arimoclomol 93 MG Oral Capsule [Miplyffa]

INDICATIONS AND USAGE MIPLYFFA is indicated for use in combination with miglustat for the treatment of neurological manifestations of Niemann-Pick disease type C (NPC) in adult and pediatric patients 2 years of age and older. MIPLYFFA is indicated for use in combination with miglustat for the treatment of neurological manifestations of Niemann-Pick disease type C (NPC) in adult and pediatric patients 2 years of age and older. ( 1 )

DOSAGE AND ADMINISTRATION Recommended MIPLYFFA oral dosage, in combination with miglustat, for patients with actual body weight of ( 2.1 ): 8 kg to 15 kg, is 47 mg three times a day > 15 kg to 30 kg, is 62 mg three times a day > 30 kg to 55 kg, is 93 mg three times a day > 55 kg, is 124 mg three times a day Administer with or without food. ( 2.1 ) See full prescribing information for recommended dosage in patients with an eGFR ≥ 15 to < 50 mL/minute. ( 2.2 ) See full prescribing information for instructions on preparation and administration. ( 2.3 ) 2.1 Recommended Dosage The recommended oral dosage of MIPLYFFA, in combination with miglustat, for patients with an actual body weight of: 8 kg to 15 kg, is 47 mg three times a day > 15 kg to 30 kg, is 62 mg three times a day > 30 kg to 55 kg, is 93 mg three times a day > 55 kg, is 124 mg three times a day Administer MIPLYFFA with or without food. Missed Dose If a dose of MIPLYFFA is missed, advise the patient to skip the missed dose and to resume taking the prescribed dose at the next scheduled time. 2.2 Recommended Dosage in Patients with Renal Impairment The recommended dosage of MIPLYFFA, in combination with miglustat, in patients with an eGFR ≥ 50 mL/minute is the same as the recommended dosage in patients with normal renal function [see Dosage and Administration ( 2.1 )]. For patients with an eGFR ≥ 15 to < 50 mL/minute, the recommended oral dosage of MIPLYFFA, in combination with miglustat, for patients with an actual body weight of [see Use in Specific Populations ( 8.6 ) and Clinical Pharmacology ( 12.3 )] : 8 kg to 15 kg, is 47 mg two times a day > 15 kg to 30 kg, is 62 mg two times a day > 30 kg to 55 kg, is 93 mg two times a day > 55 kg, is 124 mg two times a day Administer MIPLYFFA with or without food. 2.3 Preparation and Administration Instructions Swallow MIPLYFFA whole. However, for patients who have difficulty swallowing capsules, administer MIPLYFFA in one of two ways: Oral Administration Carefully open the capsule and sprinkle the entire contents into 15 mL of water or apple juice or 15 mL of soft food (e.g., applesauce, pudding, or yogurt). Stir the mixture for 15 seconds. Consume the entire mixture immediately. Feeding Tube Administration (nasogastric or gastric tube) Carefully open the capsule and sprinkle the entire contents into 20 mL of water. Do not add the capsule contents to other liquids besides water. Stir the mixture for 15 seconds. Administer the entire mixture immediately via feeding tube. Flush the feeding tube with 5 mL of water after administration. Do not save the mixture for later use.

WARNINGS AND PRECAUTIONS Hypersensitivity Reactions : Urticaria and angioedema have been reported. Discontinue MIPLYFFA in patients who develop these adverse reactions. ( 5.1 ) Embryofetal Toxicity : May cause fetal harm. Advise pregnant females of the potential risk to the fetus and consider pregnancy planning and prevention. ( 5.2 ) Increased Creatinine without Affecting Glomerular Function: Mean increases in serum creatinine of 10-20% have been reported. Use alternative measures to assess renal function which are not based on creatinine. ( 5.3 ) 5.1 Hypersensitivity Reactions Hypersensitivity reactions such as urticaria and angioedema have been reported in patients treated with MIPLYFFA during Trial 1 [see Clinical Studies ( 14 )] : two patients reported both urticaria and angioedema (6%) and one patient (3%) experienced urticaria alone. The reactions occurred within the first two months of treatment. Discontinue MIPLYFFA in patients who develop severe hypersensitivity reactions. If a mild or moderate hypersensitivity reaction occurs, stop MIPLYFFA and treat promptly. Monitor the patient until signs and symptoms resolve [see Adverse Reactions ( 6.1 )]. 5.2 Embryofetal Toxicity Based on findings from animal reproduction studies, MIPLYFFA may cause embryofetal harm when administered during pregnancy. In animal reproduction studies, oral administration of arimoclomol to pregnant rats and rabbits resulted in post-implantation loss and structural abnormalities in offspring. These occurred at exposures equal to or greater than 10- and 5-fold, for rats and rabbits respectively, the human exposure at the maximum recommended human daily dose of 372 mg. Advise pregnant females of the potential risk to the fetus. Consider pregnancy planning and prevention for females of reproductive potential [see Use in Specific Populations ( 8.1 , 8.3 )] . 5.3 Increased Creatinine without Affecting Glomerular Function Across clinical trials of MIPLYFFA consisting of patients with NPC, healthy subjects, and patients with other diseases, there were mean increases in serum creatinine of 10% to 20% compared to baseline. These increases occurred mostly in the first month of MIPLYFFA treatment and were not associated with changes in glomerular function. The increases in serum creatinine may be due to inhibition of renal tubular secretion transporters [see Drug Interactions ( 7 ) and Clinical Pharmacology ( 12.2 , 12.3 )]. During MIPLYFFA treatment, use alternative measures that are not based on creatinine to assess renal function such as BUN, cystatin C, or measured GFR. Increases in creatinine reversed upon MIPLYFFA discontinuation [see Clinical Pharmacology ( 12.2 )] .

CONTRAINDICATIONS None. None. ( 4 )

Mechanism of Action The mechanism(s) by which arimoclomol exerts its clinical effects in patients with NPC is unknown.