Erlonat is a Natco pharma item which is containing a functioning substance known as Erlotinib, a first line medication of decision in metastatic phase of non little cell lung tumor.
Erlonat is normally endorsed for the patients who are not counters to less than one chemotherapy regimen.
Erlonat is synthetically described as quinazoline subordinate, with hostile to neoplastic impact against tumor cells.
Erlonat is pharmacologically arranged as tyrosine kinase inhibitor.
Erlonat is altogether raising the serum aminotransferase levels amid the treatment and this may causes liver wounds.
Erlonat tablets are containing 150mg of Erlotinib as a hostile to tumor specialist.
Brand name: Erlonat
Active constituent: Erlotinib
Mfg: Natco pharma
Pack: 30 tablets per container
Category: Anti-neoplastic agent
Prescribing information of Erlonat ;
Before starting therapy with Erlonat , determination of mutation status is necessary for the patients to prevent the conditions like false positive or negative assessment.
Non small cell lung cancer:
Erlonat tablets are indicated primarily for the treatment of advanced NSCLC, in patients who are containing exon 19 deletions or 21substitution mutations.
Erlonat tablets are also considered as monotherapy for the advanced NSCLC patients who are progressive after 4 weeks of therapy with platinum based compounds.
Erlonat is mainly indicated for the patients who are not responding for one chemotherapy drugs.
But the potency of Erlonat has not been evaluated, for first line treatment in advanced NSCLC exon 19 deletions or mutations.
Erlotinib is also considered as a first line therapy while combining with gemcitabine which is eligible to treat advanced pancreatic carcinoma.
Mechanism of Erlonat
Erlonat has Erlotinib dynamic substance comprising hostile to neoplastic action with tyrosine kinase denying impact.
Erlotinib is depicts as epidermal development factor receptor write I tyrosine kinase inhibitor.
Erlonat displays hostile to tumor action by following up on cell surface in which the EGFR presents.
Erlonat mediates with EGFR phosphorylation which is brings about cell lyses.
Erlonat is likewise engaged with blockage of EFGR related flag exchange which is contributed for cell development.
Because of barricade of following motioning of EFGR, cell expansion is ceased and incited cell demise.
Nearly 60% of Erlotinib get absorbed after oral administration of Erlonat tablets.
The oral bioavailability reaches nearly 100%
The maximum plasma concentration time reaches at 4 hours after drug intake.
Erlotinib solubility is depends upon pH value, if pH increases leads to decrease the Erlotinib solubility.
In case of co administration of Erlonat tablets with gastric regulators like proton pump inhibitors causes depletion of Erlotinib exposure and leads to increase its concentration.
Approximately 93% of Erlotinib get binds to human plasma protein.
The apparent volume of distribution is 232L
The metabolism of Erlotinib is induced by CYP3A4 and lesser extent with CYP1A2.
There are three major metabolic pathway involves in Erlotinib metabolism;
Oxidation of carboxylic acids leads to O-demethylation of side chains.
The hydrolysis of aryl carboxylic acid causes oxidation of acetylene moiety.
Phenyl acetylene moiety undergo aromatic hydroxylation
The mean creatinine clearance value 4.47L/hr
The terminal half life period of Erlotinib is 36.2 hours
The steady state plasma concentration occurs within 7 to 8 days.
When to take the Erlonat tablets
Erlonat tablets should be administered on an empty stomach; it should be taken at least 1 hour earlier or 2 hours after food intake.
Dosage regimens of Erlonat
The prescribed dose of Erlonat in this condition is 150mg of tablet should be taken as once a day.
This therapy should be followed until disease progression and toxicity occurs.
The prescribed dose is 100mg of Erlotinib tablet should be combined with gemcitabine.
If patients not getting severe rashes, then therapy with Erlonat should be continue.
In combinational therapy of Erlonat with CYP3A4 substrates or modulators, dosage alteration is necessary for up to 50mg.
In pulmonary symptoms like cough, dyspnea, fever conditions; Erlonat tablets treatment should be postpones.
In interstitial lung disease: Discontinue the therapy.
In Bullous or exfoliative skin conditions or renal disorders; postpone or discontinue the treatment.
Severe diarrhea: Provide with supportive measures like loperamide tablets, or discontinue the treatment.
In case of dose reduction is required for the patients, Erlonat dose may reduced to 50mg
Cigarette smoking should be avoided it may causes reduction in exposure of Erlotinib.
During elevation of bilirubin, an AST or ALT level causes liver injuries; Erlotinib undergoes hepatic metabolism & biliary elimination. Treatment should be interrupt or discontinue and investigate LFT frequently.
Erlonat caused side effects
The most common adverse effects occurred in this therapy such as;
Interstitial lung disease
Hepatic function abnormalities like;
In pancreatic cancer;
Similar to NSCLC but some exceptional like;
Loss of weight
Deep venous thrombosis
Hemolytic anemia with thrombocytopenia
In both NSCLS & pancreatic;
Peptic ulcer bleeding
Post marketing effects;
Skin & subcutaneous effects like hirsutism, eyelash or eyebrows altered, nail disorders,
Drug -drug interaction
Erlotinib should not be combined with platinum based compounds; it may increases the effect of concentration of platinum based compounds.
Erlonat should not be concomitant with Capecitabine; it may causes elevation of effect of concentration of Erlotinib.
Proteasome prohibitor like Bortezomib may be conventionally significant the effect of EFGR inhibitors including Erlonat
Erlonat tablets are strong inhibitor of CYP1A1, moderate inhibitor of CYP3A4 & CYP2C8 and also potent inhibitor of Glucuronidation by UGT1A1.
Erlonat tablets combined with CYP3A4 inhibitors causes increasing the exposure of Erlonat .
CYP3A4 inhibitors like ketaconazole, ciprofloxacin, ritonavir, clarithromycin, voriconazole.
Erlonat tablet co administered with CYP3A4 inducers like rifampicin causes decreasing the exposure of Erlonat . Some CYP3A4 inducers like rifabutin, rifapentine, anti-convulsants.
Cigarette smoking is occurs during the therapy with Erlonat , leads to decreasing the exposure to Erlonat .
Erlonat solubility is occurs by pH values, once pH decreases solubility of Erlotinib get increases and causes loss of effects.
Erlonat should not be co administered with gastric regulators at a time; some time intervals like around 2 hours should be taken before or after ingestion of food.
Food drug interaction
Erlonat tablets should be taken on an empty stomach; because pH regulates the solubility of Erlotinib.
Avoid intake of grape fruit or juice during therapy with Erlotinib.
This may results as elevating the Erlotinib levels in the body leads to causes adverse effects.
Any anaphylactic reactions like rashes, Stevens Johnson syndrome may occur during the therapy due to the patients are contraindicated to the component of Erlonat .
Interstitial lung disease may occur to overcome this effect by interrupt or discontinue the treatment with Erlonat .
Patient may frequently examine by undergone ILD analysis; this may occur in combinational therapy with gemcitabine.
Some renal disorders may occur, to avoid this problem postpone or discontinue the theory with Erlonat tablets and follow the regular renal function test.
Due to increasing levels of bilirubin, AST & ALT causes liver toxicity, to prevent this effect monitor the patients with frequent hepatic function test.
In severe condition, treatment should be stopped.
Providing rehydration due to loss of fluids and also give loperamide as a alternative drug.
In severity, discontinue the therapy with Erlonat
This may occur due to concurrent use of Erlonat with NSAIDS, corticosteroids, anti-angiogenic agents, or taxane based compounds causes GI perforation by increasing the acid levels in stomach.
This may overcome by discontinuing the treatment.
6.Bullous & exfoliative skin disorders:
Interrupt or stop the treatment
Myocardial infarction may occur due to combination of Erlonat with gemcitabine, to avoid this problem stop the combinational therapy.
Hemorrhage may occurs, stop the therapy
9.Hemolytic anemia related to thrombocytopenia:
Frequently counts the blood cells before & after the therapy for avoiding this problem.
10.Ocular disorders: In serious condition, stop the treatment
Patient receiving coumarin derivatives or warfarin with Erlonat , must monitor with prothrombin time or INR values periodically to prevent bleeding disorders.
Pregnancy and lactation
Pregnancy category D
Erlotinib causes fetal harm; it should not be suggested in pregnancy condition.
Breast feeding should not be allowed.
The potency of Erlotinib has not been evaluated in pediatric patients.
Storage and handling
Erlonat tablet container should be stored at 25oC.
The container should be keep away from heat, light & moisture.
Missed dose should not be followed, if it may occur patient must be consult with medical oncologist and follow the instructions
Follow the correct dosing schedule to avoid the missed dose condition; this may results as increasing the adverse effects of Erlotinib.
Missed dose is the one of the reason for obtaining over dosage condition.
Once over dosage of Erlonat occurs in patients, must provided with supportive measures and follow the preventive measures
The over dosage of Erlotinib causes severe diarrhea & rashes, elevating AST, ALT leads to liver damage.
Discontinue the therapy.