idelalisib

idelalisib

Zydelig

Indications

Action

Pharmacokinetics

Time/action profile (increase in progression-free survival†)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• fatigue (most frequent)
• headache (most frequent)
• insomnia (most frequent)
• weakness (most frequent)

Respiratory

• pneumonitis (life-threatening)
• cough (most frequent)
• dyspnea (most frequent)
• nasal congestion

Cardiovascular

• peripheral edema (most frequent)

Gastrointestinal

• colitis/diarrhea
• hepatotixicity (life-threatening)
• intestinal perforation (life-threatening)
• abdominal pain (most frequent)
• ↑ liver enzymes (most frequent)
• nausea (most frequent)
• vomiting (most frequent)
• stomatitis

Dermatologic

• toxic epidermal necrolysis
• rash (most frequent)

Fluid and Electrolyte

• hyponatremia (most frequent)

Endocrinologic

• hyperglycemia (most frequent)
• hypoglycemia

Hematologic

• neutropenia (life-threatening)
• anemia (most frequent)
• thrombocytopenia (most frequent)

Metabolic

• hypertriglyceridemia (most frequent)

Musculoskeletal

• athralgia

Miscellaneous

• allergic reactions including anaphylaxis (life-threatening)
• chills (most frequent)
• fever (most frequent)
• night sweats (most frequent)
• pain

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Monitor for diarrhea (stools increased by >6 more/day); may occur at any time. Responds poorly to antidiarrheal agents; may respond to corticosteroids. If moderate diarrhea (increase of 4–6 stools/day over baseline) occurs, maintain dose and monitor at least weekly until resolved. If severe diarrhea (increase of ≥7 stools/day over baseline) or diarrhea requiring hospitalization occurs, withhold dose and monitor at least weekly until resolved, then resume idelalisib at 100 mg twice daily. If life-threatening diarrhea occurs, discontinue idelalisib permanently.
• Monitor for signs and symptoms of pneumonitis (cough, dyspnea, hypoxia, interstitial infiltrates, decline >5% in oxygen saturation). Discontinue therapy with any symptoms of pneumonitis and treat with corticosteroids.
• Monitor for signs and symptoms of intestinal perforation (moderate to severe diarrhea, new or worsening abdominal pain, chills, fever, nausea, vomiting). Discontinue idelalisib permanently if intestinal perforation occurs.
• Assess for cutaneous reactions (exfoliative dermatitis, rash, erythema, macular or maculo-papular rash, pruritus). Discontinue idelalisib if skin reactions occur.
• Monitor for signs and symptoms of anaphylaxis (dyspnea, wheezing, facial swelling). Discontinue idelalisib if symptoms occur.
• Lab Test Considerations: Monitor AST, ALT, and serum bilirubin every 2 wks for 3 mo, then every 4 wks for next 3 mo, then every 1–3 mo thereafter. If AST/ALT ↑ 3 times upper limit of normal, monitor weekly until resolved. If AST/ALT >3–5 times upper limit of normal or bilirubin >1.5–3 times upper limit of normal, maintain dose and monitor weekly until ≤ 1 times upper limit of normal. If AST/ALT >5–20 times upper limit of normal or bilirubin >3–10 times upper limit of normal, withhold dose. Monitor at least weekly until AST/ALT and/or bilirubin <1 times upper limit of normal, then resume dose at 100 mg twice daily. If AST/ALT >20 times upper limit of normal and/or if bilirubin >10 times upper limit of normal, discontinue idelalisib permanently. Usually occurs within first 12 wks of therapy and reversible with dose interruption.
  • Monitor CBC and platelet counts at least every 2 wks for first 3 mo. If neutropenia occurs and ANC is 1.0–<1.5 Gi/L, maintain idelalisib dose. If ANC 0.5–1.0 Gi/L, maintain dose and monitor ANC at least weekly. If ANC <0.5 Gi/L, interrupt idelalisib; monitor ANC at least weekly until ANC ≥0.5 Gi/L, then may resume idelalisib at 100 mg twice daily.
  • If thrombocytopenia occurs and platelets 50 to <75 Gi/L, maintain idelalisib dose. If platelets 25 to <50 Gi/L, maintain dose and monitor platelet count at least weekly. If platelets <25 Gi/L, interrupt idelalisib; monitor platelet counts at least weekly until platelet count ≥25 Gi/L, then may resume idelalisib at 100 mg twice daily.
  • May cause ↓ hemoglobin.

Potential Nursing Diagnoses

Implementation

• Avoid concurrent use of medications causing hepatotoxicity or diarrhea.
• Oral: Administer twice daily without regard to food. Swallow tablets whole; do not crush, break, or chew.

Patient/Family Teaching

• Instruct patient to take idelalisib as directed. If a dose is missed by less than 6 hrs take as soon as remembered; if missed by more than 6 hrs wait and take next scheduled dose at usual time. Advise patient to read Medication Guide before starting therapy and with each Rx refill in case of changes.
• Advise patient to notify health care professional immediately if diarrhea (bowel movements increase by six or more/day), severe abdominal pain, severe skin reactions (painful sores or ulcers on skin, lips, or mouth; severe rash with blisters or peeling skin), signs and symptoms of anaphylaxis, fever or signs of infection occur, or if signs and symptoms of liver toxicity (yellowing of skin or whites of eyes, dark or brown urine, bruising, abdominal pain in upper right side, bleeding), pneumonitis (cough, dyspnea), occur.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
• Caution female patient of teratogenic effects of idelalisib. Advise patient to use effective contraception and avoid breastfeeding during and for at least 1 mo after last dose of idelalisib. Advise patient to notify health care professional promptly if pregnancy is suspected.

Evaluation/Desired Outcomes

• Decreased progression of lymphoma.