NIPENT Powder for solution for injection/infusion Ref.[9111] Active ingredients: Pentostatin

Pentostatin is indicated for adult patients.

Administration to Patient

It is recommended that patients receive hydration with 500 to 1,000 ml of 5% glucose only or 5% glucose in 0.18% or 0.9% saline or glucose 3.3% in 0.3% saline or 2.5% glucose in 0.45% saline or equivalent before pentostatin administration. An additional 500 ml of 5% glucose only or 5% glucose in 0.18% or 0.9% saline or 2.5% glucose in 0.45% saline or equivalent should be administered after pentostatin is given.

The recommended dosage of pentostatin for the treatment of hairy cell leukaemia is 4 mg/m² in a single administration every other week. Pentostatin may be given intravenously by bolus injection or diluted in a larger volume and given over 20 to 30 minutes. (See Special precautions for disposal and other handling under Section 6.6.)

Higher doses are not recommended.

No extravasation injuries were reported in clinical studies.

The optimal duration of treatment has not been determined. In the absence of major toxicity and with observed continuing improvement, the patient should be treated until a complete response has been achieved. Although not established as required, the administration of two additional doses has been recommended following the achievement of a complete response.

All patients receiving pentostatin at 6 months should be assessed for response to treatment. If the patient has not achieved a complete or partial response, treatment with pentostatin should be discontinued.

If the patient has achieved a partial response, pentostatin treatment should be continued in an effort to achieve a complete response. At any time after a complete response is achieved, two additional doses of pentostatin are recommended. Pentostatin treatment should then be stopped. If the best response to treatment at the end of 12 months is a partial response, it is recommended that treatment with pentostatin be stopped.

Withholding or discontinuation of individual doses may be needed when severe adverse reactions occur. Drug treatment should be withheld in patients with severe rash, and withheld or discontinued in patients showing evidence of nervous system toxicity.

Pentostatin treatment should be withheld in patients with active infection occurring during the treatment but may be resumed when the infection is controlled.

Dosage in Patients with Cytopenias

No dosage reduction is recommended at the start of therapy with pentostatin in patients with anaemia, neutropenia, or thrombocytopenia. In addition, dosage reductions are not recommended during treatment in patients with anaemia and thrombocytopenia. Pentostatin should be temporarily withheld if the absolute neutrophil count during treatment falls below 200 cells/mm³ in a patient who had an initial neutrophil count greater than 500 cells/mm³ and may be resumed when the count returns to predose levels.

Renal Insufficiency

There is limited experience in patients with impaired renal function (creatinine clearance (Clcr) <60 ml/min) (see section 5.2).

Creatinine clearance should be determined prior to each administration of NIPENT.

Liver Impairment

Because of limited experience treating patients with abnormal liver function, treatment of such patients should be done with caution.

Administration to Elderly Patients

The recommended dosage of pentostatin for the treatment of hairy cell leukaemia in the elderly is 4 mg/m² in a single administration every other week. Clinical trials have included patients over 65 years old and no adverse reactions specific to this age group have been reported.

Paediatric Use

Hairy cell leukaemia is a disease affecting adults, most commonly in the sixth decade of life. Safety and effectiveness of Nipent in children have not been established.

No specific antidote for pentostatin overdose is known. Pentostatin administered at higher doses (20-50 mg/m²/course) than recommended was associated with deaths due to severe renal, hepatic, pulmonary, and CNS toxicity. In case of overdose, management would include general supportive measures through any period of toxicity that occurs.

Shelf life: 3 years.

The reconstituted solution for injection or reconstituted and further diluted solution for infusion should be used within 8 hours and should not be stored above 25°C. Immediate administration after reconstitution is recommended.

Store in a refrigerator (2°C–8°C).

For storage conditions of the reconstituted medicinal product, see Section 6.3.

NIPENT is supplied in single-dose, 10-mg vials packaged in individual cartons (packs of 1 vial).

Vials are made from Type I glass and siliconised stoppers.

Any unused product or waste material should be disposed of in accordance with local requirements.

Prescribers should refer to national or recognised guidelines on handling cytotoxic agents.

Procedures for proper handling and disposal of anticancer drugs should be followed.

1. Reconstitution of Nipent should only be carried out by trained personnel in a cytotoxic-designated area.
2. Adequate protective gloves should be worn.
3. The cytotoxic preparation should not be handled by pregnant staff.
4. Adequate care and precautions should be taken in the disposal of items syringes, needles etc. used to reconstitute cytotoxic drugs.
5. Contaminated surfaces should be washed with copious amounts of water.
6. Any remaining solution should be discarded.

Transfer 5 ml of Sterile Water for Injection to the vial containing NIPENT and mix thoroughly to obtain complete dissolution. The solution should be colourless to pale yellow and yield 2 mg/ml pentostatin. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.

NIPENT may be given intravenously by bolus injection or diluted in a larger volume (25 to 50 ml) with 5% Dextrose Injection (5% glucose solution) or 0.9% Sodium Chloride Injection (0.9% saline solution). Dilution of the entire contents of a reconstituted vial with 25 ml or 50 ml provides a pentostatin concentration of 0.33 mg/ml or 0.18 mg/ml, respectively, for the diluted solutions.

NIPENT solution when diluted for infusion with 5% Dextrose Injection (5% glucose solution) or 0.9% Sodium Chloride Injection (0.9% saline solution) does not interact with PVC infusion containers or administration sets at concentrations of 0.18 mg/ml to 0.33 mg/ml.