pemigatinib: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
pemigatinib: clinical details
Prescribing considerations
- Initiation should be supervised by a clinician experienced in biliary tract cancer.
- Confirm an FGFR2 fusion or rearrangement with an appropriate tumour test.
- Review renal and hepatic function, particularly severe impairment.
- Review clinically significant retinal disease, untreated or progressing CNS metastases, interacting medicines and pregnancy potential.
- Pemigatinib remains under additional monitoring and has conditional UK authorisation.
Contraindications and cautions
- Hypersensitivity to pemigatinib or any listed excipient.
- Concurrent St John's wort.
Monitoring
- Serum phosphate, with assessment for both hyperphosphataemia and treatment-related hypophosphataemia.
- Baseline and periodic ophthalmological examination including optical coherence tomography; urgent assessment for visual symptoms.
- Renal and hepatic function, electrolytes and treatment toxicity.
- Consider alternative renal-function markers if creatinine remains increased, because OCT2 and MATE1 inhibition can reduce tubular creatinine secretion.
- Pregnancy testing before initiation where relevant.
Clinical pharmacology
Pemigatinib inhibits FGFR1, FGFR2 and FGFR3 phosphorylation and signalling. It is predominantly metabolised by CYP3A4 and also inhibits P-glycoprotein, OCT2 and MATE1 in vitro.
Formulation and product differences
- Oral tablet strengths are available to support prescribing and toxicity management.
- Tablets should be swallowed intact and may be taken with or without food.
- The selected tablet contains microcrystalline cellulose, sodium starch glycolate and magnesium stearate and requires no special storage conditions.
pemigatinib preparations and strengths
Tablet
Route: Oral
Strengths: 4.5 mg, 9 mg, 13.5 mg
pemigatinib interactions
The oncology team and pharmacist should review prescribed, over-the-counter and herbal products before treatment.
St John's wort
Use is contraindicated because enzyme induction may substantially reduce pemigatinib exposure and effectiveness.
Strong CYP3A4 inhibitors, including itraconazole, ketoconazole and ritonavir
These can increase pemigatinib exposure and adverse effects, so concurrent use should generally be avoided.
Strong or moderate CYP3A4 inducers, including rifampicin, carbamazepine, phenytoin and phenobarbital
These can reduce pemigatinib exposure and potentially reduce effectiveness.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.