Vorasidenib: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
Vorasidenib: clinical details
Prescribing considerations
- Confirm a susceptible tumour IDH1 or IDH2 mutation using an appropriate diagnostic test.
- Treatment should be initiated and supervised by a clinician experienced with anticancer therapies.
- Assess liver and kidney disease and undertake a comprehensive interaction review.
- Consider pregnancy testing and reproductive counselling where relevant.
- Report suspected adverse reactions through the Yellow Card Scheme.
Contraindications and cautions
- Hypersensitivity to vorasidenib or an excipient.
- Do not use in pre-existing severe hepatic impairment.
- Use caution when eGFR is 40 mL/min/1.73 m² or lower or dialysis is required because clinical data are lacking.
- Contains lactose and is unsuitable for certain rare hereditary disorders of galactose metabolism.
Monitoring
- Check full blood count, blood chemistry, liver enzymes and bilirubin before treatment.
- Monitor liver enzymes and bilirubin regularly, increasing monitoring if hepatotoxicity occurs.
Clinical pharmacology
Vorasidenib inhibits mutant IDH1 and IDH2, reducing tumour 2-hydroxyglutarate. It penetrates brain tumour tissue, is primarily metabolised by CYP1A2 and has an active downstream metabolite. Food substantially increases exposure.
Vorasidenib preparations and strengths
Tablet
Route: Oral
Strengths: 10 mg, 40 mg
Vorasidenib interactions
The specialist team should review all prescribed, over-the-counter and complementary products. Important examples include:
Ciprofloxacin or fluvoxamine
May raise vorasidenib exposure and should generally be avoided in favour of alternatives.
Rifampicin or phenytoin
May lower vorasidenib exposure and reduce its activity.
Warfarin, tacrolimus, ciclosporin and other narrow-therapeutic-index CYP substrates
Vorasidenib may reduce their concentrations, so concurrent use should generally be avoided.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.