8.3 Nursing MothersIt is not known whether lomitapide is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for tumorigenicity shown for lomitapide in a 2-year mouse study, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

8.4 Pediatric UseSafety and effectiveness have not been established in pediatric patients.

8.5 Geriatric UseClinical studies of JUXTAPID did not include sufficient numbers of patients aged 65 years and over to determine whether they respond differently from younger patients. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dosing for an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

8.6 Females of Reproductive PotentialJUXTAPID may cause fetal harm [see Use in Specific Populations (8.1)]. Females who become pregnant during JUXTAPID therapy should stop JUXTAPID immediately and notify their healthcare provider.

Pregnancy testing

Females of reproductive potential should have a negative pregnancy test before starting JUXTAPID.

Contraception

Females of reproductive potential should use effective contraception during JUXTAPID therapy. The recommended maximum dosage of JUXTAPID is 30 mg daily with concomitant use of oral contraceptives, since oral contraceptives are weak CYP3A4 inhibitors [see Drug Interactions (7.2)]. Hormone absorption from oral contraceptives may be incomplete if vomiting or diarrhea occurs while taking JUXTAPID, warranting the use of additional contraceptive methods [see Warnings and Precautions (5.5)].

8.7 Renal ImpairmentPatients with end-stage renal disease receiving dialysis should not exceed 40 mg daily since lomitapide exposure in these patients increased approximately 50% compared with healthy volunteers. Effects of mild, moderate, and severe renal impairment, including those with end-stage renal disease not yet receiving dialysis, on lomitapide exposure have not been studied. However, it is possible that patients with renal impairment who are not yet receiving dialysis may experience increases in lomitapide exposure exceeding 50% [see Clinical Pharmacology (12.3)].

8.8 Hepatic ImpairmentPatients with mild hepatic impairment (Child-Pugh A) should not exceed 40 mg daily since the lomitapide exposure in these patients increased approximately 50% compared with healthy volunteers. JUXTAPID is contraindicated in patients with moderate (Child-Pugh B) or severe (Child-Pugh C) hepatic impairment since the lomitapide exposure in patients with moderate hepatic impairment increased 164% compared with healthy volunteers [see Contraindications (4) and Clinical Pharmacology (12.3)].

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10 OVERDOSAGE

There is no specific treatment in the event of overdose of JUXTAPID. In the event of overdose, the patient should be treated symptomatically and supportive measures instituted as required. Liver-related tests should be monitored. Hemodialysis is unlikely to be beneficial given that lomitapide is highly protein bound.

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11 DESCRIPTION