Iclusig ponatinib hydrochloride

Get an overview of ICLUSIG (ponatinib hydrochloride tablet, film coated), including its generic name, formulation (i.e. pill, oral solution, injection, inhaled medicine) and why it’s used. The medication in Iclusig can be sold under different names.

Refer to the “Also Known As” section to reference different products that include the same medication as Iclusig.

Drug Basics

Brand Name: Iclusig

Generic Name: PONATINIB HYDROCHLORIDE

Drug Type: HUMAN PRESCRIPTION DRUG

Route: ORAL

Dosage Form: TABLET, FILM COATED

Packager: Millennium Pharmaceuticals, Inc.

Data Current As Of: 2021-02-11

Boxed Warning 12/2020
Indications and Usage (1) 12/2020
Dosage and Administration (2) 12/2020
Warnings and Precautions (5) 12/2020
  Impaired Wound Healing and Gastrointestinal Perforation (5.16) 1/2020

Indications & Usage

Iclusig is indicated for the treatment of adult patients with:

  • Chronic phase (CP) chronic myeloid leukemia (CML) with resistance or intolerance to at least two prior kinase inhibitors.
  • Accelerated phase (AP) or blast phase (BP) CML or Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) for whom no other kinase inhibitors are indicated.
  • T315I-positive CML (chronic phase, accelerated phase, or blast phase) or T315I-positive Ph+ ALL.

Iclusig is a kinase inhibitor indicated for the treatment of adult patients with:

  • Chronic phase (CP) chronic myeloid leukemia (CML) with resistance or intolerance to at least two prior kinase inhibitors. (1)
  • Accelerated phase (AP) or blast phase (BP) CML or Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) for whom no other kinase inhibitors are indicated. (1)
  • T315I-positive CML (chronic phase, accelerated phase, or blast phase) or T315I-positive Ph+ ALL. (1)

Limitations of Use: Iclusig is not indicated and is not recommended for the treatment of patients with newly diagnosed CP-CML. (5.7)

Limitations of Use: Iclusig is not indicated and is not recommended for the treatment of patients with newly diagnosed CP-CML [see Warnings and Precautions (5.7)].

Drug Interactions

  • Strong CYP3A Inhibitors: Avoid coadministration or reduce Iclusig dose if coadministration cannot be avoided. (2.3, 7.1)
  • Strong CYP3A Inducers: Avoid coadministration. (7.1)

effects of other drugs on iclusig

Strong CYP3A Inhibitors

Coadministration of Iclusig with a strong CYP3A inhibitor increases ponatinib plasma concentrations [see Clinical Pharmacology (12.3)], which may increase the risk of Iclusig adverse reactions. Avoid coadministration of Iclusig with strong CYP3A inhibitors. If coadministration of Iclusig with strong CYP3A inhibitors cannot be avoided, reduce the Iclusig dosage [see Dosage and Administration (2.3)].

Strong CYP3A Inducers

Coadministration of Iclusig with a strong CYP3A inducer decreases ponatinib plasma concentrations [see Clinical Pharmacology (12.3)]. Avoid coadministration of Iclusig with strong CYP3A inducers unless the benefit outweighs the risk of decreased ponatinib exposure. Monitor patients for reduced efficacy. Selection of concomitant medication with no or minimal CYP3A induction potential is recommended.

Patient Counseling Information

Advise the patient to read the FDA-approved patient labeling (Medication Guide).

Arterial Occlusive Events and Venous Thromboembolic Events

Inform patients that serious arterial thromboses (including arterial stenosis sometimes requiring revascularization) and VTEs have occurred. Advise patients to immediately contact their healthcare provider with any symptoms suggestive of a blood clot such as chest pain, shortness of breath, weakness on one side of the body, speech problems, leg pain, or leg swelling [see Warnings and Precautions (5.1, 5.2)].

Heart Failure and Cardiac Arrhythmias

Inform patients of the possibility of heart failure, and abnormally slow or fast heart rates. Advise patients to contact their healthcare provider if they experience symptoms such as shortness of breath, chest pain, palpitations, dizziness, or fainting [see Warnings and Precautions (5.3, 5.12)].

Hepatotoxicity

Inform patients of the possibility of developing liver function abnormalities and serious hepatic toxicity. Advise patients to immediately contact their healthcare provider if signs of liver failure occur, including jaundice, anorexia, bleeding or bruising [see Warnings and Precautions (5.4)].

Hypertension

Inform patients of the possibility of new or worsening of existing hypertension. Advise patients to contact their healthcare provider for elevated blood pressure or if symptoms of hypertension occur including confusion, headache, dizziness, chest pain, or shortness of breath [see Warnings and Precautions (5.5)].

Pancreatitis

Inform patients of the possibility of developing pancreatitis that may be accompanied by nausea, vomiting, abdominal pain, or abdominal discomfort, and to promptly report these symptoms [see Warnings and Precautions (5.6)].

Neuropathy

Inform patients of the possibility of developing peripheral or cranial neuropathy while being treated with Iclusig. Advise patients to report symptoms of neuropathy, such as hypoesthesia, hyperesthesia, paresthesia, discomfort, a burning sensation, neuropathic pain, or weakness [see Warnings and Precautions (5.8)].

Ocular Toxicity

Inform patients of the possibility of ocular toxicity while being treated with Iclusig. Advise patients to report symptoms of ocular toxicity, such as blurred vision, dry eye, or eye pain [see Warnings and Precautions (5.9)].

Hemorrhage

Inform patients of the possibility of serious bleeding and to immediately contact their healthcare provider with any signs or symptoms suggestive of hemorrhage such as unusual bleeding or easy bruising [see Warnings and Precautions (5.10)].

Fluid Retention

Inform patients of the possibility of developing fluid retention and to contact their healthcare provider for symptoms such as leg swelling, abdominal swelling, weight gain, or shortness of breath [see Warnings and Precautions (5.11)].

Myelosuppression

Inform patients of the possibility of developing low blood cell counts; inform patients to report immediately should fever develop, particularly in association with any suggestion of infection [see Warnings and Precautions (5.13)].

Tumor Lysis Syndrome

Inform patients of the possibility of developing TLS and to immediately contact their healthcare provider for any signs or symptoms associated with TLS [see Warnings and Precautions (5.14)]. Advise patients to be adequately hydrated when taking Iclusig to reduce the risk of TLS.

Reversible Posterior Leukoencephalopathy Syndrome (RPLS – also known as Posterior Reversible Encephalopathy Syndrome)

Inform patients of the possibility of developing Reversible Posterior Leukoencephalopathy Syndrome while being treated with Iclusig. Advise patients to report symptoms such as seizure, headache, decreased alertness, altered mental functioning, vision loss, and other visual and neurological disturbances [see Warnings and Precautions (5.15)].

Impaired Wound Healing and Gastrointestinal Perforation

Inform patients that impaired wound healing and gastrointestinal fistula or perforation have been reported. Advise patients to inform their healthcare provider of any planned surgical procedure [see Warnings and Precautions (5.16)].

Embryo-Fetal Toxicity

Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females to inform their healthcare provider of a known or suspected pregnancy. Advise females of reproductive potential to use effective contraception during treatment with Iclusig and for 3 weeks after the last dose [see Warnings and Precautions (5.17), Use in Specific Populations (8.1, 8.3)].

Lactation

Advise women not to breastfeed during treatment with Iclusig and for 6 days after the last dose [see Use in Specific Populations (8.2)].

Infertility

Advise females of reproductive potential of the potential for reduced fertility from Iclusig [see Use in Specific Populations (8.3), Nonclinical Toxicology (13.1)].

Instructions for Taking Iclusig

Advise patients to take Iclusig exactly as prescribed and not to change their dose or to stop taking Iclusig unless they are told to do so by their healthcare provider. Iclusig may be taken with or without food. Iclusig tablets should be swallowed whole. Patients should not cut, crush or dissolve the tablets.

Patients should not take two doses at the same time to make up for a missed dose.

Advise patients not to drink grapefruit juice or eat grapefruit as it may increase the amount of Iclusig in their blood and therefore increase their risk of adverse reactions.

Lactose

Inform patients that Iclusig tablets contain lactose monohydrate.

Distributed by:
Millennium Pharmaceuticals, Inc.
40 Landsdowne Street
Cambridge, MA 02139-4234

ICLUSIG® is a registered trademark of ARIAD Pharmaceuticals, Inc. TAKEDA® is a registered trademark of Takeda Pharmaceutical Company Limited.

©2020 ARIAD Pharmaceuticals Inc. All rights reserved.

ICL348 R7

This Medication Guide has been approved by the U.S. Food and Drug Administration. Revised: December 2020
MEDICATION GUIDE
ICLUSIG® (eye-CLUE-sig)
(ponatinib)
tablets
What is the most important information I should know about Iclusig?
Iclusig can cause serious side effects, including:
Blood clots or blockage in your blood vessels (arteries and veins).
Blood clots or blockage in your blood vessels may lead to heart attack, stroke, or death. A blood clot or blockage in your blood vessels can prevent proper blood flow to your heart, brain, bowels (intestines), legs, eyes, and other parts of your body. You may need emergency surgery or treatment in a hospital. Get medical help right away if you get any of the following symptoms:
  • chest pain or pressure
  • pain in your arms, legs, back, neck or jaw
  • shortness of breath
  • numbness or weakness on one side of your body
  • leg swelling
  • trouble talking
  • headache
  • dizziness
  • severe stomach area pain
  • decreased vision or loss of vision
Blood clots or blockage in your blood vessels can happen in people with or without risk factors for heart and blood vessel disease, including people 50 years of age or younger. The most common risk factors for these problems are a history of high blood pressure (hypertension), high cholesterol, and heart disease. Blood clots or blockages in your blood vessels happen more often in people as they get older, and in people with a history of decreased blood flow, high blood pressure, diabetes, or high cholesterol.
Heart problems. Iclusig can cause heart problems, including heart failure which can be serious and may lead to death. Heart failure means your heart does not pump blood well enough. Iclusig can also cause irregular, slow, or fast heartbeats and heart attack. Your healthcare provider will check you for heart problems during your treatment with Iclusig. Get medical help right away if you get any of the following symptoms: shortness of breath, chest pain, fast or irregular heartbeats, dizziness, or feel faint.
Liver problems. Iclusig can cause liver problems, including liver failure, which can be severe and may lead to death. Your healthcare provider will do blood tests before and during your treatment with Iclusig to check for liver problems. Get medical help right away if you get any of these symptoms of liver problems during treatment:
  • yellowing of your skin or the white part of your eyes
  • dark "tea-colored" urine
  • sleepiness
  • loss of appetite
  • bleeding or bruising

See "What are the possible side effects of Iclusig?" for information about side effects.

What is Iclusig?
Iclusig is a prescription medicine used to treat adults who have:
  • chronic phase chronic myeloid leukemia (CML) who did not tolerate or no longer benefit from treatment with at least 2 prior kinase inhibitor medicines
  • accelerated phase or blast phase CML, or Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) who cannot receive any other kinase inhibitor medicines
  • a specific type of abnormal gene (T315I-positive) chronic phase, accelerated phase, or blast phase CML, or T315I-positive Ph+ ALL

Iclusig is not for use to treat people with newly diagnosed chronic phase CML.It is not known if Iclusig is safe and effective in children.

Before you take Iclusig, tell your healthcare provider about all of your medical conditions, including if you:
  • have a history of blood clots in your blood vessels (arteries or veins)
  • have heart problems, including heart failure, irregular heartbeats, and QT prolongation
  • have diabetes
  • have a history of high cholesterol
  • have liver problems
  • have had inflammation of your pancreas (pancreatitis)
  • have high blood pressure
  • are pregnant or plan to become pregnant. Iclusig can harm your unborn baby.
    • Your healthcare provider will do a pregnancy test before you start taking Iclusig.
    • You should not become pregnant during treatment with Iclusig.
    • For females who can become pregnant:
      • Use an effective form of birth control during treatment and for 3 weeks after your last dose of Iclusig.
      • Tell your healthcare provider right away if you become pregnant or think you might be pregnant during treatment with Iclusig.
      • Iclusig may affect your ability to have children. Tell your healthcare provider if this is a concern for you.
  • are breastfeeding or plan to breastfeed. It is not known if Iclusig passes into your breast milk. Do not breastfeed during treatment and for 6 days after your last dose of Iclusig.

Tell your healthcare provider about all the medicines you take, including prescription medicines and over-the-counter medicines, vitamins, and herbal supplements. Iclusig and other medicines may affect each other causing side effects.
Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How should I take Iclusig?
  • Take Iclusig exactly as your healthcare provider tells you to take it.
  • Do not change your dose or stop taking Iclusig unless your healthcare provider tells you.
  • Swallow Iclusig tablets whole. Do not crush, break, cut, chew or dissolve Iclusig tablets.
  • Take Iclusig with or without food.
  • Do not eat grapefruit or drink grapefruit juice during treatment with Iclusig.
  • If you miss a dose of Iclusig, take your next dose at your regularly scheduled time the next day. Do not take 2 doses at the same time to make up for a missed dose.
  • If you take too much Iclusig, call your healthcare provider or go to the nearest hospital emergency room right away.
What are the possible side effects of Iclusig?
Iclusig may cause serious side effects, including:
  • See "What is the most important information I should know about Iclusig?".
  • High blood pressure (hypertension). Iclusig can cause new or worsening high blood pressure. Your blood pressure should be checked regularly, and any high blood pressure should be treated during treatment with Iclusig. Tell your healthcare provider right away if you get confusion, headaches, dizziness, chest pain or shortness of breath.
  • Inflammation of the pancreas (pancreatitis). Tell your healthcare provider right away if you get any of the following symptoms: sudden stomach-area pain or discomfort, nausea, and vomiting. Your healthcare provider should do blood tests to check for pancreatitis during treatment with Iclusig.
  • Neuropathy. Iclusig may cause damage to the nerves in your arms, brain, hands, legs, or feet (neuropathy). Tell your healthcare provider right away if you get any of these symptoms during treatment with Iclusig:
    • muscle weakness, tingling, burning, pain, discomfort or loss of feeling in your hands and feet
    • double vision and other problems with eyesight, trouble moving the eye, drooping of part of the face, sagging or drooping eyelids, or change in taste
  • Eye problems. Serious eye problems that can lead to blindness or blurred vision may happen with Iclusig. Tell your healthcare provider right away if you get any of the following symptoms: bleeding in the eye, perceived flashes of light, light sensitivity, floaters, blurred vision, dry, inflamed, swollen, or itchy eyes, or eye pain. Your healthcare provider will monitor your vision before and during your treatment with Iclusig.
  • Serious bleeding. Iclusig can cause bleeding which can be serious and may lead to death. Tell your healthcare provider right away if you get any signs of bleeding during treatment with Iclusig including:
  • vomiting blood or if your vomit looks like coffee-grounds
  • pink or brown urine
  • red or black (looks like tar) stools
  • coughing up blood or blood clots
  • unusual bleeding or bruising of your skin
  • menstrual bleeding that is heavier than normal
  • unusual vaginal bleeding
  • nose bleeds that happen often
  • drowsiness or difficulty being awakened
  • confusion
  • headache
  • change in speech
  • Fluid retention. Your body may hold too much fluid (fluid retention) which can be serious and may lead to death. Tell your healthcare provider right away if you get any of these symptoms during treatment with Iclusig:
    • swelling of your hands, ankles, feet, face, or all over your body
    • weight gain
    • shortness of breath and cough
  • Irregular heartbeat. Iclusig may cause an irregular heartbeat. Tell your healthcare provider right away if you experience loss of consciousness, fainting, dizziness, chest pain or palpitations.
  • Low blood cell counts. Iclusig may cause low blood cell counts, which can be severe. Your healthcare provider will check your blood counts regularly during treatment with Iclusig. Tell your healthcare provider right away if you have a fever or any signs of an infection while taking Iclusig.
  • Tumor Lysis Syndrome (TLS). TLS is caused by a fast breakdown of cancer cells. TLS can cause you to have:
    • kidney failure and the need for dialysis treatment
    • an abnormal heartbeat

    Your healthcare provider may do blood tests to check for TLS. Drink plenty of water during treatment with Iclusig to help reduce your risk of getting TLS.

  • Reversible Posterior Leukoencephalopathy Syndrome (RPLS – also known as Posterior Reversible Encephalopathy Syndrome). Iclusig may trigger a condition called RPLS. Call your healthcare provider right away if you get headaches, seizures, confusion, changes in vision or problems thinking.
  • Wound healing problems. Wound healing problems have happened in some people who take Iclusig. Tell your healthcare provider if you plan to have any surgery before or during treatment with Iclusig.
    • You should stop taking Iclusig at least 1 week before planned surgery.
    • Your healthcare provider should tell you when you may start taking Iclusig again after surgery.
  • A tear in your stomach or intestinal wall (perforation). Tell your healthcare provider right away if you get:
    • severe pain in your stomach-area (abdomen)
    • swelling of the abdomen
    • high fever

The most common side effects of Iclusig include:

  • skin rash
  • joint pain
  • stomach-area (abdomen) pain
  • headache
  • constipation
  • dry skin
  • high blood pressure
  • tiredness
  • swelling of your hands, ankles, feet, face, or all of your body (fluid retention and edema)
  • fever
  • nausea
  • inflammation of the pancreas
  • increase in lipase levels (a blood test done to check your pancreas)
  • bleeding
  • low hemoglobin in the blood (anemia)
  • liver problems
  • blood clots or blockage in blood vessels (arteries)
  • low blood platelet counts
  • low blood levels of white blood cells (including neutrophils)
Your healthcare provider may change your dose, temporarily stop, or permanently stop treatment with Iclusig if you have certain side effects.
Tell your healthcare provider if you have any side effect that bothers you or that does not go away.
These are not all of the possible side effects of Iclusig. For more information, ask your healthcare provider or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
How should I store Iclusig?
Store Iclusig at room temperature between 68°F to 77°F (20°C to 25°C).
Keep Iclusig and all medicines out of the reach of children.
General information about the safe and effective use of Iclusig
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Iclusig for a condition for which it was not prescribed. Do not give Iclusig to other people, even if they have the same symptoms you have. It may harm them. You can ask your healthcare provider or pharmacist for information about Iclusig that is written for health professionals.
What are the ingredients in Iclusig?
Active ingredient:
ponatinib
Inactive ingredients: lactose monohydrate, microcrystalline cellulose, sodium starch glycolate (type B), colloidal silicon dioxide and magnesium stearate. The tablet coating consists of talc, polyethylene glycol, polyvinyl alcohol and titanium dioxide.
For more information, go to www.iclusig.com or call 1-844-817-6468.
Distributed by: Millennium Pharmaceuticals, Inc. 40 Landsdowne Street, Cambridge, MA 02139-4234
ICLUSIG® is a registered trademark of ARIAD Pharmaceuticals, Inc. TAKEDA® is a registered trademark of Takeda Pharmaceutical Company Limited.
©2020 ARIAD Pharmaceuticals, Inc. All rights reserved.
ICL348 R7
This drug label information is as submitted to the Food and Drug Administration (FDA) and is intended for informational purposes only. If you think you may have a medical emergency, immediately call your doctor or dial 911. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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