Breast cancer

                • Peak plasma concentration: 178 mcg/mL (8 mg/kg); 88.3 mcg/mL (4 mg/kg)
                • Peak plasma concentration at steady state: 179 mcg/mL (8 mg/kg); 109 mcg/mL (4 mg/kg)
                • AUC: 1373 mcg·day/mL (8 mg/kg); 1066 mcg·day/mL (4 mg/kg)
                • AUC at steady state: 1794 mcg·day/mL (8 mg/kg); 1765 mcg·day/mL (4 mg/kg)
                • Steady state: 12 weeks

                Metastatic gastric cancer

                • Peak plasma concentration: 132 mcg/mL (8 mg/kg)
                • Peak plasma concentration at steady state: 131 mcg/mL (8 mg/kg)
                • AUC: 1109 mcg·day/mL (8 mg/kg)
                • AUC at steady state: 1338 mcg·day/mL (8 mg/kg)
                • Steady state: 9 weeks

                Pharmacogenomics

                Mediates antibody-dependent cellular cytotoxicity against cells that overproduce HER2, and lacks effect on cells not overexpressing HER2

                HER2 testing should be performed

                Patients with breast cancers with intensive staining (3+) should definitely receive anti-HER2 therapy; the clinical relevance of 2+ staining is uncertain

                Genetic testing laboratories

                • The following companies currently offer IHC and/or FISH testing for HER2 overexpression
                • Dako (http://www.dakousa.com/)
                • Ventana Medical Systems (http://www.ventanamed.com/)
                • Vysis/Abbott Molecular (http://www.abbottmolecular.com/)
                • Invitrogen (http://www.invitrogen.com/)
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                Administration

                IV Incompatibilities

                Dextrose solutions

                Not to be mixed with other drugs

                IV Preparation

                420 mg multiple-dose vial

                • Reconstitute powder with 20 mL of supplied diluent (bacteriostatic water for injection [BWFI]; contains 1.1% benzyl alcohol as a preservative)
                • If patient has known hypersensitivity to benzyl alcohol, drug may be reconstituted with sterile water for injection (SWI), but use SWI-reconstituted drug immediately
                • Reconstituted vial yields 21 mg/mL
                • Slowly inject 20 mL of diluent into vial; stream of diluent should be directed into the lyophilized cake
                • Do not shake; swirl vial gently to aid reconstitution
                • Slight foaming of the product may be present upon reconstitution; allow vial to stand undisturbed for ~5 minutes
                • Solution should be free of visible particulates; appear clear to slightly opalescent and colorless to pale yellow
                • See also Storage

                150 mg single-dose vial

                • Reconstitute with 7.4 mL of Sterile Water for Injection (SWFI) (not supplied) to yield a solution containing 21 mg/mL trastuzumab
                • Do not shake; swirl vial gently to aid reconstitution
                • Slight foaming of the product may be present upon reconstitution; allow vial to stand undisturbed for ~5 minutes
                • Solution should be free of visible particulates; appear clear to slightly opalescent and colorless to pale yellow

                Further dilution

                • Withdraw calculated dose from reconstituted vial and add to a polyvinylchloride- or polyethylene-bag containing 250 mL 0.9% NaCl
                • Gently invert the bag to mix the solution

                IV Administration

                Not for IV push or bolus administration

                Administer initial IV infusion over 90 min

                Subsequent weekly IV infusions may be administered over 30 min if prior infusions are well tolerated

                Missed dose ≤1 week

                • Usual maintenance dose (weekly schedule: 2 mg/kg; three-weekly schedule: 6 mg/kg) should be administered as soon as possible
                • Do not wait until next planned cycle
                • Subsequent maintenance doses should be administered 7 days or 21 days later according to qWeek or q3Weeks schedule, respectively

                Missed dose >1 week

                • Reload dose (weekly schedule: 4 mg/kg; three-weekly schedule: 8 mg/kg) over ~90 min, as soon as possible
                • Subsequent maintenance doses (weekly schedule: 2 mg/kg; three-weekly schedule 6 mg/kg) should be administered 7 days or 21 days later according to qWeek or q3Weeks schedule, respectively

                Storage

                Do not freeze

                Unopened vials: Stable at 2-8°C (36-46°F) prior to reconstitution

                Unopened vials (Trazimera only): If needed, may store at room temperature up to 30°C (86°F) for a single period of up to 3 months in original carton to protect from light; once removed from refrigerator, do not return to the refrigerator and discard after 3 months or by vial expiration date, whichever occurs first; write revised expiration date in the space provided on the carton labeling

                Reconstituted vials with BWFI: Once reconstituted with BWFI, may be stored in refrigerator (2-8°C) for 28 days

                Reconstituted vials with SWI: Vials reconstituted with unpreserved SWI (not supplied) should be used immediately and not stored

                Diluted solution: May be refrigerated (2-8°C) for up to 24 hr

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                Herceptin intravenous
                -
                440 mg vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                trastuzumab intravenous

                TRASTUZUMAB - INJECTION

                (trass-TOOZE-you-mob)

                COMMON BRAND NAME(S): Herceptin, Herzuma, Kanjinti, Ogivri, Trazimera

                WARNING: Trastuzumab may cause serious heart problems, including heart failure. The risk of heart problems is increased if you also use an anthracycline (such as doxorubicin). Your doctor may stop treatment with this medication if heart problems occur.Reactions may happen with your injection, usually during or within 24 hours of the dose. Careful monitoring may decrease your risk. Tell your health care professional right away if you have symptoms such as fever, chills, flushing, headache, nausea/vomiting, trouble breathing, dizziness, weakness, or feeling faint. Your doctor may slow down or temporarily stop your injection.Trastuzumab can cause serious (possibly fatal) harm to an unborn baby if used during pregnancy. Discuss reliable forms of birth control with your doctor.

                USES: Trastuzumab is used to treat certain types of breast, stomach, or esophagus cancer. This medication is used to treat tumors that produce more than the normal amount of a certain substance called HER2 protein. Trastuzumab belongs to a class of medications known as monoclonal antibodies. It works by slowing or stopping the growth of cancer cells.This monograph is about the following trastuzumab products: trastuzumab, trastuzumab-anns, trastuzumab-dkst, trastuzumab-dttb, trastuzumab-pkrb, trastuzumab-qyyp.

                HOW TO USE: This medication is given by slow injection into a vein by a health care professional, usually once every week or once every 3 weeks. The first injection is given over at least 90 minutes.The dosage is based on your medical condition, response to treatment, weight, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Use this medication regularly to get the most benefit from it. To help you remember, mark the days on the calendar when you need to receive the medication.Your doctor may prescribe other medications (such as acetaminophen, diphenhydramine) for you to take before each dose to help prevent serious side effects. Follow your doctor's directions carefully.

                SIDE EFFECTS: See also Warning section.Redness/irritation at the injection site, diarrhea, muscle/joint/back pain, stomach/abdominal pain, headache, trouble sleeping, nausea, vomiting, mouth sores, and loss of appetite may occur. Nausea and vomiting can be severe. In some cases, your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals, not eating before treatment, or limiting activity may help lessen some of these effects. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain), bone pain, numbness/tingling, mental/mood changes, fast/irregular heartbeat, easy bruising/bleeding.Get medical help right away if you have any very serious side effects, including: chest pain, weakness on one side of the body, trouble speaking, vision changes, confusion.This medication may lower your ability to fight infections. This may make you more likely to get a serious (rarely fatal) infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection (such as sore throat that doesn't go away, fever, chills, cough).Trastuzumab can commonly cause a rash that is usually not serious. However, you may not be able to tell it apart from a rare rash that could be a sign of a severe reaction. Tell your doctor right away if you develop any rash.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: See also Warning section.Before using trastuzumab, tell your doctor or pharmacist if you are allergic to it; or to any trastuzumab, trastuzumab deruxtecan, trastuzumab emtansine, or trastuzumab-hyaluronidase products; 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: current/recent infection, heart disease, lung problems, previous cancer treatments (including radiation treatment).Trastuzumab 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.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).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 at greater risk for heart problems (such as heart failure) while using this drug.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using trastuzumab. Trastuzumab may harm an unborn baby. Ask about reliable forms of birth control while using this medication and for 7 months after stopping treatment. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding while using this medication and for 7 months after stopping treatment.

                DRUG INTERACTIONS: See also Warning section.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.Trastuzumab is very similar to trastuzumab deruxtecan, trastuzumab emtansine, and trastuzumab-hyaluronidase. Do not use a trastuzumab deruxtecan, trastuzumab emtansine, or trastuzumab-hyaluronidase product while using a trastuzumab product.

                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: Lab and/or medical tests (such as heart exams, complete blood count) should be done before you start using this medication and while you are using it. In women of childbearing age, a pregnancy test may also be done before starting treatment. Keep all medical and lab appointments.

                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.

                MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

                Information last revised February 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.