1 What is Istodax?

Brand: Istodax

Generic: Romidepsin

Istodax is an anticancer drug approved to treat cutaneous and peripheral T-cell lymphoma cases that have received at least one systemic treatment.

T-cell lymphoma is a type of blood cancer (leukemia) that originates from white blood cells called lymphocytes. These lymphocytes are an important part of the immune system that actively hunts and kills foreign and disease-causing bacteria.

Cancer occurs when these lymphocytes grow uncontrollably and form tumors and lesions. Peripheral T-cell lymphomas are characterized by the presence of tumors in the lymph nodes, spleen, bone marrow and other organs, while cutaneous T-cell lymphomas form dark-colored lesions just under the skin. Both of these lymphomas are fast-growing cancers and a significant number of cases resists first-line anticancer drugs.

In such cases, doctors prescribe drugs such as Romidepsin.

Romidepsin works by causing changes in the cell to cause cell death. Doctors give Romidepsin when other medicines have been tried and failed to treat symptoms.

Romidepsin is an injectable drug and requires a prescription.

Like many drugs for cancer, Romidepsin is a hazardous substance and treatment is associated with severe adverse effects so it must be used only with doctor’s supervision.

2 What to know before using

Before using Istodax, you must know all about the risks and complications associated with it.

You cannot use Romidepsin if you are allergic to it. If you experienced allergies or sensitivities to Romidepsin before, tell it to your doctor before receiving the medication.
Mention all your health conditions before receiving Romidepsin.

You cannot use Romidepsin if you have the following health problems:

  • Any form of heart disease
  • Abnormalities in heart rate rhythm
  • Liver disease
  • Kidney disease
  • Any abnormalities in levels of potassium, magnesium, and other electrolytes
  • Have severe nausea, vomiting or diarrhea

Tell the doctor if you are pregnant or breastfeeding before receiving Romidepsin.

Romidepsin is highly contraindicated in pregnant women because it can harm the unborn baby.

Do not breastfeed when receiving Romidepsin.

You must mention all the medicines you take before starting treatment with Romidepsin. Romidepsin is known to interact with many medications.

The doctor will need to know if you recently took or are taking the following medications:

  • All kinds of vaccines
  • Drugs for treating HIV infection
  • Most antidepressants
  • Most antibiotics
  • Drugs for correcting heart rhythm issues
  • Bosentan
  • Clozapine
  • Drugs that activate or inhibit Cytochrome P450 3A4 such as anticonvulsants, moods stabilizers, barbiturates, glucocorticoids, certain antivirals, antibiotics and antifungals
  • Dabrafenib
  • Deferasirox
  • Deferiprone
  • Denosumab
  • Dexamethasone
  • Dipyrone
  • Herbs such as Echinacea and St. John’s wort
  • Fingolimod
  • Drugs that cause QT prolongation, like Chlorpromazine, Olanzapine, Disopyramide and Flecainide Encainide
  • Leflunomide
  • Mifepristone
  • Natalizumab
  • Nivolumab
  • Osimertinib
  • P-glycoprotein/ABCB1 inducers and inhibitors
  • Pimecrolimus
  • Ranolazine
  • Rifampin
  • Roflumilast
  • Siltuximab
  • Sipuleucel-T
  • Tacrolimus
  • Tocilizumab
  • Tofacitinib
  • Trastuzumab
  • Warfarin and other blood thinners

3 Proper usage

To use Istodax properly, you must follow all instructions given by your doctor.

The doctor will determine your dose of Romidepsin. The medication is injected into your vein (intra venous route), so you can only have it in the hospital or doctor’s office. Note that Romidepsin must be given very slowly and the infusion can last at least 4 hours. Romidepsin is infused once every 7 days for 3 weeks, and the cycle is repeated until the cancer is treated or until side effects become too severe.

The doctor will give you other medications to reduce the likelihood of nausea or vomiting that might occur.

If adverse effects occur, the doctor may delay infusion of Romidepsin until it is treated. Then, Romidepsin is restarted at a reduced dose. If adverse effects become too intolerable to the patient or if it happens repeatedly, the doctor may have to stop treatment with Romidepsin.

You will be closely monitored by the doctor during and several hours after infusion of Romidepsin. When receiving treatment with Romidepsin, you need to undergo regular lab tests to check the function of your heart and liver. Romidepsin also reduces your body’s ability to fight infection.

If you miss an appointment for infusion of Romidepsin, call the doctor right away.

Because Romidepsin is given by professionals and infused in a clinical setting, overdosing is very unlikely.

4 Precautions to take

Before using Istodax, there are some precautions you must take.

It is very important for you to be monitored during and shortly after infusion of Romidepsin. If you will go home after Romidepsin infusion, maintain open communication with your doctor and call right away if you experience any symptoms.

Romidepsin can be present in body fluids, feces and urine for up to 48 hours after infusion of the medication.

Romidepsin can cause dangerously low white blood cells and other serious problems if it comes into contact with other people. Caregivers must wear rubber gloves when cleaning up patient’s body fluids. Make sure to flush the toilet twice and generously rinse surfaces soiled with body fluids. Soiled linens and clothing must be washed separately from household laundry.

If you have a history of hepatitis B infection, taking Romidepsin can cause reactivation of hepatitis B virus.

Do not take any medication, including prescription medicaitons, over-the-counter medications and herbal supplements without your doctor’s permission.

If you became pregnant or breastfeed while receiving Romidepsin, call your doctor right away.

5 Potential side effects

As with many medications, there are several potential side effects associated with Istodax.

Romidepsin can cause severe side effects that require immediate medical attention.

Call your doctor right away if you experience the following symptoms:

  • Severe allergic reaction symptoms such as hives, difficulty breathing, swelling of the lips, mouth, tongue or throat
  • Symptoms of infection such as fever, chills and flu symptoms
  • Symptoms of possible pulmonary thrombosis such as stabbing chest pain, wheezing, and cough with yellow or green mucus
  • Symptoms of liver problem such as upper stomach pain, loss of appetite, passing out dark urine and jaundice
  • Symptoms of very low platelets such as easy bruising, bleeding in the nose, mouth, vagina or rectum, purple and pinpoint spots under the skin
  • Symptoms of very low red blood cell counts such as pale skin, lightheadedness, shortness of breath and trouble concentrating
  • Symptoms of tumor lysis syndrome (breakdown of too many tumor cells) such as lower back pain, blood in urine, passing too little or no urine, numbness, tingling sensation around the mouth, muscle weakness or tightness, too fast or too slow heart rate, weak pulse, and confusion
  • Swollen gums
  • Painful mouth sores
  • Muscle pain
  • Extreme fatigue
  • Pain or burning sensation during urination
  • Chest pain and shortness of breath

Romidepsin may cause the following side effects that are minor and not harmful to health:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Loss of hair
  • Mild fatigue or tiredness

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