Indications
Reluciba tablet is a gonadotropin-releasing hormone (GnRH) receptor
antagonist indicated for the treatment of adult patients with advanced prostate
cancer.
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Pharmacology
Relugolix is a non-peptide small molecule, GnRH receptor
antagonist. Relugolix competitively binds to pituitary GnRH receptors, thereby,
reducing the release of luteinizing hormone (LH) and follicle-stimulating
hormone (FSH), and consequently testosterone.
Absorption: Relugolix is a substrate for intestinal P-gp.
The mean (CV%) absolute bioavailability of Relugolix is approximately 12%. The
median (range) Tmax of Relugolix is 2.25 hours.
Effect of Food: No clinically meaningful differences in the
pharmacokinetics of Relugolix were observed following consumption of a
high-calorie, high-fat meal.
Distribution: Plasma protein binding of Relugolix is 68 to
71%, primarily to albumin and to a lesser extent to α1- acid glycoprotein. The
mean blood-to-plasma ratio is 0.78.
Elimination: The mean effective half-life of Relugolix is 25
hours and the mean (CV %) terminal elimination half-life is 60.8 (11%) hours.
The mean (CV %) total clearance of Relugolix is 29.4 (15%) L/h and the renal
clearance is 8 L/h.
Metabolism: Relugolix is metabolized primarily by CYP3A and
to a lesser extent by CYP2C8 in vitro.
Excretion: After oral administration of a single 80mg
radiolabeled dose of Relugolix, approximately 81% of the radioactivity was
recovered in feces (4.2% as unchanged) and 4.1% in urine (2.2% as unchanged).
Dosage & Administration
A loading dose of 360 mg on the first day of treatment
followed by 120 mg taken once daily, at approximately the same time each day.
Relugolix Tablet can be taken with or without food. Advise patients to take a
missed dose of Relugolix as soon as they remember. If the dose was missed by
more than 12 hours, patients should not take the missed dose and resume with
the next scheduled dose. If treatment with Relugolix is interrupted for greater
than 7 days, restart Relugolix with a loading dose of 360 mg on the first day,
and continue with a dose of 120 mg once daily.
Pediatric Use: The safety and efficacy of Relugolix in
pediatric patients have not been established.
Geriatric Use: No overall differences in safety or
effectiveness were observed between older and younger subjects.
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Interaction
P-gp Inhibitors: Avoid co-administration. If unavoidable,
take Reluciba first, separate dosing by at least 6 hours, and monitor patients
more frequently for adverse reactions. Combined P-gp and
Strong CYP3A Inducers: Avoid co-administration. If
unavoidable, increase the Relupros ® dose to 240 mg once daily.
Side Effects
Adverse Reactions: The most common adverse reactions (≥10%)
and laboratory abnormalities (≥15%) were hot flushes, glucose increased,
triglycerides increased, musculoskeletal pain, haemoglobin decreased, alanine
aminotransferase (ALT) increased, fatigue, aspartate aminotransferase (AST)
increased, constipation, and diarrhea.
Common Side Effects: Hot flushes, Increased blood sugar
levels, Increased blood fat (triglyceride) levels, Muscle and joint pain,
Decreased hemoglobin levels, Increased liver enzymes, Tiredness, Constipation,
Diarrhoea
Rare Side Effects: Reluciba may cause rare side effects,
including Changes in the electrical activity of your heart (QT prolongation),
Dizziness, Fainting, Feeling that your heart is pounding or racing
(palpitations), Chest pain. Other side effects include weight gain, decreased
sex drive, and erectile function problems.
Pregnancy & Lactation
The safety and efficacy of Relugolix at the recommended dose
of 120 mg daily have not been established in females. Females and Males of
Reproductive Potential. Based on findings in animals and mechanism of action,
Relugolix may impair fertility in males of reproductive potential.
Precautions & Warnings
QT/QTc Interval Prolongation: Androgen deprivation therapy
may prolong the QT interval.
Embryo-Fetal Toxicity: Reluciba can cause fetal harm. Advise
males with female partners of reproductive potential to use effective
contraception.
Overdose Effects
There is no specific experience in the management of
Reluciba overdose in patients.
Therapeutic Class
Gonadotropin-releasing hormone (GnRH) antagonist
Storage Conditions
Store in a cool and dry place, protect from light &
moisture. Keep all medicines out of the reach of children.
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