Pharmaceutical class:

Anticancer

Drug form:

100 and 150 mg coated tablets

Drug combinations:

Erlotinib as hydrochloride

Mechanism of action:

Inhibitor of the tyrosine kinase enzyme inside the cell, thereby preventing the growth and facilitating the death of the cancer cell

Uses of Lotiva:

Non-small cell lung cancer, pancreatic cancer

Use in pregnancy and breastfeeding ilotiva:

Classification of use in pregnancy: D
Pregnancy: Adequate and controlled studies have not been conducted in pregnant women. Side effects have been observed in animal reproduction studies. Therefore, during treatment with erlotinib, it is recommended to prevent pregnancy in women of reproductive age. During the treatment and at least 2 weeks after the end of the treatment with this drug, you should use safe methods of pregnancy prevention.
Erlotinib does not impair fertility in male and female rats
Breastfeeding: So far, no information is available regarding the secretion of this drug in breast milk. Since many drugs are secreted in human milk and due to the possibility of side effects in infants, its use during breastfeeding is not recommended.

Regarding the correct way to take the medicine, pay attention to these points

1- This medicine should be taken at least 1 hour before or 2 hours after food.
2- In patients who are unable to swallow tablets completely, tablets can be dissolved in 100 ml of water and administered to the patient orally or through a feeding tube (made of silicone); In order to ensure complete absorption of the medicine, wash the container containing the medicine with 40 ml of water, prescribe it to the patient and repeat the rinsing operation.
3- According to the doctor’s prescription, it is important to take this medicine daily.
4- If you take too much of this medicine, contact your doctor or pharmacist immediately. In such a situation, the side effects of the drug may increase and the doctor may have to stop the treatment.
5- Grapefruit and grapefruit juice may interfere with erlotinib and cause unwanted side effects. Therefore, avoid simultaneous use of erlotinib with products containing grapefruit.
6- Do not take this medicine at the same time with a herbal supplement containing tea grass.
7- If you forget to take a dose of medicine, take it immediately as soon as you remember. But if it is almost time to take the next dose, take only that dose and avoid doubling the amount of medicine.

Lotiva drug interactions:

Antacids – may decrease the serum concentration of erlotinib. In order to reduce the significant risk of drug interactions, a few hours should be taken between erlotinib and antacids. Adjust the treatment dose. Operapitant, ciprofloxacin (systemic), dasatinib, fluvoxamine, fosaparpitant, ivaceftor, loriconazole, simprevir may increase the serum concentration of erlotinib. Treatment monitoring is essential.
Bosentan, deferasirox, ciltuximab, tocilizumab may decrease the serum concentration of erlotinib. Treatment monitoring is essential.
Cardiac glycosides Erlotinib may decrease the absorption of cardiac glycosides. This may only affect digoxin tablets and not digitoxin. Treatment monitoring is essential.
Canivapetan, fusidic acid (systemic) may increase the serum concentration of erlotinib. Avoid taking them at the same time. .
(Strong) inducers of CYP3A4 such as carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, rifapentine, stearyl pentol may increase the metabolism of erlotinib. Adjust the treatment.
CYP3A4 (very strong) inhibitors (eg ketoconazole), CYP3A4 (strong) inhibitors (eg atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelninavir, ritonavir, saquinavir, telithromycin, troleandomycin, voriconazole) – may decrease the metabolism of erlotinib give Adjust the treatment.
(Moderate) CYP3A4 inhibitors may decrease the metabolism of erlotinib. Treatment monitoring is essential. Dabrafenib may decrease the serum concentration of erlotinib, the treatment should be adjusted.
H2 receptor antagonists may decrease the serum concentration of erlotinib. If possible, avoid co-administration with erlotinib. If it is necessary to take drugs together, erlotinib should be taken once a day and 10 hours after taking H2 receptor antagonists and at least 2 hours before taking them. Adjust the treatment. . Mifepristone may increase the serum concentration of erlotinib. Erlotinib doses should be reduced and increased Smith concentrations should be monitored during treatment and 2 weeks after treatment with mifepristone. Adjust the treatment.
Mitotane may decrease the serum concentration of erlotinib. Erlotinib doses may be adjusted in patients treated with mitotane. Adjust the treatment.
Proton pump inhibitors may decrease the serum concentration of erlotinib. Avoid taking them at the same time.
Vitamin K antagonists (such as warfarin) Erlotinib may increase or decrease the anticoagulant effect of vitamin K antagonists. Treatment monitoring is essential.
Non-steroidal anti-inflammatory drugs used together with erlotinib may increase the risk of gastrointestinal bleeding.
Tobacco Avoid smoking while taking erlotinib. Patients should inform their doctor of any changes in their smoking status. If avoidance, the dose of erlotinib is increased by 50 mg every 2 weeks up to a maximum of 300 mg per day.

Precautions for Lotiva:

Pulmonary toxicity The occurrence of interstitial lung disease (ILD), which is rare and sometimes fatal, has been reported. Symptoms include acute respiratory distress syndrome, interstitial pneumonia, constrictive bronchiolitis, pneumonitis (including radiation and sensitivity), pulmonary fibrosis and pulmonary infiltrates. The onset of symptoms was within 5 days to more than 9 months from the start of treatment (median: 39 days), treatment should be stopped for new unknown symptoms or worsening respiratory symptoms (shortness of breath, cough and fever); Permanent discontinuation of treatment for confirmed ILD.
Renal failure Acute renal failure (in some cases fatal), renal insufficiency and hepatorenal syndrome, caused by primary liver failure or due to severe dehydration, have been reported. This medicine should be used with caution in patients with or at risk of kidney failure. In case of severe renal failure, the treatment should be stopped until the complete elimination of toxicity.
Hepatotoxicity Liver failure and hepatorenal syndrome (in some cases fatal), especially in patients with primary liver failure, have been reported. Liver function (transaminases, bilirubin and alkaline phosphatase) should be monitored, and in case of changes, reduction of dosage, interruption or complete discontinuation of treatment may be recommended.
Gastrointestinal Perforation Perforation of the digestive tract (including cases of death) has been reported with the use of this drug; The risk of perforation increases with the simultaneous use of this drug with antiangiogenic drugs, corticosteroids, non-steroidal anti-inflammatory drugs, or treatment with taxanes, as well as in patients with a history of gastrointestinal ulcers or diverticulitis. In case of perforation and severe or continuous diarrhea, nausea, loss of appetite or vomiting, the use of the drug should be stopped permanently.
Dermatotoxicity flaking, scaling, or exfoliative skin diseases, some of which are a sign of Stevens-Johnson syndrome or toxic epidermal necrosis, have been reported in some cases fatal. In case of severe skin reactions, reduce the dose or temporarily stop the treatment; Treatment should be discontinued if flaking, scaling, or exfoliative skin toxicity occurs.
Hematological effects with the combined use of erlotinib and gemcitabine, microangiopathic hemolytic anemia with thrombocytopenia (rare) have been reported.
Cardiovascular complications of cerebrovascular accidents, myocardial infarction and myocardial ischemia have been reported.
Ocular toxicity with the use of this drug, corneal perforation and ulceration have been reported. In patients with eye pain or other acute or worsening eye symptoms (such as redness, tearing, blurred vision, or sensitivity to light), treatment should be interrupted or discontinued.
Bleeding Increased international normalized ratio (INR) and bleeding events (including fatal bleeding) have been reported with coadministration of erlotinib and warfarin. Accurate monitoring of prothrombin time and INR should be done.
Genomics of non-small cell lung cancer patients with non-small cell lung cancer associated with EGFR mutations, especially exon 19 deletion and exon 21 mutation, show a better response to erlotinib. While erlotinib treatment is not recommended in patients with non-small cell lung cancer associated with KRAS mutations.
Medicines affecting stomach pH should be avoided at the same time as proton pump inhibitors. In case of concomitant use with an H2 receptor antagonist drug (such as ranitidine), Erlotinib should be taken 10 hours after taking the H2 receptor antagonist drug and at least 2 hours before the next dose of the H2 receptor antagonist drug. In case of taking together with antacid, a few hours should be taken between their consumption.
High-risk drug, proper precautions for transportation and disposal of the drug should be considered.
The appropriate use of erlotinib and platinum-based chemotherapy in the treatment of locally advanced or metastatic non-small cell lung cancer is not recommended due to the lack of therapeutic benefit.
Lactose intolerance This medicine contains lactose. In patients with Lapp type lactase deficiency, glucose-galactose malabsorption or glucose intolerance, this drug should be avoided.

Lotiva contraindications:

Hypersensitivity to erlotinib or any of
Ingredients of this medicine

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