Do not use in patients with hypersensitivity to midostaurin or its excipients. Hypersensitivity reactions have included anaphylactic shock, dyspnea, flushing, chest pain, and angioed…
Dosing & Administration
Dosing & Administration of RYDAPT® (midostaurin) capsules for the Treatment of Advanced Systemic Mastocytosis*
In this short video, Dr. Michael Schuster, a professor of medicine in the Division of Hematology/Oncology at Stony Brook University, Long Island, New York, talks about RYDAPT® (midostaurin) capsules for the treatment of advanced systemic mastocytosis.*
To begin, Dr. Shuster emphasizes the need to take Rydapt with food. He also shares his tips about when patients should take their twice daily 100 mg doses. Then he talks about the fact that GI upset is an issue and advises his patients to take an antiemetic before their dose of Rydapt. Next, Dr. Shuster outlines why, and how, he might modify the dose of Rydapt. Lastly, Dr. Shuster talks about drug and food interactions that can be problematic such as CYP3A inhibitors and grapefruit and grapefruit juice.
Dr. Shuster received compensation from Novartis Pharmaceuticals Corporation for participation in this program.
*Aggressive systemic mastocytosis (ASM), Systemic mastocytosis with associated hematological neoplasm (SM-AHN) and Mast cell leukemia (MCL) are collectively referred to as advanced SM.
Recommended dosage of RYDAPT for adult patients with advanced SM1
- 100 mg (four 25-mg capsules) orally twice daily with food
- Continue treatment until disease progression or unacceptable toxicity occurs
Administer RYDAPT orally twice daily at approximately 12-hour intervals
RYDAPT should be taken with food
RYDAPT capsules should not be opened or crushed
- Monitor patients for toxicity at least weekly for the first 4 weeks, every other week for the next 8 weeks, and monthly thereafter while on treatment
- Administer prophylactic antiemetics before treatment with RYDAPT to reduce the risk of nausea and vomiting
- For grade 3/4 nausea and/or vomiting despite optimal antiemetic therapy, interrupt RYDAPT for 3 days (6 doses), then resume RYDAPT at 50 mg twice daily and, if tolerated, increase to 100 mg twice daily
- If a dose of RYDAPT is missed or vomited, the patient should not make up the dose; the next dose should be taken at the usual scheduled time
- Consider interval assessments of QT by ECG if RYDAPT is taken concurrently with medications that can prolong the QT interval
National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) severity: grade 1 = mild symptoms; 2 = moderate symptoms; 3 = severe symptoms; 4 = life-threatening symptoms.
- Adverse reactions led to dose modifications (interruption or reduction) in 56% of patients. Among these, the most frequent adverse reactions (>5%) were GI symptoms, QT prolongation, neutropenia, pyrexia, thrombocytopenia, GI hemorrhage, lipase increase, and fatigue1
- The median time to first dose modification for toxicity was 1.6 months, with 75% of dose modifications first occurring within 5 months of starting treatment1
ANC, absolute neutrophil count; ECG, electrocardiogram.
- Rydapt [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2021.
INDICATION for RYDAPT® (midostaurin) capsules
RYDAPT is indicated for the treatment of adult patients with aggressive systemic mastocytosis (ASM), systemic mastocytosis with associated hematological neoplasm (SM-AHN), or mast cell leukemia (MCL).
IMPORTANT SAFETY INFORMATION for RYDAPT® (midostaurin) capsules
- Do not use in patients with hypersensitivity to midostaurin or its excipients. Hypersensitivity reactions have included anaphylactic shock, dyspnea, flushing, chest pain, and angioedema
- Do not use during pregnancy. Midostaurin caused severe embryo-fetal abnormalities and death in animal studies
- Verify pregnancy status of females of reproductive potential within 7 days prior to initiating RYDAPT
- Advise females of reproductive potential to use effective contraception during treatment and for at least 4 months after the last dose
- Males taking RYDAPT should use effective contraception with females of reproductive potential and pregnant women and for at least 4 months after the last dose
- Pregnancy exposure registry to monitor pregnancy outcomes: Females who may have been exposed to RYDAPT during pregnancy, directly or through a male partner receiving RYDAPT, should contact Novartis Pharmaceuticals Corporation at 1-888-669-6682 and/or at https://report.novartis.com
- Cases of interstitial lung disease and pneumonitis, some fatal, have occurred in patients treated with RYDAPT as monotherapy or with chemotherapy
- Monitor patients for pulmonary symptoms. Discontinue RYDAPT in patients who experience signs or symptoms of interstitial lung disease or pneumonitis without an infectious etiology
- Prolonged (≥44 days) grade 4 neutropenia and thrombocytopenia were reported in 2 pediatric patients with FLT3 mutation-positive AML treated with midostaurin and combination chemotherapy. An azole antifungal (a strong CYP3A4 inhibitor) was coadministered which may increase midostaurin concentrations and risk of toxicity
- The safety and effectiveness of RYDAPT in pediatric patients have not been established
- Because of the potential for serious adverse reactions in breastfed infants from RYDAPT, advise women not to breastfeed during treatment with RYDAPT and for at least 4 months after the last dose
- Based on findings in animals, RYDAPT may impair fertility in females and males of reproductive potential. It is unknown whether these effects on fertility are reversible
- Strong CYP3A Inducers: Avoid concomitant use as strong CYP3A4 inducers decrease exposure to midostaurin and may reduce efficacy
- Strong CYP3A Inhibitors: Coadministration with strong CYP3A4 inhibitors may increase midostaurin concentrations and may increase the risk of toxicity. Monitor patients for increased risk of adverse reactions, especially during the first week of RYDAPT use in each chemotherapy cycle and the first week of consecutive RYDAPT administration. Consider alternative therapies that do not strongly inhibit CYP3A4 activity
- CYP2B6, BCRP, OATP1B1 Substrates: RYDAPT decreased the systemic exposure of a sensitive CYP2B6 substrate. Coadministration of RYDAPT increased the exposure of a breast cancer resistance protein (BCRP) and organic anion transporter polypeptide (OATP)1B1 substrate. Dose adjustments for coadministered CYP2B6, BCRP, or OATP1B1 substrates may be necessary with RYDAPT
Aggressive Systemic Mastocytosis (SM), SM With Associated Hematologic Neoplasm, Mast Cell Leukemia
- Most common adverse reactions (≥20%) excluding laboratory terms were nausea (82%), vomiting (68%), diarrhea (54%), edema (40%), musculoskeletal pain (35%), abdominal pain (34%), fatigue (34%), upper respiratory tract infection (30%), constipation (29%), pyrexia (27%), headache (26%), and dyspnea (23%)
- Grade ≥3 adverse reactions (≥5%) excluding laboratory terms were fatigue (9%), sepsis (9%), gastrointestinal hemorrhage (9%), pneumonia (8%), diarrhea (8%), febrile neutropenia (8%), edema (7%), dyspnea (7%), nausea (6%), vomiting (6%), abdominal pain (6%), and renal insufficiency (5%)
- Most common (≥10%) nonhematologic grade ≥3 laboratory abnormalities were hyperglycemia (nonfasting) (18%), lipase increase (18%), and hyperuricemia (11%)
- Most common (≥20%) hematologic grade ≥3 laboratory abnormalities were lymphopenia (42%), anemia (38%), thrombocytopenia (27%), and neutropenia (22%)
Please see full Prescribing Information for RYDAPT® (midostaurin) capsules.
*Aggressive systemic mastocytosis (ASM), systemic mastocytosis with an associated hematological neoplasm (SM-AHN), and mast cell leukemia (MCL) are collectively referred to as advanced systemic mastocytosis (SM).