Carfilzomib (Intravenous)

Overview

Carfilzomib is a chemotherapy drug that can either be used alone or alongside other medications for the treatment of multiple myeloma.

Multiple myeloma is a type of bone marrow cancer that affects the production of healthy blood cells within the patient. This is because the bone marrow is deteriorated and unable to produce healthy blood cells at the usual rate. Commonly this cancer will be affecting multiple locations in the body at the same time. The reduction in healthy blood cells will lower the immune system of the patient, making them more vulnerable to the spread of the condition and to other infections.

Carfilzomib is often used alongside other medications such as dexamethasone and lenalidomide and is used when patients have not responded well to other treatments. This treatment is not a first response to the occurrence of multiple myeloma and can cause very serious side effects and trigger significant medical conditions.

This medication is only to be given under the supervision of a doctor and is injected through intravenous infusion into the veins of the patient.

This medication should not be administered to pregnant women and both men and women should avoid impregnation during use and for a period after the treatment has ceased. Patients should discuss effective contraception with the doctor before beginning treatment.

Condition treated

• Multiple myeloma

Type of medicine

• Chemotherapy

Side Effects

Along with the desired effects of this medication, this serious chemotherapy treatment can cause serious side effects. Chemotherapy treatments work by attacking cells and they are unable to distinguish between healthy and cancerous cells. As such the treatment will have unwanted side effects caused by the attacking of healthy cells. Some of the following side effects may require you to seek medical attention.

If you experience any of the following side effects then you should contact your doctor immediately:

Occurring more commonly:

• Agitation or restlessness
• Black stools with a tar-like appearance
• Bleeding of the gums
• Bloating or swelling of or around the face, arms and hands or lower legs and feet
• Blood found in the urine or stools
• Blurring of vision
• Burning or tingling feelings occurring on the skin
• Changed heartbeat
• Chest pains
• Coma or loss of consciousness
• Confusion or disorientation
• Coughing or hoarseness
• Decreased volume of urine output
• Depression or extreme sadness
• Difficulty breathing or labored breath
• Difficulty experienced when moving
• Dizziness
• Drowsiness or sleepiness
• Feeling of tightness in the chest
• Headaches
• Hostility or quickness to anger
• Irregular heartbeat
• Irritability or annoyance
• Lethargy
• Lower back and/or side pain
• Muscle spasming or twitching
• Nausea
• Numbness or tingling of the hands, feet, face or lips
• Pain or difficulty experienced during urination
• Paleness of the skin
• Pounding sensation in the ears
• Rapid weight gain
• Red spots appearing on the skin
• Seizures or fits
• Stupor
• Tingling of the hands or feet
• Trembling or shaking
• Troubled breathing when exerting oneself
• Ulcers or sores
• Unsteadiness or awkwardness
• Unusual bleeding
• Unusual bruising
• Unusual tiredness
• Unusual weakness
• Unusual weight gain
• Unusual weight loss
• Vomiting
• White spots in the mouth

Occurring less commonly:

• Chills
• Feverishness
• Muscle cramping
• Muscle pain
• Painful blisters on the body
• Weakness experienced in the arms, hands, legs, or feet

Occurring only rarely:

• Darkening of the color of urine
• Feeling of illness
• General feeling of discomfort
• General feeling of tiredness
• General feeling of tiredness weakness
• Lightened coloration of the stools
• Stomach pains that are ongoing
• Thickening of bronchial secretions
• Yellow eyes
• Yellow skin

Frequency of incidence not known:

• Blindness or loss of quality of vision
• Dizziness or faintness experienced when getting up rapidly from a lying or sitting position
• Fainting or faintness
• Joint pains, stiffness and/or swelling
• Seizures or convulsions
• Stomach pains
• Sweating when cool

Side effects may occur that do not require you to seek medical attention. In some cases these side effects may abate over time. If they do become bothersome or if they are ongoing then you can contact your healthcare professional to see if they may be able to help you to alleviate these side effects.

Occurring more commonly:

• Back pains
• Body aches or pain
• Bone pains
• Constipation or difficulty in the passing of stools
• Diarrhea
• Dry mouth or feeling of dehydration
• Ear congestion
• Flushed and dry skin
• Fruit-like odor to the breath
• Increased appetite
• Increased thirst
• Increased volume of urination
• Loss of appetite
• Loss of or change in voice
• Metallic taste
• Muscle weakness
• Pain in the arms or legs
• Runny nose
• Side pains
• Sneezing
• Soreness of the throat
• Troubled sleep
• Weight loss

In some patients it is possible that other side effects not listed herein may occur. If you experience any other side effects that you are concerned about then you should contact your doctor.

Dosage

This medication will be given to you by a trained healthcare professional under the supervision of a doctor. Treatment will be given in a hospital or clinic. The treatment is administered through a needle that is placed into the vein.

This medication should be given on a fixed schedule and it is very important that you attend all appointments that you are scheduled.

You should drink an increased level of fluids before and after treatment so that you pass more urine. This will prevent a build up of the treatment in the kidney and will help to prevent kidney problems. This medication will be excreted through your urine.

Other medications may be administered at the same time to prevent side effects from occurring or being too severe.

Interactions

Certain medications should not be used alongside one another. In some cases medications can react violently with one another in the body and cause severe side effects. In other cases it is possible for medications to stop others from working and to increase the risk of side effects caused by one or both medications. The use of Carfilzomib will lower the immune system and expose you to infection. Patients should avoid the following treatments in particular.

Use with the following medications is not recommended. Your doctor may suggest and alternative treatment:

• Measles Virus Vaccine, Live
• Mumps Virus Vaccine, Live
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Varicella Virus Vaccine

Use with the following medications is not usually recommended. In some cases where it is required they can be used in conjunction, but doses may need to be altered:

• Adenovirus Vaccine
• Bacillus of Calmette and Guerin Vaccine, Live
• Cholera Vaccine, Live
• Influenza Virus Vaccine, Live
• Poliovirus Vaccine, Live
• Smallpox Vaccine
• Typhoid Vaccine
• Yellow Fever Vaccine

Medications can also have an impact on other medical conditions that the patient may have. You should inform your doctor of any conditions from which you suffer. This is particularly important with the following conditions which may all be worsened by use of this treatment:

• Angina
• Blood clots
• Cardiomyopathy
• Congestive heart failure
• Deep vein thrombosis
• Recent heart attack
• Heart disease
• Hypertension
• Interstitial lung disease
• Kidney disease
• Liver disease
• Lung problems
• Breathing problems
• Pneumonitis
• Pulmonary edema
• Pulmonary embolism
• Pulmonary hypertension
• Thrombocytopenia

Other medical conditions not listed herein can also interact with the use of Carfilzomib. Ensure that you inform your doctor of all conditions that you suffer from or have suffered from in the past.

Warnings

When deciding to use this medication it is important to weight the risks of use against the benefits of use. This decision should be made by you and your doctor. Before using this treatment you should consider the following:

Allergies – You should inform your doctor if you have ever suffered any allergic reactions to either this medication or to any other medication. You should also share any information you have of allergies to dyes, preservatives, animals or foods.

Pediatric – Safety and effectiveness of the use of this medication in children has not be established. Discuss use with your doctor.

Geriatric – No limitations have been determined for the use of Carfilzomib on the elderly. Pay extra attention to the presence of medical conditions that may inhibit use.

Pregnancy – This treatment is known to be harmful to the fetus. You should avoid getting pregnant during treatment and you should not use the treatment when pregnant. Talk to your doctor about effective use of birth control. Male patients should also avoid impregnating a woman while he is receiving treatment. Women should wait at least 30 days after the most recent dose before getting pregnant. Men should wait at least 90 days are the most recent dose before ceasing use of protection. If you think a pregnancy may have occurred during the period of treatment then you should consult your doctor immediately.

Breastfeeding – The risks of breastfeeding during use of this medication are unknown. You should discuss the benefits in relation to the potential risks with your doctor before beginning treatment.

Patients will need to have regular check ups with the doctor during the period of treatment. Blood and urine tests may be required to ensure that the treatment is working as desired and to check for the occurrence of unwanted side effects.

This medication can trigger serious heart conditions in patients. Patients should be alert to symptoms of heart problems and should inform their doctor immediately if they start to experience them.

Kidney problems can also occur from the use of this medication. To mitigate the changes of this you should drink plenty of fluids in the lead up to treatment and following treatment. Patients should be alert to the signs of kidney problems before beginning treatment.

This medication can cause the patient to suffer from a serious allergic reaction known as an infusion reaction. This life-threatening condition will require immediate medical attention. You should inform your doctor immediately if you begin to experience the following during receipt of the treatment:

• Coughing
• Difficulty swallowing
• Dizziness
• Increased heartrate
• Fever
• Troubled breathing
• Itching or appearance of hives
• Feeling of faintness

This medication can also cause serious liver problems. Patients should be aware of the signs of liver problems in advance of treatment and you should contact your doctor immediately if you recognize the symptoms.

A nervous system problem called posterior reversible encephalopathy syndrome (PRES) can occur when using this treatment. If you experience the following the you should seek emergency medical care and inform the doctor that you are receiving this treatment:

• Seizures or convulsions
• Headache
• Confusion
• Problems with vision or changed vision
• Unexplained drowsiness
• Unusual weakness

Do not take any other kinds of medication while you are receiving this treatment without first discussing use with your doctor.

Storage

Store between 2°C to 8°C.

Store in original packaging and protect from light.

Dispose of all unwanted and used materials appropriately. Do not keep outdated medications.

Summary

Carfilzomib is an injected medication that is delivered under the supervision of a doctor by intravenous infusion.

This medication can be used alone or alongside other treatments in the treatment of multiple myeloma.

Multiple myeloma is a developed bone marrow cancer that affects multiple locations in the body at once. It attacks the bone marrow and as such prevents the production of healthy blood cells. In turn this lowers the immune system of the patient and has wider impacts on the body.

Carfilzomib is a chemotherapy treatment that attacks the cancerous cells. In doing so this treatment will also attack healthy cells and will cause unwanted side effects.

Patients should consider the risks of use and weigh them against the benefits of using the treatment with the doctor before proceeding with treatment.

The treatment will be given on a strict schedule at a hospital or clinic and it is important that the patient attends all of these appointment to get treatment.

This medication should not be used in pregnant women and both men and women should avoid impregnation during treatment and for a period following treatment. Effective contraception should be discussed with the doctor before treatment begins.

To reduce the risk of damage to the kidney during treatment the patient should consume an increased amount of fluid before, during and after administration of the treatment. The patient will excrete the medication through the urine stream and the increased intake of fluids will ensure that the medication is not sitting in the kidneys for longer than necessary.

This medication also increase the risks of liver problems and cardiovascular problems in the patient. You should discuss these increased risks with your doctor before beginning treatment.

Patients must avoid exposure to infection when receiving treatment. Consider wearing face protection around people with infections and avoid infection wherever it is possible to do so.