natgillin/translations-raw huggingface dataset:
Patients should be instructed to avoid grapefruit and grapefruit juice as they may inhibit CYP3A in the gut wall and may increase the bioavailability of ceritinib.
Bolesnike treba uputiti da izbjegavaju grejp i sok od grejpa, budući da oni mogu inhibirati CYP3A u stijenci crijeva te mogu povećati bioraspoloživost ceritiniba.
QTc >500 msec or >60 msec change from baseline and torsade de pointes or polymorphic ventricular tachycardia or signs/symptoms of serious arrhythmia
QTc >500 msec ili promjena >60 msec u odnosu na početnu vrijednost i torsade de pointes ili polimorfna ventrikularna tahikardija ili znakovi/simptomi ozbiljne aritmije
Use of Zykadia in combination with other agents known to cause bradycardia (e.g. beta blockers, non-dihydropyridine calcium channel blockers, clonidine and digoxin) should be avoided as far as possible.
Primjena Zykadie u kombinaciji s drugim tvarima za koje je poznato da uzrokuju bradikardiju (npr. beta blokatori, nedihidropiridinski blokatori kalcijevih kanala, klonidin i digoksin) treba se izbjegavati koliko god je moguće.
The European Medicines Agency has waived the obligation to submit the results of studies with Zykadia in all subsets of the paediatric population in lung carcinoma (small cell and non-small cell carcinoma) (see section 4.2 for information on paediatric use).
Europska agencija za lijekove izuzela je obvezu podnošenja rezultata ispitivanja lijeka Zykadia u svim podskupinama pedijatrijske populacije u raku pluća (raku malih stanica i raku nemalih stanica) (vidjeti dio 4.2 za informacije o pedijatrijskoj primjeni).
What Zykadia contains
Što Zykadia sadrži
Of the 163 ALK-positive NSCLC patients who had received prior treatment with an ALK inhibitor, the median age was 52 years (range: 24-80 years); 86.5% were younger than 65 years and 54% were female.
Kod 163 bolesnika s ALK-pozitivnim NSCLC-om koji su se prethodno liječili ALK inhibitorom, medijan dobi bio je 52 godine (raspon: 24-80 godina); 86,5% bilo je mlađe od 65 godina, a 54% bolesnika bilo je ženskog spola.
Dose interruption and dose reduction should be employed as necessary (see sections 4.2 and 4.8).
Prekid doziranja i smanjivanje doze treba primjenjivati prema potrebi (vidjeti dijelove 4.2 i 4.8).
Strong CYP3A inhibitors
Snažni CYP3A inhibitori
Duration of follow-up Median (months) (min - max) Overall response rate Investigator (95% CI) BIRC (95% CI) Duration of response* Investigator (months, 95% CI) BIRC (months, 95% CI) Progression-free survival Investigator (months, 95% CI) BIRC (months, 95% CI) Overall survival (months, 95% CI)
Trajanje praćenja Medijan (mjeseci) (min - maks) Stopa ukupnog odgovora Ispitivač (95% CI) BIRC (95% CI) Trajanje odgovora* Ispitivač (mjeseci, 95% CI) BIRC (mjeseci, 95% CI) Preživljenje bez progresije Ispitivač (mjeseci, 95% CI) BIRC (mjeseci, 95% CI) Ukupno preživljenje (mjeseci, 95% CI)
If vomiting occurs during the course of treatment, the patient should not take an additional dose, but should continue with the next scheduled dose.
Ako dođe do povraćanja tijekom liječenja, bolesnik ne smije uzeti dodatnu dozu, već nastaviti sa sljedećom dozom po rasporedu.
The efficacy of Zykadia 450 mg with food was evaluated in a multicentre, open-label dose optimisation study A2112 (ASCEND-8).
Djelotvornost Zykadie od 450 mg uz hranu bila je procijenjena u multicentričnom, otvorenom ispitivanju optimizacije doze A2112 (ASCEND-8).
Patients should be monitored with liver laboratory tests (including ALT, AST and total bilirubin) prior to the start of treatment, every 2 weeks during the first three months of treatment and monthly thereafter.
Bolesnike treba pratiti laboratorijskim pretragama jetre (uključujući ALT, AST i ukupni bilirubin) prije početka liječenja, svaka 2 tjedna tijekom prva tri mjeseca liječenja te svaki mjesec nakon toga.
Based on in vitro data, ceritinib competitively inhibits the metabolism of a CYP3A substrate, midazolam, and a CYP2C9 substrate, diclofenac.
Na temelju in vitro podataka, ceritinib kompetitivno inhibira metabolizam CYP3A supstrata, midazolama, te CYP2C9 supstrata, diklofenaka.
Zykadia should not be used during breast-feeding.
Zykadia se ne smije uzimati tijekom dojenja.
There are no safety data in patients older than 85 years of age.
Nema podataka o sigurnosti u bolesnika starijih od 85 godina.
Particular caution should be exercised when treating patients with severe hepatic impairment and the dose should be reduced by approximately one third, rounded to the nearest multiple of the 150 mg dosage strength (see sections 4.4 and 5.2).
Potreban je poseban oprez kod liječenja bolesnika s teškim oštećenjem jetre te je dozu potrebno smanjiti za otprilike jednu trećinu, zaokruženo na najbliži višekratnik doze jačine 150 mg (vidjeti dijelove 4.4 i 5.2).
The population characteristics across the two arms were: mean age 53 years, age less than 65 (79%), female (57%), Caucasian (54%), Asian (33%), never or former smoker (95%), WHO PS 0 or 1 (93%), adenocarcinoma histology (94%), and metastases to the brain (33%).
Karakteristike populacije u obje skupine bile su: srednja vrijednost dobi 53 godine, dob manja od 65 (79%), žene (57%), bijelci (54%), Azijati (33%), nepušači ili bivši pušači (95%), WHO PS 0 ili 1 (93%), histologija adenokarcinoma (94%), i metastaze na mozgu (33%).
Eye disorders Vision disorder a
Poremećaji oka Poremećaj vida a
Abdominal pain f
Bol u abdomenu f
How long to take Zykadia
Koliko dugo uzimati Zykadiu
Capsule with white opaque body and blue opaque cap, with “LDK 150MG” imprinted on the cap and “NVR” on the body, containing white to almost white powder.
Kapsula s bijelim neprozirnim tijelom i plavom neprozirnom kapicom, s oznakom „LDK 150MG“ otisnutom na kapici i „NVR“ na tijelu, koja sadrži bijeli do gotovo bijeli prašak.
Chemotherapy (N=116)
Kemoterapija (N=116)
Co-administration of ceritinib with strong CYP3A/P-gp inducers decreases ceritinib plasma concentrations.
Istodobna primjena ceritiniba sa snažnim CYP3A/P-gp induktorima smanjuje koncentracije ceritiniba u plazmi.
Liver laboratory tests including ALT, AST and total bilirubin should be performed prior to the start of treatment, every 2 weeks during the first three months of treatment and monthly thereafter, with more frequent testing for grade 2, 3 or 4 elevations.
Laboratorijske pretrage jetre koje uključuju ALT, AST i ukupni bilirubin trebaju se obaviti prije početka liječenja, svaka 2 tjedna tijekom prva tri mjeseca liječenja te svaki mjesec nakon toga, uz učestalije pretrage za povišenja stupnja 2, 3 ili 4.
Based on in vitro data, ceritinib is a substrate of the efflux transporter P-glycoprotein (P-gp).
Na temelju in vitro podataka, ceritinib je supstrat efluksnog transportera P-glikoproteina (P-gp).
Effects on the thyroid were observed in both rat (mild increases in thyroid stimulating hormone and triiodothyronine/thyroxine T3/T4 concentrations with no microscopic correlate) and monkey (depletion of colloid in males in 4-week study, and one monkey at high dose with diffuse follicular cell hyperplasia and increased thyroid stimulating hormone in 13-week study).
Učinci na štitnjaču bili su uočeni i u štakora (blaga povišenja koncentracija tireotropnog hormona i trijodtironina/tiroksina T3/T4 bez mikroskopskog korelata) i u majmuna (deplecija koloida u mužjaka u 4-tjednom ispitivanju, te jedan majmun pri visokoj dozi s difuznom hiperplazijom folikularnih stanica i povišenim tireotropnim hormonom u 13-tjednom ispitivanju).
The majority of patients had adenocarcinoma (97.0%) and had either never smoked or were former smokers (96.1%).
Velika većina bolesnika imala je adenokarcinom (97,0%) te ili nikada nisu pušili ili su bili bivši pušači (96,1%).
ALK translocation determines expression of the resulting fusion protein and consequent aberrant ALK signaling in NSCLC.
Translokacija ALK-a određuje ekspresiju rezultirajućeg fuzijskog proteina i posljedičnu poremećenu signalizaciju ALK-a kod NSCLC-a.
The principal toxicity related to ceritinib administration in rats and monkeys was inflammation of the extra-hepatic bile ducts accompanied by increased neutrophil counts in the peripheral blood.
Glavna toksičnost povezana s primjenom ceritiniba u štakora i majmuna bila je upala ekstrahepatičkih žučnih vodova popraćena povećanim brojem neutrofila u perifernoj krvi.
Therefore, ceritinib may have the potential to increase plasma concentrations of co-administered medicinal products that are predominantly metabolised by these enzymes.
Stoga bi ceritinib mogao imati potencijal povećavanja koncentracija u plazmi istodobno primijenjenih lijekova koji se pretežno metaboliziraju putem tih enzima.
A total of 376 patients were randomised in a 1:1 ratio (stratified by WHO performance status, prior adjuvant/neoadjuvant chemotherapy and presence/absence of brain metastasis at screening) to receive either ceritinib (750 mg daily, fasted) or chemotherapy (based on investigator's choice - pemetrexed [500 mg/m2] plus cisplatin [75 mg/m2] or carboplatin [AUC 5-6], administered every 21 days).
Ukupno je 376 bolesnika bilo randomizirano u omjeru 1:1 (stratificirano prema funkcionalnom statusu po SZO-u, prethodnoj adjuvantnoj/neoadjuvantnoj kemoterapiji i prisutnosti/odsutnosti metastaza na mozgu kod probira) na primanje ili ceritiniba (750 mg na dan, natašte) ili kemoterapije (na temelju ispitivačevog izbora - pemetreksed [500 mg/m2] plus cisplatin [75 mg/m2] ili karboplatin [AUC 5-6], primijenjeni svakih 21 dan).
The maximum recommended dose with food is 450 mg taken orally once daily.
Maksimalna preporučena doza uz hranu je 450 mg koja se uzima peroralno jedanput dnevno.
Asymptomatic cases of bradycardia (heart rate less than 60 bpm) have been observed in 21 out of 925 (2.3%) patients treated with ceritinib in clinical studies.
Asimptomatski slučajevi bradikardije (srčane frekvencije niže od 60 otkucaja u minuti) uočeni su u 21 od 925 (2,3%) bolesnika liječenih ceritinibom u kliničkim ispitivanjima.
The effect of hepatic impairment on the single-dose pharmacokinetics of ceritinib (750 mg under fasted conditions) was evaluated in subjects with mild (Child-Pugh class A; N=8), moderate (ChildPugh class B; N=7), or severe (Child-Pugh class C; N=7) hepatic impairment and in 8 healthy subjects with normal hepatic function.
Učinak oštećenja jetre na farmakokinetiku jednokratne doze ceritiniba (750 mg natašte) bio je procijenjen u ispitanika s blagim (Child-Pugh klasa A; N = 8), umjerenim (Child-Pugh klasa B; N = 7) ili teškim (Child-Pugh klasa C; N = 7) oštećenjem jetre i u 8 zdravih ispitanika s normalnom jetrenom funkcijom.
Heart rate less than 60 beats per minutes (bpm)
Srčana frekvencija niža od 60 otkucaja u minuti b
Number of events, n (%) Median, months (95% CI) HR (95% CI)
Broj događaja, n (%) Medijan, mjeseci (95% CI) HR (95% CI)
No patients required dose reduction or discontinuation of Zykadia due to diarrhoea, nausea or vomiting (see section 4.8).
Nijedan bolesnik nije zahtijevao smanjenje doze ili trajni prekid primjene Zykadie zbog proljeva, mučnine ili povraćanja (vidjeti dio 4.8).
The active substance of Zykadia is ceritinib.
Djelatna tvar Zykadie je ceritinib.
If it is not possible to avoid concomitant use with strong CYP3A inhibitors (including, but not limited to, ritonavir, saquinavir, telithromycin, ketoconazole, itraconazole, voriconazole, posaconazole and nefazodone), reduce the ceritinib dose by approximately one third, rounded to the nearest multiple of the 150 mg dosage strength.
Ako nije moguće izbjeći istodobnu primjenu sa snažnim CYP3A inhibitorima (uključujući, između ostaloga, ritonavir, sakvinavir, telitromicin, ketokonazol, itrakonazol, vorikonazol, posakonazol i nefazodon), potrebno je smanjiti dozu ceritiniba za otprilike jednu trećinu, zaokruženo na najbliži višekratnik jačine doze od 150 mg.
Table 1 summarises recommendations for dose interruption, reduction or discontinuation of Zykadia in the management of selected ADRs.
Tablica 1 sadrži sažetak preporuka za privremeni prekid, smanjenje doze ili trajni prekid primjene Zykadie u zbrinjavanju odabranih nuspojava.
The tablets should be administered orally once daily with food at the same time every day.
Tablete se trebaju uzimati peroralno jedanput na dan uz hranu, svakoga dana u isto vrijeme.
However, based on available data, ceritinib elimination via the kidney is negligible.
Međutim, na temelju dostupnih podataka, eliminacija ceritiniba putem bubrega je zanemariva.
23.9 (16.6, NE)
23,9 (16,6; NP)
The geometric mean AUCinf (unbound AUCinf) of ceritinib was increased by 66% (108%) in subjects with severe hepatic impairment compared to subjects with normal hepatic function (see section 4.2).
Geometrijska srednja vrijednost AUCinf (nevezani AUCinf) ceritiniba bila je povećana za 66% (108%) u ispitanika s teškim oštećenjem jetre u usporedbi s ispitanicima s normalnom jetrenom funkcijom (vidjeti dio 4.2).
The median PFS by BIRC using RECIST 1.1 was longer in the ceritinib arm compared to the chemotherapy arm in both subgroups of patients with brain metastases and without brain metastases.
Medijan PFS-a prema BIRC-u uz korištenje kriterija RECIST 1.1 bio je dulji u ceritinib skupini nego u kemoterapijskoj skupini u obje podskupine bolesnika s metastazama na mozgu i bez njih.
Study A2201 involved 140 patients who had been previously treated with 1-3 lines of cytotoxic chemotherapy followed by treatment with crizotinib, and who had then progressed on crizotinib.
Ispitivanje A2201 uključivalo je 140 bolesnika koji su prethodno bili liječeni s 1-3 linije citotoksične kemoterapije, a nakon toga krizotinibom, i koji su zatim imali progresiju na krizotinibu.
Severe diarrhoea, nausea or vomiting
Teški proljev, mučnina ili povraćanje
Use of Zykadia in patients with congenital long QT syndrome should be avoided.
Primjenu Zykadie u bolesnika s kongenitalnim sindromom produljenog QT intervala treba izbjegavati.
Table 2 shows the frequency category of ADRs reported for Zykadia in patients treated at a dose of 750 mg fasted (N=925) in seven clinical studies.
Tablica 2 prikazuje kategoriju učestalosti nuspojava prijavljenih uz Zykadiu u bolesnika liječenih dozom od 750 mg natašte (N=925) u sedam kliničkih ispitivanja.
Gastrointestinal toxicity was observed in both species characterised by body weight loss, decreased food consumption, emesis (monkey), diarrhoea and, at high doses, by histopathological lesions including erosion, mucosal inflammation and foamy macrophages in the duodenal crypts and submucosa.
Gastrointestinalna toksičnost bila je uočena u obje vrste i karakterizirana gubitkom tjelesne težine, smanjenim unosom hrane, emezom (majmuni), proljevom te, pri višim dozama, histopatološkim lezijama koje su uključivale eroziju, upalu sluznice i pjenaste makrofage u duodenalnim kriptama i submukozi.
Other side effects are listed below.
Ostale nuspojave navedene su u nastavku.
Zykadia should be withheld in patients who develop QTc >500 msec on at least two separate ECGs until recovery to baseline or a QTc ≤480 msec, then reinitiated with dose reduced by 150 mg (see sections 4.2, 4.8 and 5.2).
Primjena Zykadie mora se privremeno prekinuti u bolesnika u kojih se razvije QTc >500 msek na najmanje dva zasebna EKG-a, do oporavka na početnu vrijednost ili na QTc ≤480 msek, a zatim ponovno započeti primjenu dozom smanjenom za 150 mg (vidjeti dijelove 4.2, 4.8 i 5.2).
Caution should be exercised with concomitant use of P-gp inducers.
Potreban je oprez kod istodobne primjene P-gp induktora.
Adverse drug reactions (ADRs) described below reflect exposure to Zykadia 750 mg once daily fasted in 925 patients with ALK-positive advanced NSCLC across a pool of seven clinical studies including two randomised, active-controlled, phase 3 studies (studies A2301 and A2303).
Nuspojave opisane u nastavku odražavaju izloženost Zykadii od 750 mg uzetoj jedanput dnevno natašte u 925 bolesnika s ALK-pozitivnim uznapredovalim NSCLC-om u skupu od sedam kliničkih ispitivanja koja uključuju i dva randomizirana, ispitivanja faze 3 s aktivnom kontrolom (ispitivanja A2301 i A2303).
The Eastern Cooperative Oncology Group (ECOG) performance status was 0/1/2 in 37.0%/56.4%/6.4% of patients, and 32.2% had brain metastasis at baseline.
Eastern Cooperative Oncology Group, ECOG) bilo je 0/1/2 u, redom, 37,0%/56,4%/6,4% bolesnika, a 32,2% imalo je metastaze na mozgu na početku.
ALT or AST elevation >3 times ULN with concurrent total bilirubin elevation >2 times ULN (in the absence of cholestasis or haemolysis)
Povišenje ALT-a ili AST-a >3 puta GGN uz istodobno povišenje ukupnog bilirubina >2 puta GGN (u odsutnosti kolestaze ili hemolize)
When ceritinib is co-administered with other medicinal products, the Summary of Product Characteristics (SmPC) for the other product must be consulted for the recommendations regarding co-administration with CYP3A4 inhibitors.
Kada se ceritinib primjenjuje istodobno s drugim lijekovima, potrebno je pogledati Sažetak opisa svojstava lijeka (SmPC) tih drugih lijekova vezano uz preporuke kod istodobne primjene s CYP3A4 inhibitorima.
Skin and subcutaneous tissue disorders Rash j
Poremećaji kože i potkožnog tkiva Osip j
Abnormal results of blood tests to check liver function (high levels of enzymes called alanine aminotransferase and/or aspartate aminotransferase and/or gamma glutamyltransferase and/or blood alkaline phosphatase, high levels of bilirubin) Abdominal pain
Poremećeni rezultati krvnih pretraga za provjeru jetrene funkcije (visoke razine enzima koji se zovu alanin aminotransferaza i/ili aspartat aminotransferaza i/ili gama glutamiltransferaza i/ili alkalna fosfataza u krvi, visoke razine bilirubina) Bol u trbuhu
CYP3A and CYP2C9 substrates
CYP3A i CYP2C9 supstrati
Ceritinib 450 mg with food (N=41)
Ceritinib 450 mg uz hranu (N=41)
Packs containing 40, 90 or 150 (3 packs of 50) hard capsules.
Pakiranja sadrže 40, 90 ili 150 (3 pakiranja po 50) tvrdih kapsula.
Based on a population pharmacokinetic analysis of 345 patients with mild renal impairment (CLcr 60 to <90 ml/min), 82 patients with moderate renal impairment (CLcr 30 to <60 ml/min) and 546 patients with normal renal function (≥90 ml/min), ceritinib exposures were similar in patients with mild and moderate renal impairment and normal renal function, suggesting that no dose adjustment is necessary in patients with mild to moderate renal impairment.
Na temelju populacijske farmakokinetičke analize 345 bolesnika s blagim oštećenjem bubrega (CLcr 60 do <90 ml/min), 82 bolesnika s umjerenim oštećenjem bubrega (CLcr 30 do <60 ml/min) te 546 bolesnika s normalnom bubrežnom funkcijom (≥90 ml/min), izloženosti ceritinibu bile su slične u bolesnika s blagim i umjerenim oštećenjem bubrega i normalnom bubrežnom funkcijom, što ukazuje na to da nije potrebno prilagođavanje doze u bolesnika s blagim do umjerenim oštećenjem bubrega.
If you vomit after you swallow the Zykadia capsules, do not take any more capsules until your next scheduled dose.
Ako povratite nakon što progutate Zykadia kapsule, nemojte uzimati nove kapsule do sljedeće doze po rasporedu.
Serial ECGs were collected following a single dose and at steady-state to evaluate the effect of ceritinib on the QT interval in 925 patients treated with Zykadia 750 mg once daily fasted.
Serijski EKG-ovi bili su prikupljeni nakon jednokratne doze te u stanju dinamičke ravnoteže da bi se ocijenio učinak ceritiniba na QT interval u 925 bolesnika liječenih Zykadiom 750 mg jedanput dnevno natašte.
Patients should be managed as recommended in sections 4.2 and 4.4.
Bolesnike je potrebno zbrinjavati kako je preporučeno u dijelovima 4.2 i 4.4.
Seventy-three (73) patients received docetaxel and 40 received pemetrexed.
Sedamdeset tri (73) bolesnika primalo je docetaksel, a 40 je primalo pemetreksed.
Across the seven clinical studies, 9.7% of patients treated with ceritinib had events of QT prolongation (any grade), including grade 3 or 4 events in 2.1% of patients.
U sedam kliničkih ispitivanja, 9,7% bolesnika liječenih ceritinibom imalo je događaje produljenja QT-a (bilo kojeg stupnja), uključujući događaje stupnja 3 ili 4 u 2,1% bolesnika.
Diarrhoea, nausea, or vomiting occurred in 74.2% of 89 patients treated with Zykadia at the recommended dose of 450 mg taken with food in a dose optimisation study and were mainly grade 1 events (49.4%).
Proljev, mučnina ili povraćanje javili su se u 74,2% od 89 bolesnika liječenih Zykadiom pri preporučenoj dozi od 450 mg uzetoj uz hranu u ispitivanju optimizacije doze i bili su većinom događaji stupnja 1 (49,4%).
Vomiting e
Povraćanje e
The maximum recommended dose of Zykadia is 450 mg taken orally once daily with food (see section 4.2).
Maksimalna preporučena doza Zykadie je 450 mg uzeta peroralno jedanput dnevno uz hranu (vidjeti dio 4.2).
Single arm studies X2101 and A2201
Ispitivanja X2101 i A2201 s po jednom skupinom
Vision disorder (vision impairment, vision blurred, photopsia, vitreous floaters, visual acuity reduced, accommodation disorder, presbyopia)
Poremećaj vida (oštećenje vida, zamagljeni vid, fotopsija, opaciteti u staklovini, smanjena vidna oštrina, poremećaj akomodacije, prezbiopija)
Avoid concomitant use of strong CYP3A inhibitors during treatment with Zykadia (see section 4.5).
Potrebno je izbjegavati istodobnu primjenu snažnih CYP3A inhibitora tijekom liječenja Zykadiom (vidjeti dio 4.5).
Patients should be monitored for lipase and amylase elevations prior to the start of Zykadia treatment and periodically thereafter as clinically indicated (see sections 4.2 and 4.8).
Bolesnike treba pratiti radi povišenja lipaze i/ili amilaze prije početka liječenja Zykadiom te periodički nakon toga prema kliničkim indikacijama (vidjeti dijelove 4.2 i 4.8).
Following single oral doses of ceritinib under fasted conditions, the geometric mean apparent plasma terminal half-life (T½) of ceritinib ranged from 31 to 41 hours in patients over the 400 to 750 mg dose range.
Nakon jednokratnih peroralnih doza ceritiniba natašte, geometrijska srednja vrijednost prividnog terminalnog poluvijeka ceritiniba u plazmi (T½) bila je u rasponu od 31 do 41 sata u bolesnika koji su primali doze u rasponu od 400 do 750 mg.
Increases to grade 3 or 4 ALT elevations were observed in 25% of patients receiving ceritinib.
Povišenja ALT-a stupnja 3 ili 4 su uočena u 25% bolesnika koji primaju ceritinib.
Pneumonitis (interstitial lung disease, pneumonitis)
Pneumonitis (intersticijska bolest pluća, pneumonitis)
The use of concomitant medicinal products associated with bradycardia should be carefully evaluated.
Potrebno je pažljivo ocijeniti istodobnu primjenu drugih lijekova povezanih s bradikardijom.
Patients who develop symptomatic bradycardia should be managed as recommended in sections 4.2 and 4.4.
Bolesnike u kojih se razvije simptomatska bradikardija potrebno je zbrinjavati prema preporukama iz dijelova 4.2 i 4.4.
You must use a highly effective method of birth control during treatment with Zykadia and for 3 months after stopping treatment.
Morate koristiti vrlo učinkovitu metodu kontrole začeća tijekom liječenja Zykadiom te tri mjeseca nakon prestanka liječenja.
Caution should be exercised with concomitant use of BCRP substrates (e.g. rosuvastatin, topotecan, sulfasalazine) and P-gp substrates (digoxin, dabigatran, colchicine, pravastatin) and ADRs carefully monitored.
Potreban je oprez pri istodobnoj primjeni s BCRP supstratima (npr. rosuvastatin, topotekan, sulfasalazin) i P-gp supstratima (digoksin, dabigatran, kolhicin, pravastatin) te se nuspojave na lijek moraju oprezno pratiti.