Enzalutamide is an active ingredient of Azel tablets available in the strength of 40mg. Azel 40mg tablets are used to treat the metastatic prostate cancer, in men. Azel 40mg is exhibits its action by stopping the advancement of tumor cells by blockade of androgen hormones especially testosterone.
Azel containing Enzalutamide is also categorized as an anti-androgen chemo medicine. Azel 40mg is not self medication; it is used under the knowledge of medical oncologist.
Azel 40mg tablets are prescribing for; Metastatic or long lasting castration resistant prostate cancer
MECHANISM OF ACTION
Azel 40mg containing anti-androgen agent like Enzalutamide, it expels an anti-tumor activity in different steps. Azel tablets are interfere in androgen receptor signaling pathway, which prohibiting androgen binding to androgen receptors leads to androgen receptor nuclear translocation inhibition and interact with DNA. The major metabolite of Azel is N-desmethyl Enzalutamide which is similar to Enzalutamide activity. The anti-tumor activity of Azel is exposed by depleting the multiplication and persuades cell lysis in prostate cancer cells.
After an oral administration of Azel 40mg tablets (160mg of dose), undergoes ADME process and exhibits activity. The peak plasma concentration time of Azel occurs at 1 hour with the range of 0.5 to 3 hours). The steady state of Azel occurs in day 28. The volume of distribution occur after single dose of Azel is 110L Azel has highly bounds to the human plasma protein with the range of 97 to 98%.
The major metabolite of Enzalutamide is N-desmethyl Enzalutamide has 95% bound to human plasma protein. The most important isoenzymes responsible for the metabolism of Enzalutamide are CYP2C8 & CYP3A4. CYP2C8 is involved in the formation of an active metabolite N-desmethyl Enzalutamide. Azel is majorly excreted through liver metabolism, 71% of metabolite present in urine and 14% in feces. The terminal half life period of Azel 40mg tablet is occurs after a single dose at 5.8days and N-desmethyl Enzalutamide is taken 7.8 to 8.6 days.
The usual recommended dosage of Azel is 160mg, but available strength of Azel 40mg Four tablets of Azel 40mg should be taken at a time as a single dose. Azel tablet should be administered with or without food.
Dosing alteration: In ≥ grade 3 toxicity or extreme side effects: Postpone the dose of Azel for 1 week or as far as symptoms progress to ≤ grade 2, continue at the same or reduced to 120mg or 80mg. Concurrent use with strong CYP2C8 inhibitors:
In case of combination with strong CYP2C8 inhibitors, diminish the dose of Azel to 80mg as a single dose. Concurrent use with strong CYP3A4 inducers: In case of combination with strong CYP3A4 inducers, increasing the dose of Azel 160mg to 240mg as a single dose.
Azel 40MG TABLETS SAFETY PRECAUTIONS
The major adverse effect during the therapy of Azel tablets are;
Seizure may produce during the treatment with Azel tablets, if seizure occurs the treatment should be discontinued until seizure resolved. To avoid this condition, patient should be counsel about the problems occurred during the therapy before starting the treatment. Seizure may leads to loss of consciousness.
Posterior reversible encephalopathy syndrome PRES
Patient who are all taking Azel tablets acquired PRES, is a neurological problem produce symptoms like headache, lethargy, confusion, loss of vision, other neurological problems related with hypertension. PRES diagnosed by MRI. If patient acquired with PRES, discontinue the Azel therapy
AZEL 40MG TABLETS CAUSING SIDE EFFECTS
Back pain, arthralgia
Spinal cord compression
Caude equine syndrome
Respiratory tract infections
Non pathologic fractures
Azel tablets concomitant with strong CYP2C8 inhibitors like gemfibrozil which may increase the plasma concentration time curve of Enzalutamide, so avoid this concomitant if possible. If required condition, the dose of Azel is reduced to 80mg. Azel tablet combined with CYP3A4 inducers, causes depletion of AUC of Enzalutamide and its active metabolite.
CYP3A4 inducers like rifampicin, anti-convulsants, st. Johns wort. This combination should be avoided, in unavoidable condition the dose of Azel is increased up to 240mg. Azel with st. Johns wort causes depletion of Enzalutamide exposure.
Azel with CYP3A4 strong inducer, CYP2C9 & CYP2C19 moderate inducers; CYP3A4 strong inducer: Midazolam CYP2C9: warfarin CYP2C19: Omeprazole The concurrent use of Azel with these drugs may cause depletion of plasma exposure of these drugs. Drugs metabolized by CYP3A4 such as cyclosporine, dihydroergotamine, fentanyl, pimozide, quinidine, sirolimus etc combined with Azel causes decreasing the exposure of these drugs.
Azel is contraindicated to pregnancy conditions, which may causes fetal harm Anaphylactic reactions occurs, if patients are contraindicated to the component occurred in Azel tablets
PREGNANCY & LACTATION
The pregnancy category of Azel tablet is X Azel tablets are contraindicated to pregnancy conditions; it may cause fetal harm even to death. Azel tablets are contraindicated in lactation period, breast feeding should not be recommended.
The storage condition of Azel tablets container at 20°C to 25°C (68°F to 77°F). Container should be kept at dry and cool place.
Azel is a chemo tablets, if patient fail to take the dose of Azel tablets must be consult with medical oncologist and take the dose within a time. In any other way the missed dose should be avoid and follow the regular dosing schedule.
In case of over dosage of Azel tablets, patients must provided with some supportive measures and discontinue the therapy. The half life of Azel is occurs for 5.8 days. Seizure is the major adverse effect occurred due to over dosage of Azel . Seizure is not described at ≤240mg daily; since three seizures occurs at 360mg, 480mg and 600mg daily.