Indications for: SIKLOS
To reduce the frequency of painful crises and to reduce the need for blood transfusions in patients with sickle cell anemia with recurrent moderate to severe painful crises.
Adults and Children:
<2yrs: not established. Base dose on ideal or actual weight, whichever is less. If difficulty swallowing, may disperse tab in teaspoonful of water immediately before use. ≥2yrs: initially 20mg/kg/day as a single dose. May increase dose by 5mg/kg/day every 8 weeks or if painful crisis occurs; give until mild myelosuppression (ANC 2000–4000/uL) is achieved, up to max 35mg/kg/day; increase dose only if blood counts are in an acceptable range; do not increase dose if myelosuppression occurs. If blood counts toxic, discontinue until hematologic recovery, see full labeling for dosage adjustments. Renal impairment (CrCl <60mL/min or ESRD): initially 10mg/kg/day; give dose following dialysis (monitor).
Risk of severe myelosuppression. Monitor blood counts at baseline and every 2 weeks during therapy; interrupt or reduce dose if necessary; resume at lower dose. Markedly depressed bone marrow function: do not initiate. Monitor for secondary malignancies. Avoid sun exposure. Macrocytosis may mask folic acid deficiency; prophylactic folic acid is recommended. Myeloproliferative disorders; reduce dose or discontinue if cutaneous vasculitic ulcerations occur. Avoid in those with leg ulcers. Obtain fetal hemoglobin (HbF) levels every 3–4 months; may be used to assess efficacy. Renal or hepatic impairment: monitor closely. Embryo-fetal toxicity. Pregnancy: avoid; exclude status prior to initiation. Advise females with reproductive potential and males (w. female partners) to use effective contraception during and for ≥6 months after therapy. Nursing mothers: not recommended.
Avoid concomitant didanosine, with or without stavudine, or other antiretrovirals (may cause pancreatitis [permanently discontinue if occurs], fatal hepatotoxicity, peripheral neuropathy). Avoid live vaccines. Increased risk of vasculitic toxicities with interferon therapy. May cause falsely elevated results in urea, uric acid, and lactic acid assays.
Infections, leukopenia, thrombocytopenia, anemia, neutropenia, skin and subcutaneous disorders, GI upset, Vit.D deficiency, headache, fever; secondary malignancies, vasculitic toxicities, macrocytosis.
Wear disposable gloves when handling tabs or bottle.
Generic Drug Availability:
Tabs 100mg—60; 1000mg—30