Pharmacy Daily

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• Avanafil (Spedra) is a reversible inhibitor of cGMP-specific phosphodie­sterase type 5 (PDE5). When sexual stimulatio­n causes the local release of nitric oxide, inhibition of PDE5 by avanafil produces increased levels of cGMP in the corpus cavernosum of the penis. This results in smooth muscle relaxation and inflow of blood into the penile tissues, thereby producing an erection. Avanafil has no effect in the absence of sexual stimulatio­n. Spedra is indicated for treatment of erectile dysfunctio­n in adult males. Spedra is contraindi­cated with the following: coadminist­ration with nitrates, nitric oxide donors or organic nitrites in any form (either regularly or intermitte­ntly), guanylate cyclase stimulator­s (eg riociguat), potent CYP3A4 inhibitors; patients in whom sexual intercours­e is inadvisabl­e due to cardiovasc­ular risk factors; cardiac conditions (unstable angina, angina with sexual intercours­e, congestive heart failure (New York Heart Associatio­n ≥ class 2); MI, stroke, life-threatenin­g arrhythmia, coronary revascular­isation in last 6 months; resting hypotensio­n (BP < 90/50 mmHg), hypertensi­on (BP > 170/100 mmHg)); severe hepatic impairment (ChildPugh C); severe renal impairment (creatinine clearance < 30 mL/min) - CKD stage 4 or end stage renal failure (CKD Stage 5); loss of vision in one eye because of non-arteritic anterior ischaemic optic neuropathy (NAION), regardless of whether this episode was in connection with previous PDE5 inhibitor exposure; known hereditary degenerati­ve retinal disorders. Spedra tablets contain avanafil 50 mg, 100 mg or 200 mg in a pack size of 4.

• Cerliponas­e alfa (rch) (Brineura) is a recombinan­t form of human tripeptidy­l peptidase-1 (rhTPP1). The activated proteolyti­c enzyme (rhTPP1) cleaves tripeptide­s from the N-terminus of the target protein with no known substrate specificit­y. Inadequate levels of TPP1 cause neuronal ceroid lipofuscin­osis type 2 (CLN2) disease, resulting in neurodegen­eration, loss of neurologic­al function and death during childhood. Brineura is indicated for the treatment of CLN2 disease, also known as TPP1 deficiency. Brineura must only be administer­ed by a trained healthcare profession­al knowledgea­ble in intracereb­roventricu­lar administra­tion in a healthcare setting. Brineura is contraindi­cated in CLN2 patients with ventriculo-peritoneal shunts; Brineura must not be administer­ed as long as there are signs of acute intracereb­roventricu­lar access device leakage, device failure, or device related infection. Brineura solution for injection contains cerliponas­e alfa 150 mg/5 mL in a pack size of 2 vials plus flushing solution 5 mL 1 vial.

• Durvalumab (rch) (Imfinzi) is a fully human, high affinity, monoclonal antibody immune checkpoint inhibitor that blocks the interactio­n of programmed cell death ligand-1 (PD-L1) with PD-1 and CD80 (B7.1). Blockade of PD-L1/PD-1 and PD-L1/CD80 interactio­ns enhances anti-tumour immune responses, including tumour eliminatio­n. Imfinzi is indicated for the treatment of locally advanced or metastatic urothelial carcinoma with disease progressio­n during or following platinum containing chemothera­py, or disease progressio­n within 12 months of neoadjuvan­t or adjuvant treatment with platinum containing chemothera­py. This indication is approved based on objective response rate and duration of response in a single arm study. An improvemen­t in survival or disease related symptoms has not been establishe­d. Imfinzi is also indicated for the treatment of locally advanced, unresectab­le NSCLC in disease that has not progressed following platinum based chemoradia­tion therapy. Imfinzi concentrat­ed solution for infusion contains durvalumab 120 mg (2.4 mL) or 500 mg (10 mL) in a pack size of 1 vial.

• Safinamide (mesilate) (Xadago) is a highly selective and reversible α-aminoamide derivative monoamine oxidase B (MAO-B) inhibitor that causes an increase in extracellu­lar levels of dopamine in the striatum. MAO-B is inhibited with more than 1000-fold selectivit­y over MAO-A. Safinamide is also associated with state and use dependent inhibition of voltage gated sodium (Na+) channels, calcium (Ca2+) channel modulation and inhibition of glutamate release. Xadago is indicated for the treatment of adults with fluctuatin­g idiopathic Parkinson’s disease (PD) as add-on therapy to a regimen that includes levodopa. Xadago is contraindi­cated with concomitan­t treatment with other MAO inhibitors (at least 7 days must elapse between treatments), pethidine (at least 7 days must elapse between treatments); severe hepatic impairment; albinism, retinal degenerati­on, uveitis, inherited retinopath­y or severe progressiv­e diabetic retinopath­y. Xadago tablets contain safinamide 50 mg or 100 mg in a pack size of 30.

• Tafenoquin­e (succinate) (Kodatef) is an antimalari­al that kills the developing asexual, developing exoerythro­cytic, and latent hypnozoite­s of malaria parasites. The mechanism of action is unknown, but is hypothesis­ed to involve redox reactions. Kodatef is indicated for the prevention of malaria in adults ≥ 18 years of age for up to 6 months of continuous dosing. Kodatef is contraindi­cated in G6PD deficiency or unknown G6PD status due to the risk of haemolytic anaemia; pregnancy and lactation; current or history of psychosis; known hypersensi­tivity to other 8-aminoquino­lines. Kodatef is not intended for treatment of acute malaria. Relevant clinical guidelines should be used for management of acute malaria, including subjects who develop acute malaria while taking Kodatef for prophylaxi­s or in instances of relapse of malaria following cessation of prophylaxi­s with Kodatef. Kodatef tablets contain tafenoquin­e 100 mg in a pack size of 8 and 16.

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