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Dosing and administration of Zokinvy®

Getting patients with progeria or processing-deficient progeroid laminopathies (PDPL) onto an appropriate dosage of Zokinvy matters.

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Zokinvy is available in 50-mg and 75-mg capsules, which allows for flexible administration between starting and final dose. Recommended dosing is capsules twice daily with food.1

Recommended dosage of Zokinvy is based on body surface area (BSA)
Starting dosage of Zokinvy

For patients with a BSA ≥ 0.39 m2, the starting dosage is 115 mg/m2 twice daily with morning and evening meals. An appropriate dosage strength of Zokinvy is not available for patients with a BSA below 0.39 m2.1

After 4 months of treatment

Increase the dosage to 150 mg/m2 twice daily. Round all total daily doses to the nearest 25-mg increment.1

If a dose is missed
  • Instruct the patient to take the dose as soon as possible, with food, up to 8 hours prior to the next scheduled dose.1
  • If fewer than 8 hours remain before the next scheduled dose, skip the missed dose and resume taking Zokinvy at the next scheduled dose.1
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Download more details on dosing

Information regarding recommended dosages of 115 mg/m2 and 150 mg/m2 is included.

Managing progeria and PDPL can be complicated. With Zokinvy, you have options.

Administration options:

Depending on the patient’s ability to swallow, Zokinvy can be taken alone or mixed with Ora-Blend SF®, Ora-Plus®, orange juice, or applesauce. Do not mix with any juice containing grapefruit or Seville oranges. Ensure that the mixture is taken within approximately 10 minutes of mixing.1

Adverse reactions:

For unmanageable adverse reactions, dosing of Zokinvy can be reduced to the starting dosage (115 mg/m² twice daily).1

Use with loperamide:

Loperamide is contraindicated in patients less than 2 years of age. When Zokinvy is coadministered with loperamide, do not exceed loperamide 1 mg once daily when first coadministered. Slowly increase loperamide dosage with caution in accordance with its approved product labeling.1

Use with midazolam:

Discontinue Zokinvy for 10 to 14 days before and 2 days after administration of midazolam.1

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Starting and staying on Zokinvy matters. Enroll your patient today.

Eiger OneCare™ helps patients and their caregivers with access to a dedicated, specialized team. Each member of this team is focused on the care and needs of patients with progeria or PDPL. Download an enrollment form to start the process.

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IMPORTANT SAFETY INFORMATION

Contraindications

ZOKINVY is contraindicated in patients taking:

  • Strong or moderate CYP3A inhibitors or inducers
  • Midazolam
  • Lovastatin, simvastatin, and atorvastatin

Warnings and Precautions

Laboratory Abnormalities

Some patients treated with ZOKINVY developed laboratory abnormalities. These included:

  • Electrolyte abnormalities (43%), such as hyperkalemia, hypokalemia, hyponatremia, or hypercalcemia
  • Myelosuppression (35%), such as reductions in absolute neutrophil count, white blood cell counts, lymphopenia, hemoglobin, or hematocrit
  • Increased liver enzymes, such as aspartate aminotransferase (35%), or alanine aminotransferase (27%)

These laboratory abnormalities often improved while continuing ZOKINVY, but it is not possible to exclude ZOKINVY as a cause of the abnormalities. Periodically monitor electrolytes, complete blood counts, and liver enzymes, and manage abnormalities accordingly.

Nephrotoxicity
  • Lonafarnib caused nephrotoxicity in rats at plasma drug exposures approximately equal to that achieved with the human dose. Monitor renal function at regular intervals during ZOKINVY therapy.
Retinal Toxicity
  • Lonafarnib caused rod-dependent, low-light vision decline in monkeys at plasma drug exposures similar to that achieved with the human dose. Perform ophthalmological evaluation at regular intervals and at the onset of any new visual changes during ZOKINVY therapy.
Impaired Fertility
  • Based on findings in rats Zokinvy may reduce fertility. Advise males and females of reproducitve potential of the animal findings and that the impact on pubertal development and the potential for impaired fertility with Zonkivy have not been adequately evaluated.
Adverse Reactions
  • The most common adverse reactions were vomiting (90%), diarrhea (81%), infection (78%), nausea (56%), decreased appetite (53%), fatigue (51%), upper respiratory tract infection (51%), abdominal pain (48%), musculoskeletal pain (48%), electrolyte abnormalities (43%), headache (37%), decreased weight (37%), increased aspartate aminotransferase (35%), myelosuppression (35%), cough (33%), decreased blood bicarbonate (33%), hypertension (29%), and increased alanine aminotransferase (27%).
Gastrointestinal Adverse Reactions
  • Gastrointestinal adverse reactions were the most frequently reported adverse reactions. Of the 57 patients (90%) that experienced vomiting, 30 (53%) patients had mild vomiting, 26 (46%) patients had moderate vomiting, and 1 (2%) patient had severe vomiting.
  • Of the 35 patients (56%) that experienced nausea, 34 (97%) patients had mild nausea and 1 (3%) patient had moderate nausea.
  • Of the 51 patients (81%) that experienced diarrhea, the majority of patients (92%) experienced mild or moderate diarrhea; 38 (75%) patients reported mild diarrhea and 9 (18%) patients reported moderate diarrhea. Four (8%) patients reported severe diarrhea.
  • Loss of fluids and dehydration can be severe, leading to hospitalization. As a result, patients should receive therapy for diarrhea at the earliest signs in order to avoid possible severe complications.
Alanine Aminotransferase and Aspartate Aminotransferase Elevations
  • Increased alanine aminotransferase was commonly reported (17 [27%] patients). Of the 17 patients with increased alanine aminotransferase, 14 (82%) patients had mild increases, 1 (6%) patient had moderate increases, and 2 (12%) patients had severe increases.
  • Increased aspartate aminotransferase was also commonly reported (22 [35%] patients). Of the 22 patients with increased aspartate aminotransferase, 21 (95%) patients had mild increases and 1 (5%) patient had a severe increase.
Hypertension
  • Increases in blood pressure have been documented in patients treated with ZOKINVY. In clinical trials the incidence of hypertension was 8.1%.
Drug Interactions
  • Strong or moderate CYP3A inhibitors
    • ZOKINVY administration with strong or moderate CYP3A inhibitors, including herbal supplements can increase exposures of ZOKINVY resulting in risk of clinically significant adverse events.
      • Do not mix the contents of ZOKINVY with any food or juice containing grapefruit or Seville oranges.
  • Weak CYP3A inhibitors
    • Avoid coadmistration of Zokinvy with weak CYP3A inhibitors. If coadministration is unavoidable, reduce ZOKINVY dosage. Resume previous dosage 14 days after discontinuing the weak CYP3A inhibitor. Closely monitor patients for arrhythmias and events such as syncope and heart palpitations.
  • Strong or moderate CYP3A inducers
    • ZOKINVY administration with CYP3A inducers, including herbal supplements, can decrease exposure of ZOKINVY, which may impact efficacy.
  • CYP2C9 Inhibitors
    • Avoid coadministration of Zokinvy with CYP2C9 inhibitors. If coadminstration is unavoidable, closely monitor patients for arrhythmias and events such as syncope and heart palpitations because the effect of increased Zokinvy exposures on the QT interval is unknown.
  • Certain CYP3A substrates
    • When ZOKINVY is coadministered with certain CYP3A substrates where minimal concentration changes may lead to serious or life-threatening toxicities, monitor for adverse reactions and reduce the dosage of the CYP3A substrate in accordance with its approved product labeling.
  • Loperamide
    • Lonafarnib is a weak inhibitor of P-gp and strong inhibitor of CYP3A. Do not exceed loperamide 1 mg once daily when first coadministered with ZOKINVY. Slowly increase loperamide dosage with caution as needed to treat diarrhea in accordance with its approved product labeling.
  • CYP2C19 substrates
    • Lonafarnib is a moderate CYP2C19 inhibitor. Avoid coadministration of ZOKINVY with CYP2C19 substrates. If coadministration is unavoidable, monitor for adverse reactions and reduce the dosage of the CYP2C19 substrate in accordance with its approved product labeling.

Use in Specific Populations

Patients who are pregnant or lactating: Based on findings from animal studies, ZOKINVY can cause embryofetal harm. There are no human data on ZOKINVY use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Advise females of reproductive potential to use effective contraception during treatment with ZOKINVY. There are no data on the presence of ZOKINVY in human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ZOKINVY and any potential adverse effects of the breastfed infant from ZOKINVY or from the underlying maternal condition.

To report SUSPECTED ADVERSE REACTIONS, contact Eiger BioPharmaceuticals, Inc. at 833-267-0545 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Please see accompanying full Prescribing Information.

References:

  • 1. Zokinvy [package insert]. Palo Alto, CA: Eiger BioPharmaceuticals Inc; 2020.

INDICATION AND USAGE

ZOKINVY is indicated in adult and pediatric patients 12 months of age and older with a body surface area (BSA) of 0.39 m2 and above:

  • To reduce the risk of mortality in Hutchinson-Gilford Progeria Syndrome (HGPS)
  • For the treatment of processing-deficient Progeroid Laminopathies with either:
    • Heterozygous LMNA mutation with progerin-like protein accumulation
    • Homozygous or compound heterozygous ZMPSTE24 mutations

Limitations of Use

ZOKINVY is not indicated for use in patients with non-HGPS Progeroid Syndromes or with Progeroid Laminopathies known to be processing-proficient. Based upon its mechanism of action, ZOKINVY would not be expected to be effective in these populations.

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IMPORTANT SAFETY INFORMATION

Contraindications

ZOKINVY is contraindicated in patients taking:

  • Strong or moderate CYP3A inhibitors or inducers
  • Midazolam
  • Lovastatin, simvastatin, and atorvastatin

INDICATION AND USAGE

ZOKINVY is indicated in adult and pediatric patients 12 months of age and older with a body surface area (BSA) of 0.39 m2 and above:

  • To reduce the risk of mortality in Hutchinson-Gilford Progeria Syndrome (HGPS)
  • For the treatment of processing-deficient
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