Defibrotide
What is Defibrotide?[edit | edit source]
- Defibrotide (Defitelio) is an oligonucleotide mixture with profibrinolytic properties used to treat hepatic veno-occlusive disease (a condition in which small veins in the liver are blocked) in patients who have kidney or lung problems after a stem cell transplant.
What are the uses of this medicine?[edit | edit source]
- Defibrotide (Defitelio) is used for the treatment of adult and pediatric patients with hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), with renal or pulmonary dysfunction following hematopoietic stem-cell transplantation (HSCT).
How does this medicine work?[edit | edit source]
- The mechanism of action of defibrotide sodium has not been fully elucidated.
- In vitro, defibrotide sodium enhances the enzymatic activity of plasmin to hydrolyze fibrin clots.
- In vitro, defibrotide sodium increased tissue plasminogen activator (t-PA) and thrombomodulin expression, and decreased von Willebrand factor (vWF) and plasminogen activator inhibitor‑1 (PAI-1) expression, thereby reducing EC activation and increasing EC‑mediated fibrinolysis.
- Defibrotide sodium protected ECs from damage caused by chemotherapy, tumor necrosis factor-α (TNF-α), serum starvation, and perfusion.
Who Should Not Use this medicine ?[edit | edit source]
This medicine cannot be used in patients with:
- systemic anticoagulant or fibrinolytic therapy
- Known hypersensitivity to Defitelio or to any of its excipients
What drug interactions can this medicine cause?[edit | edit source]
- Concomitant use of Defitelio with antithrombotic or fibrinolytic drugs is contraindicated because of an increased risk of hemorrhage.
Is this medicine FDA approved?[edit | edit source]
- It was approved for use in the United States in 2016.
How should this medicine be used?[edit | edit source]
Recommended Dosage:
- The recommended dosage of Defitelio for adult and pediatric patients is 6.25 mg/kg every 6 hours given as a 2‑hour intravenous infusion.
- Administer Defitelio for a minimum of 21 days.
- If after 21 days signs and symptoms of hepatic VOD have not resolved, continue Defitelio until resolution of VOD or up to a maximum of 60 days.
Administration
- Defitelio must be diluted prior to infusion.
- Prior to administration of Defitelio, confirm that the patient is not experiencing clinically significant bleeding and is hemodynamically stable on no more than one vasopressor.
- Administer Defitelio by constant intravenous infusion over a 2-hour period.
- Administer the diluted Defitelio solution using an infusion set equipped with a 0.2 micron in-line filter.
- Flush the intravenous administration line (peripheral or central) with 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP immediately before and after administration.
- Do not co‑administer Defitelio and other intravenous drugs concurrently within the same intravenous line.
What are the dosage forms and brand names of this medicine?[edit | edit source]
This medicine is available in fallowing doasage form:
- As Injection: 200 mg/2.5 mL (80 mg/mL) in a single-patient-use vial.
This medicine is available in fallowing brand namesː
- Defitelio
What side effects can this medication cause?[edit | edit source]
The most common side effects of this medicine include:
- hypotension
- diarrhea
- vomiting
- nausea
- epistaxis
What special precautions should I follow?[edit | edit source]
- Defitelio may increase the risk of bleeding in patients with VOD after hematopoietic stem-cell transplantation (HSCT). Monitor patients for bleeding. Withhold or discontinue Defitelio if significant bleeding occurs.
- Hypersensitivity reactions have occurred in less than 2% of patients treated with Defitelio. These reactions include rash, urticaria and angioedema.
- If severe or life threatening allergic reaction occurs, discontinue Defitelio, treat according to standard of care, and monitor until signs and symptoms resolve.
What to do in case of emergency/overdose?[edit | edit source]
- There are no known cases of overdose with Defitelio.
Management for overdosage:
- There is no known antidote for Defitelio, and Defitelio is not dialyzable.
- If an overdose occurs, institute general supportive measures.
Can this medicine be used in pregnancy?[edit | edit source]
- There are no available data on Defitelio use in pregnant women.
Can this medicine be used in children?[edit | edit source]
- The safety and effectiveness of Defitelio have been established in pediatric patients.
What are the active and inactive ingredients in this medicine?[edit | edit source]
Active ingredient:
- defibrotide sodium
Inactive ingredients:
- trisodium citrate dihydrate
- water
- hydrochloric acid
- sodium hydroxide
Who manufactures and distributes this medicine?[edit | edit source]
Distributed by:
- Jazz Pharmaceuticals, Inc.
- Palo Alto
What should I know about storage and disposal of this medication?[edit | edit source]
- Store Defitelio (defibrotide sodium) injection at 20°C-25°C (68°F-77°F); excursions permitted between 15°C to 30°C (59°F to 86°F)
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