Adult Dosing
Non-Small Cell Lung Cancer (NSCLC)
- 150 mg PO Daily; administered 1hr before or 2 hrs after meals
- Reduce dose in 50 mg decrements if severe adverse reactions occur or if using strong CYP3A4 inhibitor
- Used in conjunction with gemcitabine
Pancreatic CA
- 100 mg PO Daily in combination with gemcitabine; administered 1 hr before or 2 hrs after meals
- Reduce dose in 50 mg decrements if severe adverse reactions occur or if using strong CYP3A4 inhibitor
Note:
- See prescribing information for details about dose adjustments based on toxicity
- For first-line therapy of metastatic NSCLC, patients should be selected based on of the presence of EGFR exon 19 deletions or exon 21 (L858R) substitution mutations in tumor specimens
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
Renal Dose Adjustment
- Renal impairment: No dose adjustments
Hepatic Dose Adjustment
- Total bilirubin > ULN or Child Pugh A/B/C: Monitor closely for adverse events
- Total bilirubin >3 x ULN: Use cautiously, dose adjustments not defined
Cigarette Smokers
- Increase up to 300mg daily. Reduce if smoking cessation occurs
Concomitant CYP3A4 inducers
- May require dose increases at 2 week intervals. Up to 450 mg with rifampicin. Reduce dose if inducer is discontinued
Concomitant CYP3A4 inhibitors
- Includes grapefruit juice
- May require dose reduction in 50 mg decrements
Severe diarrhea (unresponsive to treatment) and severe reactions
- May require dose reduction in 50 mg decrements
- Serious Interstitial Lung Disease (ILD)-like events, including fatalities have been reported in patients receiving erlotinib. Interrupt the therapy pending diagnostic evaluation if new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever occurs and discontinue the therapy is ILD is confirmed
- Cerebrovascular accidents have been reported
- Hepatorenal syndrome, acute renal failure and renal insufficiency associated with severe dehydration have been reported with erlotinib therapy
- Monitor renal function and serum electrolytes in patients at risk of dehydration and interrupt the therapy in the event of dehydration and provide appropriate measures to rehydrate the patient
- Erlotinib therapy can cause hepatic failure and hepatorenal syndrome. Monitor liver function periodically, dose interruption and/or dose reduction with frequent liver function test monitoring should be considered in case of worsening liver function tests
- Gastrointestinal perforation has been reported in patients receiving erlotinib. Patients on anti-angiogenic agents, corticosteroids, NSAIDs, and/or taxane-based chemotherapy, or who have prior history of peptic ulceration or diverticular disease are at increased risk. Permanently discontinue the therapy if gastrointestinal perforation develops
- Myocardial infarction/ischemia have been reported with erlotinib therapy
- Corneal perforation or ulceration have been reported with erlotinib therapy
- Avoid in pregnancy as the drug may cause fetal harm. Women of child-bearing potential should avoid becoming pregnant during treatment
- International Normalized Ratio (INR) elevations and infrequent reports of bleeding events, including gastrointestinal and non-gastrointestinal bleeding some associated with concomitant warfarin administration have been reported with erlotinib therapy
- Microangiopathic hemolytic anemia with thrombocytopenia has been reported
- Severe skin disorders have been reported. Interrupt or discontinue therapy for severe conditions
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- Pulmonary disease
- History of radiation
- Electrolyte disturbances
- Chemotherapy
- Hypothyroidism
- Dehydration
- Total bilirubin >3 x ULN
- CYP3A4 inducers (i.e. rifabutin, rifapentine, phenytoin, carbamazepine, phenobarbital, St John's Wort)
- Concomitant use with proton pump inhibitors
Pregnancy Category:D
Breastfeeding: Safety Unknown; Because of the potential for possible serious adverse reactions in nursing infants a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Tarceva 150 MG TABS [Bottle] (GENENTECH)
30 mg = $5635.04
90 mg = $16575.79 - Tarceva 25 MG TABS [Bottle] (GENENTECH)
30 mg = $1747.94
90 mg = $5122.99 - Tarceva 100 MG TABS [Bottle] (GENENTECH)
30 mg = $4688.87
90 mg = $13859.93
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
