Drug interactions -summary

Irinotecan -  frequency and severity of diarrhea increased when panitumumab s given
concomittamtly with irinotecan.  Avoid co-administration

Colorectal carcinoma

Common adverse reactions-
abdominal pain, diarrhea,( including diarrhea resulting in dehydration)  fatigue,
hypomagnesiumia, paronychia, nausea, skin and rash

Serious adverse reactions-
abdominal pain, constipation, infusion reactions, hypomagnesiumnia, pulmonary fibrosis,
nausea, severe dermatolgical toxicity, coplicated by infectious sequelae and septic death
and vomiting.
Adverse reactions requiring discontinuation were infusion reactions, paronychia,
pulmonary fibrosis and severe skin toxicity

Dermatologic -   all skin /integument toxicity   85%     hair  8%   growth of eye lashes  5%
                         nail  25% other nail disorders  8%   paronnychia   23%   skin   85%
                         acne   12%  acneform dermitis    53%    dry skin  8%    eryhthema  60%
                         pruritus    52%   rash  20%    skin exfoliation 23%    skin fissures   18%

GI -                 abdominal pain 22%     constipation  20%   diarrhea   20%  nausea   21%
                       vomiting  17%

Metabolic /nutritional -       hypomagnesiumia  35%        periheral edema   10%

Respiratory -   cough   12%

Special senses -   eye related toxicites   12%

Miscellaneous -   fatigue    23%    general deterioration 10%

Special Precautions/Warnings-

Infusion reactions- depending on the severity and/or persistence of the reaction, permanently discontinue pantitumumab

Pulmonary fibrosis - permanently discontinue panitumumab therapy in patients developing interstitial lung infiltration or pneumonitis

Electrolyte depletion-  periodically monitor patients electrolytes during and for 8 weeks after the completion of panitumumab therapy

Photosensitivity -It is recommended that patients wear sunscreen and hats and limit sun exposure while receiving the drug because sunlight can exacerbate  skin reactions tat may occur.

Pregnancy- If panitumumab is used during pregnancy or if the patient becomes pregnant  while receiving the drug, explain to her the potential risk to the loss of pregnancy or the potential hazards to the fetus,

Lactation- advice women to discontinue breast-feeding during treatment with the drug and for 2 months after the last dose of panitumumab

Children- Safety and efficacy has not been established in children.

Monitoring- monitor vital signs, heart rate, blood pressure, respiratory rate, temperature every 15 to 30  minutes during infusion and for 1 hourafterwards.

Monitor patients for inflammatory or infectious sequelae in patients with severe dermatological toxicites.
Monitor patients during  administration of infusion

Indication-

Colorectal carcinoma

Dosage -

6mg/kg adninistered 60 minutes as an intrevenous IV infusion through a peripheral
linevindwelling catheter every 14 days . Dose higher than 1000mg should be over 90 minutes

Reduce the infusion 50% in patients experiencing a mild to moderate ( grade 1 to 2 ) reaction for the duration of that infusion

Immediately and permanently discontinue in patients experiencing severe ( grade 3 or 4 ) infusion reactions

1. Inform patients of the possible adverse reactions of panitumumab including dermatological toxicity , infusion reactions, pulmonary fibrosis, and potential embryofetal lethality .

2. Instruct patients to report skin and ocular changes and dyspnea to their doctor.

3. Instruct patients that periodic monitoring of electrolye levels are required

4. In women of child bearing age, appropiate contraceptive methods must be used during
treatment with penitumumab and for 6 months following the last dose of panitumumab

5. Advice women to discontinue breast feeding during treatmentand for 2 months after the
last dose of the drug.

5. It is recommended that patients wear sunscreen and hats and limit sun exposure
while receiving the drug because sunlight can exacerbate  skin reactions tat may occur.

Pregnancy-
 If panitumumab is used during pregnancy or if the patient becomes pregnant  while
receiving the drug, explain to her the potential risk to the loss of pregnancy or the potential
hazards to the fetus,

Lactation-
Advice women to discontinue breast-feeding during treatment with the drug and for
2 months after the last dose of panitumumab

Children-
Safety and efficacy has not been established in children.