motixafortide

General

Pronunciation:
moe-tix-a-for-tide

Trade Name(s)

• Aphexda

Ther. Class.

none assigned

Pharm. Class.

hematopoietic stem cell mobilizers

Indications

Mobilizes hematopoietic stem cells to peripheral blood for collection and use in autologous transplantation in patients with multiple myeloma (in combination with filgrastim).

Action

Inhibits the CXCR-4 chemokine receptor, which decreases adherence of stem cells to bone marrow, freeing them up to mobilize to peripheral blood.

Therapeutic Effect(s):

Mobilization of stem cells to peripheral blood allowing collection.

Pharmacokinetics

Absorption: Well absorbed following SUBQ administration.

Distribution: Largely confined to extravascular fluid space.

Protein Binding: >99%.

Metabolism and Excretion: Undergoes catabolism into small peptides and individual amino acids. Primarily excreted in the urine.

Half-life: 2 hr.

TIME/ACTION PROFILE (mobilization of stem cells)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity;
• Leukemia;
• OB:   Pregnancy;
• Lactation:  Lactation.

Use Cautiously in:

• Rep:  Women of reproductive potential
• Pedi:   Safety and effectiveness not established in children.

Adverse Reactions/Side Effects

CV: hypertension

Derm: erythema, flushing, pruritus, rash, urticaria

F and E: hypokalemia

GI: nausea

Hemat: leukocytosis, tumor cell mobilization

Local: injection site reactions

MS: back pain

Neuro: paresthesia, dizziness, tremor

Misc: chills, fever, HYPERSENSITIVITY REACTIONS (including anaphylaxis)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None reported.

Route/Dosage

SUBQ (Adults): Following pretreatment with filgrastim for 4 days: 1.25 mg/kg (using actual body weight) once daily given 10–14 hr prior to the initiation of the first apheresis. A second dose of 1.25 mg/kg (using actual body weight) can be administered 10–14 hr before a third apheresis, if needed.

Availability

Lyophilized powder for injection: 62 mg/vial

Assessment

• Monitor for hypersensitivity reaction for 1 hr after injection. Keep epinephrine and resuscitation equipment nearby.
• Assess injection site for reaction (pain, erythema, pruritus, bruising, mass, urticaria).  If reaction occurs,  use analgesics and local treatments as clinically indicated.

Lab Test Considerations:

• Verify a negative pregnancy test before starting therapy.
• Monitor CBC during therapy.
• May cause hypokalemia.

Implementation

• Premedicate before each dose of motixafortide to ↓ risk of hypersensitivity and injection site reaction. Administer an H₁  antagonist (i.e., antihistamine), an H₂  antagonist, and a leukotriene inhibitor 30–60 min prior to injection.
• Calculate dose, total volume of solution required, and number of vials required based on actual body weight.  Reconstitution: Bring vial(s) to room temperature for ≥30 min. Inject 2 mL of 0.45% NaCl (alternately 1 mL of sterile water for injection and 1 mL of 0.9% NaCl) into each vial.  Concentration: 36.5 mg/mL. Gently swirl and invert ≤3 min to dissolve. Do not use if discolored, cloudy, or contains particulates. May store refrigerated or at room temperature protected from light ≤24 hr.
• SUBQ Divide doses between injection sites if volume >2 mL. Inject SUBQ slowly into abdomen, back or side of arm, or thigh. Rotate sites. Avoid 5 cm diameter around ubilicus. Discard any unused portion.

Patient/Family Teaching

• Explain purpose and side effects of medication to patient. Advise patient to read  Patient Information  before starting therapy.
• Advise patient to notify health care professional immediately if injection site reaction, fever, chills, nausea, flushing, rash, dizziness, or difficulty breathing occur.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
• Rep:  May cause fetal harm. Advise women of reproductive potential to use effective contraception during therapy with motixafortide and for 8 days after the final dose. Advise patients not to breastfeed during therapy and for 8 days after final dose.

Evaluation/Desired Outcomes

Mobilization of stem cells to peripheral blood allowing collection.