OJEMDA is indicated for the treatment of patients 6 months of age and older with relapsed or refractory pediatric low-grade glioma (LGG) harboring a BRAF fusion or rearrangement, or BRAF V600 mutation. This indication is approved under accelerated approval based on response rate and duration of response [see Clinical Studies (14) ]. Continued approval for this indication may be contingent upon verification and des...
Dosage and administration
Select patients for treatment with OJEMDA based on the presence of BRAF fusion or rearrangement, or BRAF V600 mutation in tumor specimens [see Clinical Studies (14) ]. Information on FDA-approved tests for the detection of BRAF fusions, BRAF rearrangements, and BRAF V600 mutations is available at http://www.fda.gov/companiondiagnostics . Before initiating OJEMDA, evaluate liver function tests, including ALT, AST a...
Storage and handling
OJEMDA tablets: 100 mg: orange, film-coated, oval tablets debossed with "100" on one side and "D101" on the opposite side and supplied as follows: Weekly dose Each carton contains Each blister card contains NDC 400 mg 4 blister cards four 100 mg tablets NDC 82950-001-16 500 mg 4 blister cards five 100 mg tablets NDC 82950-001-20 600 mg 4 blister cards six 100 mg tablets NDC 82950-001-24 Store at 20°C to 25°C (68°F...
OJEMDA is indicated for the treatment of patients 6 months of age and older with relapsed or refractory pediatric low-grade glioma (LGG) harboring a BRAF fusion or rearrangement, or BRAF V600 mutation.
This indication is approved under accelerated approval based on response rate and duration of response [see Clinical Studies (14)]. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).
2 DOSAGE AND ADMINISTRATION
DOSAGE & ADMINISTRATION SECTION
2.1 Patient Selection
SPL UNCLASSIFIED SECTION
Select patients for treatment with OJEMDA based on the presence of BRAF fusion or rearrangement, or BRAF V600 mutation in tumor specimens [see Clinical Studies (14)].
Information on FDA-approved tests for the detection of BRAF fusions, BRAF rearrangements, and BRAF V600 mutations is available at www.fda.gov/companiondiagnostics.
2.2 Recommended Testing Before Initiating OJEMDA
SPL UNCLASSIFIED SECTION
Before initiating OJEMDA, evaluate liver function tests, including ALT, AST and bilirubin [see Warnings and Precautions (5.3)].
2.3 Recommended Dosage
SPL UNCLASSIFIED SECTION
The recommended dosage of OJEMDA based on body surface area (BSA) is 380 mg/m2 orally once weekly (the maximum recommended dosage is 600 mg orally once weekly) with or without food [see Administration (2.4) and Clinical Pharmacology (12.3)] until disease progression or intolerable toxicity. OJEMDA may be administered as an immediate release tablet (see Table 1) or as an oral suspension (see Table 2). A recommended dosage for patients with BSA less than 0.3 m2 has not been established.
Table 1 Recommended OJEMDA Tablets Dosage Based on Body Surface Area
Body Surface Area (m2)
Recommended Dosage
0.30-0.89
Administer OJEMDA oral suspension once weekly (see Table 2)
0.90-1.12
400 mg once weekly
1.13-1.39
500 mg once weekly
≥ 1.40
600 mg once weekly
Table 2 Recommended Dosage for OJEMDA for Oral Suspension Based on Body Surface Area
3 days or less, take the missed dose as soon as possible, and take the next dose on its regularly scheduled day.
more than 3 days, skip the missed dose and take the next dose on its regularly scheduled day.
If vomiting occurs immediately after taking a dose, repeat that dose.
SPL UNCLASSIFIED SECTION
OJEMDA tablets
Swallow tablets whole with water.
Do not chew, cut, or crush.
SPL UNCLASSIFIED SECTION
OJEMDA for oral suspension
Prior to first time use of OJEMDA for oral suspension, ensure that caregivers (and if appropriate, patients) read and understand the "Instructions for Use" before preparing, measuring, and administering OJEMDA.
SPL UNCLASSIFIED SECTION
Preparation and Administration
Reconstitute the powder in each supplied bottle with exactly 14 mL of room temperature water to form the OJEMDA for oral suspension. After reconstitution each mL contains 25 mg of tovorafenib. Product foaming after reconstitution reduces the deliverable volume.
Each bottle delivers 300 mg of tovorafenib in 12 mL. For doses greater than 300 mg, reconstitute two bottles to achieve the dose. Split the dose as equally as possible between the two bottles (e.g., 6 mL and 7 mL for a 325 mg dose). Prepare the first bottle and administer dose prior to preparing the second bottle.
Administer OJEMDA for oral suspension using the supplied oral dosing syringe or feeding tube (minimum 12 French) immediately after preparation.
If the OJEMDA for oral suspension is not administered within 15 minutes after preparation, instruct the patient to discard it.
2.5 Dosage Modifications for Adverse Reactions
SPL UNCLASSIFIED SECTION
The recommended dosage reductions for adverse reactions for OJEMDA tablets are provided in Table 3 and OJEMDA for oral suspension in Table 4.
Table 3 OJEMDA Tablets: Recommended Dosage Reductions for Adverse Reactions
BSA (m2)
First Dosage Reduction
Second Dosage Reduction
0.30-1.12
Administer the oral suspension once weekly (see Table 4)
1.13-1.39
400 mg once weekly
Administer OJEMDA oral suspension once weekly (see Table 4)
≥1.40
500 mg once weekly
400 mg once weekly
Table 4 OJEMDA for Oral Suspension: Recommended Dosage Reductions for Adverse Reactions
BSA (m2)
First Dosage Reduction
Second Dosage Reduction
Volume (mL)
Dose (mg)
Volume (mL)
Dose (mg)
0.30-0.35
4
100 mg once weekly
3
75 mg once weekly
0.36-0.42
5
125 mg once weekly
4
100 mg once weekly
0.43-0.48
6
150 mg once weekly
5
125 mg once weekly
0.49-0.54
7
175 mg once weekly
6
150 mg once weekly
0.55-0.63
8
200 mg once weekly
6
150 mg once weekly
0.64-0.77
9
225 mg once weekly
8
200 mg once weekly
0.78-0.83
10
250 mg once weekly
8
200 mg once weekly
0.84-0.89
12
300 mg once weekly
10
250 mg once weekly
0.90-1.05
13
325 mg once weekly
11
275 mg once weekly
1.06-1.25
15
375 mg once weekly
13
325 mg once weekly
1.26-1.39
18
450 mg once weekly
15
375 mg once weekly
≥1.40
20
500 mg once weekly
16
400 mg once weekly
The recommended dosage modifications of OJEMDA for adverse reactions are in Table 5.
Table 5 Recommended Dosage Modifications for Adverse Reactions
If not improved, consider permanent discontinuation of OJEMDA.
First occurrence of any Grade 4
Withhold OJEMDA.
If improved to Grade 0-1, resume at lower dosage.
OR
Permanently discontinue OJEMDA.
Recurrent Grade 4
Permanently discontinue OJEMDA.
* National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0.
† See Table 3 and Table 4 for recommended dosage reductions.
3 DOSAGE FORMS AND STRENGTHS
DOSAGE FORMS & STRENGTHS SECTION
Tablets:
100 mg: orange, film-coated, oval tablets debossed with "100"; on one side and "D101" on the opposite side. Each tablet contains 100 mg of tovorafenib.
For Oral Suspension:
25 mg/mL: white to off white powder. After reconstitution, each mL of strawberry flavored tovorafenib suspension contains 25 mg of tovorafenib. Each bottle delivers 300 mg of tovorafenib in 12 mL.
4 CONTRAINDICATIONS
CONTRAINDICATIONS SECTION
None.
5 WARNINGS AND PRECAUTIONS
WARNINGS AND PRECAUTIONS SECTION
5.1 Hemorrhage
SPL UNCLASSIFIED SECTION
Hemorrhage, including major hemorrhage defined as symptomatic bleeding in a critical area or organ, can occur with OJEMDA. In the pooled safety population [see Adverse Reactions (6.1)], hemorrhagic events occurred in 37% of patients, including epistaxis in 26% and intratumoral hemorrhage in 9%. Serious events of bleeding occurred in 5% of patients including Grade 5 tumor hemorrhage in 1 patient (0.6%). OJEMDA was permanently discontinued for hemorrhage in 2% of patients.
Advise patients and caregivers of the risk of hemorrhage during treatment with OJEMDA. Monitor for signs and symptoms of hemorrhage and evaluate as clinically indicated. Withhold and resume at reduced dose upon improvement, or permanently discontinue based on severity [see Dosage and Administration (2.5)].
5.2 Skin Toxicity Including Photosensitivity
SPL UNCLASSIFIED SECTION
OJEMDA can cause rash, including maculopapular rash and photosensitivity. In the pooled safety population [see Adverse Reactions (6.1)], rash occurred in 67% of patients treated with OJEMDA, including Grade 3 rash in 12%. Rash resulted in dose interruption in 15% of patients and dose reduction in 7% of patients. OJEMDA was permanently discontinued due to rash in 1% of patients (n=2). In the pooled safety population, dermatitis acneiform occurred in 26% of patients treated with OJEMDA, including Grade 3 dermatitis acneiform in 0.6% of patients (n=1). Dose reduction was required in 2% of patients (n=3) due to dermatitis acneiform.
Monitor for new or worsening skin reactions. Consider dermatologic consultation and initiate supportive care as clinically indicated. Withhold, reduce the dose, or permanently discontinue OJEMDA based on severity of adverse reaction [see Dosage and Administration (2.5)].
SPL UNCLASSIFIED SECTION
Photosensitivity
In the pooled safety population [see Adverse Reactions (6.1)], photosensitivity occurred in 12% of patients treated with OJEMDA, including Grade 3 events in 0.6% of patients (n=1). Advise patients to use precautionary measures against ultraviolet exposure such as use of sunscreen, sunglasses, and/or protective clothing during treatment with OJEMDA. Withhold, reduce the dose, or permanently discontinue OJEMDA based on severity of adverse reaction [see Dosage and Administration (2.5)].
5.3 Hepatotoxicity
SPL UNCLASSIFIED SECTION
OJEMDA can cause hepatotoxicity. In the pooled safety population [see Adverse Reactions (6.1)], increased alanine aminotransferase (ALT) occurred in 42% and increased aspartate aminotransferase (AST) occurred in 74%, including Grade 3 ALT in 4% and increased AST in 2% of patients treated with OJEMDA. The median time to onset of increased ALT or AST was 14 days (range: 3 to 280 days). Increased ALT or AST leading to dose interruption occurred in 5% of patients and dose reductions were required in 1.2% of patients. Increased bilirubin occurred in 23% of patients, including Grade 3 increased bilirubin in 0.6% of patients (n=1) treated with OJEMDA. Hyperbilirubinemia leading to dose discontinuation occurred in a single adult patient with an advanced non-CNS solid tumor.
Monitor liver function tests, including ALT, AST and bilirubin, before initiation of OJEMDA, one month after initiation and then every three months thereafter and as clinically indicated. Withhold and resume at the same or reduced dose upon improvement, or permanently discontinue OJEMDA based on the severity [see Dosage and Administration (2.5)].
5.4 Effect on Growth
SPL UNCLASSIFIED SECTION
OJEMDA can cause reductions in growth velocity. In FIREFLY-1 [see Adverse Reactions (6.1)], treatment-emergent adverse effects on growth were reported in 46% of 133 patients 18 years of age or younger; 35% were Grade 3 or higher. Reduction in growth velocity resulted in dose interruption in 5% of patients, dose reduction in 2.3% of patients, and permanent discontinuation in 3% of patients. The median change from baseline in height percentile was -14 (z-score change -0.6) for evaluable patients on study for 12 months (N=107) and -20 (z-score change -0.9) for evaluable patients on study for 18 months (N=95).
Growth velocity improved after interruption of treatment with OJEMDA. Among 81 evaluable patients, the median annualized growth velocity ranged from 0.86 to 1.8 cm/year during the 2-year treatment period. Of those, 17 patients had height measurements recorded at least 90 days off-treatment and had a 4.2 cm/year median annualized growth velocity. Routinely monitor patient growth during treatment with OJEMDA [see Adverse Reactions (6), Use in Specific Populations (8.4)].
5.5 Embryo-Fetal Toxicity
SPL UNCLASSIFIED SECTION
Based on findings from animal studies and its mechanism of action, OJEMDA may cause fetal harm when administered to a pregnant woman. Tovorafenib was embryo lethal in rats at doses approximately 0.8-fold the human exposure at the recommended dose based on area under the curve (AUC). Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective nonhormonal contraception during treatment with OJEMDA and for 28 days after the last dose, since OJEMDA can render some hormonal contraceptives ineffective [see Drug Interactions (7.2)]. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with OJEMDA and for 2 weeks after the last dose [see Use in Specific Populations (8.1, 8.3)].
5.6 NF1 Associated Tumors
SPL UNCLASSIFIED SECTION
Based on nonclinical data in NF1 models without BRAF alterations, tovorafenib may promote tumor growth in patients with NF1 tumors [see Nonclinical Toxicology (13.2)]. Confirm evidence of a BRAF alteration prior to initiation of treatment with OJEMDA.
6 ADVERSE REACTIONS
ADVERSE REACTIONS SECTION
The following clinically significant adverse reactions are described elsewhere in the labeling:
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The safety population described in WARNINGS AND PRECAUTIONS reflects exposure to OJEMDA taken orally once weekly at a dose based on body surface area [see Clinical Studies (14)] in 140 patients with relapsed or refractory pediatric LGG or advanced solid tumors harboring a RAF alteration and a flat dose of 600 mg in 32 adult patients with advanced solid tumors until disease progression or intolerable toxicity. Among 172 patients treated with OJEMDA, 86% were exposed for 6 months or longer and 49% were exposed for 1 year or longer.
SPL UNCLASSIFIED SECTION
Pediatric Low-grade Glioma
The safety of OJEMDA was evaluated in 137 patients with relapsed or refractory pediatric LGG harboring a BRAF alteration in FIREFLY-1 (Arms 1 and 2) [see Clinical Studies (14)]. Patients received OJEMDA at a dose based on body surface area [see Dosage and Administration (2.3] orally once weekly until disease progression or intolerable toxicity.
The median age of patients was 9 years (range 1 to 24 years); 53% male; 58% White, 7% Asian, 2% Black or African American, 6% other races, 25% race was not reported; 2.9% were Hispanic or Latino; and 90% Karnofsky/Lansky performance status of 80 to 100.
Serious adverse reactions occurred in 45% of patients who received OJEMDA. Serious adverse reactions in >2% of patients included viral infection (9%), pneumonia (4%), and sepsis (4%). A fatal adverse reaction of tumor hemorrhage occurred in 1 patient (1%).
Permanent discontinuation of OJEMDA due to an adverse reaction occurred in 7% of patients. Adverse reactions which resulted in permanent discontinuation of OJEMDA in more than one patient were tumor hemorrhage and reduction in growth velocity.
Dosage interruptions of OJEMDA due to an adverse reaction occurred in 57% of patients. Adverse reactions which required dose interruption in ≥5% of patients included rash, pyrexia, vomiting, and hemorrhage.
Dosage reductions of OJEMDA due to an adverse reaction occurred in 24% of patients. Adverse reactions which required dose reduction in ≥2% of patients included rash, and fatigue.
The most common adverse reactions (≥30%) were rash, hair color changes, fatigue, viral infection, vomiting, headache, hemorrhage, pyrexia, dry skin, constipation, nausea, dermatitis acneiform, and upper respiratory tract infection.
The most common Grade 3 or 4 laboratory abnormalities (≥2%) were decreased phosphate, decreased hemoglobin, increased creatine phosphokinase, increased alanine aminotransferase, decreased albumin, decreased lymphocytes, decreased leukocytes, increased aspartate transferase, decreased potassium, and decreased sodium.
Table 6 and Table 7 present adverse reactions and laboratory abnormalities, respectively, identified in FIREFLY-1 (Arms 1 and 2).
Table 6 Adverse Reactions (≥20%) in Patients with Pediatric LGG Who Received OJEMDA in FIREFLY-1 (Arms 1 and 2)
Other clinically important adverse reactions observed in <20% of patients treated with OJEMDA were reductions in growth velocity [see Warnings and Precautions (5.4)] skin discoloration, myalgia, photosensitivity reaction [see Warnings and Precautions (5.2)], and arthralgia.
Table 7 Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients with Pediatric LGG Who Received OJEMDA in FIREFLY-1 (Arms 1 and 2)
* Severity as defined by National Cancer Institute CTCAE v5.0
† The denominator for each laboratory parameter is based on the number of patients with a baseline and post-treatment laboratory value available which ranged from 67 to 137 patients.
Increased creatine phosphokinase was a clinically important laboratory abnormality that worsened from baseline in patients treated with OJEMDA.
7 DRUG INTERACTIONS
DRUG INTERACTIONS SECTION
7.1 Effects of Other Drugs on OJEMDA
SPL UNCLASSIFIED SECTION
Table 8 describes drug interactions where coadministration with another drug affects OJEMDA.
Table 8 Coadministration with Other Drugs that Affect the Use of OJEMDA
Strong or Moderate CYP2C8 Inhibitors
Prevention or Management
Avoid coadministration of OJEMDA with a strong or moderate CYP2C8 inhibitor.
Mechanism and Clinical Effect(s)
Tovorafenib is a CYP2C8 substrate. Strong or moderate CYP2C8 inhibitors are predicted to increase tovorafenib exposure based on a mechanistic understanding of its elimination [see Clinical Pharmacology (12.3)], which may increase the risk of adverse reactions with OJEMDA.
Strong or Moderate CYP2C8 Inducers
Prevention or Management
Avoid coadministration of OJEMDA with a strong or moderate CYP2C8 inducer.
Mechanism and Clinical Effect(s)
Tovorafenib is a CYP2C8 substrate. Strong or moderate CYP2C8 inducers are predicted to decrease tovorafenib exposure based on a mechanistic understanding of its elimination [see Clinical Pharmacology (12.3)], which may reduce the effectiveness of OJEMDA.
7.2 Effects of OJEMDA on Other Drugs
SPL UNCLASSIFIED SECTION
Table 9 describes drug interactions where coadministration with OJEMDA affects another drug.
Table 9 Coadministration with OJEMDA that Affects the Use of Other Drugs
CYP3A Substrates
Prevention or Management
Hormonal Contraceptives: Avoid coadministration of hormonal contraceptives with OJEMDA. If coadministration is unavoidable, use an additional effective nonhormonal contraceptive method during coadministration and for 28 days after discontinuation of OJEMDA.
Other CYP3A Substrates: Avoid coadministration of OJEMDA with certain CYP3A substrates where minimal concentration changes may lead to serious therapeutic failures. If coadministration is unavoidable, monitor patients for loss of efficacy unless otherwise recommended in the Prescribing Information for CYP3A substrates.
Mechanism and Clinical Effect(s)
Tovorafenib is a CYP3A inducer.
Tovorafenib is predicted to decrease exposure of certain CYP3A substrates where minimal concentration changes may lead to serious therapeutic failures [see Clinical Pharmacology (12.3)], which may reduce the effectiveness of these substrates.
Coadministration with hormonal contraceptives (CYP3A substrate) may decrease progestin-x and ethinyl estradiol exposure, which may lead to contraceptive failure and/or an increase in breakthrough bleeding [see Warnings and Precautions (5.5), Use in Specific Populations (8.3)].
8 USE IN SPECIFIC POPULATIONS
USE IN SPECIFIC POPULATIONS SECTION
8.1 Pregnancy
PREGNANCY SECTION
SPL UNCLASSIFIED SECTION
Risk Summary
Based on findings from animal studies and its mechanism of action [see Clinical Pharmacology (12.1)], OJEMDA can cause fetal harm when administered to a pregnant woman. There are no available data on the use of OJEMDA in pregnant women. Oral administration of tovorafenib to pregnant rats during the period of organogenesis resulted in embryo lethality at exposures 0.8 times the human exposure at the recommended dose based on AUC (see Data). Advise pregnant women of the potential risk to a fetus. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.
SPL UNCLASSIFIED SECTION
Data
SPL UNCLASSIFIED SECTION
Animal Data
In an embryo-fetal development study, once daily oral administration of tovorafenib to pregnant rats during the period of organogenesis from gestation days 7 through 17 at doses of 37.5, 75, and 150 mg/kg resulted in early resorptions and total litter loss at all doses. The dose of 37.5 mg/kg/day is approximately 0.8-fold the human exposure at the recommended dose based on AUC.
8.2 Lactation
LACTATION SECTION
SPL UNCLASSIFIED SECTION
Risk Summary
There are no data on the presence of tovorafenib or its metabolites in human milk, their effects on the breastfed child, or on milk production. Due to the potential for serious adverse reactions in breastfed children from OJEMDA, advise lactating women not to breastfeed during treatment with OJEMDA and for 2 weeks following the last dose.
Advise females of reproductive potential to use effective nonhormonal contraception during treatment with OJEMDA and for 28 days after the last dose. OJEMDA can render hormonal contraceptives ineffective [see Drug Interactions (7.2)].
SPL UNCLASSIFIED SECTION
Males
Advise male patients with female partners of reproductive potential to use effective contraception during treatment with OJEMDA and for 2 weeks after the last dose.
SPL UNCLASSIFIED SECTION
Infertility
Based on findings in animals, OJEMDA may impact fertility in males and females of reproductive potential. The effects on male animal fertility were reversible. The effects on female animal fertility were not reversible [see Nonclinical Toxicology (13.1)].
8.4 Pediatric Use
PEDIATRIC USE SECTION
The safety and effectiveness of OJEMDA in pediatric patients 6 months of age and older with relapsed or refractory pediatric LGG harboring a BRAF fusion or rearrangement, or BRAF V600 mutation have been established based on data from a multicenter, open-label, single-arm clinical trial [see Clinical Studies (14)].
The efficacy of OJEMDA was evaluated in 76 patients with relapsed or refractory pediatric LGG. The safety of OJEMDA was evaluated in 137 patients with relapsed or refractory pediatric LGG in FIREFLY-1 (Arms 1 and 2). Of these 137 patients, 2% (n=3) were 6 month to < 2 years of age, 67% (n=92) were 2 years to < 12 years of age, and 31% (n=42) were >12 years of age [see Adverse Reactions (6.1)]. Cmax and AUC in pediatric patients aged 11 months to 17 years were within the range of values observed in adults given the same dose per body surface area.
The safety and effectiveness of OJEMDA in patients younger than 6 months of age have not been established.
SPL UNCLASSIFIED SECTION
Effect on Growth
Patients with pediatric LGG treated with OJEMDA for up to 24 months showed reductions from baseline in Z-scores for height compared to age and sex-matched normative data. Among 35 patients who experienced reductions in growth velocity who had hand radiographs taken to assess bone age, there was no evidence of premature closure of the epiphyseal growth plates or advancement of bone age. Patients followed after interruption of treatment with OJEMDA showed recovery of growth and increase in Z-scores. Monitor growth routinely during treatment [see Warnings and Precautions (5.4)].
8.6 Hepatic Impairment
HEPATIC IMPAIRMENT SUBSECTION
No dose adjustment is recommended for patients with mild (bilirubin ≤ upper limit of normal (ULN) and aspartate aminotransferase (AST) > ULN or bilirubin > 1× to 1.5× ULN and any AST) hepatic impairment. OJEMDA has not been studied in patients with moderate (bilirubin > 1.5× to 3× ULN and any AST) to severe (bilirubin > 3× ULN and any AST) hepatic impairment [see Clinical Pharmacology (12.3)].
8.7 Renal Impairment
RENAL IMPAIRMENT SUBSECTION
No dose adjustment is recommended for patients with mild-to-moderate renal impairment (eGFR ≥ 30 mL/min/1.73 m2 calculated by Schwartz equation or MDRD equation). OJEMDA has not been studied in patients with severe renal impairment (eGFR <30 mL/min/1.73 m2) [see Clinical Pharmacology (12.3)].
11 DESCRIPTION
DESCRIPTION SECTION
OJEMDA contains tovorafenib, a kinase inhibitor. Tovorafenib has the molecular formula C17H12Cl2F3N7O2S and a molecular weight of 506.29. The chemical name for tovorafenib is 6-amino-5-chloro-N-[(1R)-1-[5-[[[5-chloro-4-(trifluoromethyl)-2-pyridinyl]amino]carbonyl]-2-thiazolyl]ethyl]-4-pyrimidinecarboxamide. Tovorafenib has the following chemical structure:
Chemical Structure
It is a white to off-white powder. The solubility of tovorafenib at 37ºC is ≤ 3 micrograms/mL from pH 1.2 to 8 in aqueous media.
OJEMDA (tovorafenib) tablets are supplied as 100 mg strength tablets for oral administration. Each tablet contains 100 mg tovorafenib and the following inactive ingredients: copovidone, colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, and orange film coating (hypromellose, polyethylene glycol 8000, titanium dioxide, ferric oxide yellow, ferric oxide red).
OJEMDA (tovorafenib) for oral suspension is a white to off white powder which produces a white suspension when reconstituted with water. Each mL of reconstituted tovorafenib suspension contains 25 mg of tovorafenib and the following inactive ingredients: artificial strawberry flavor, colloidal silicon dioxide, copovidone, maltodextrin, mannitol, microcrystalline cellulose, simethicone, sodium lauryl sulfate, and sucralose.
12 CLINICAL PHARMACOLOGY
CLINICAL PHARMACOLOGY SECTION
12.1 Mechanism of Action
MECHANISM OF ACTION SECTION
Tovorafenib is a Type II RAF kinase inhibitor of mutant BRAF V600E, wild-type BRAF, and wild-type CRAF kinases.
Tovorafenib exhibited antitumor activity in cultured cells and xenograft tumor models harboring BRAF V600E and V600D mutations, and in a xenograft model harboring a BRAF fusion.
12.2 Pharmacodynamics
PHARMACODYNAMICS SECTION
SPL UNCLASSIFIED SECTION
Exposure Response Relationships
Tovorafenib exposure is associated with reduction in height-for-age z-scores in pediatric patients. Reduced height-for-age risk persists during treatment with tovorafenib.
Higher tovorafenib exposure is associated with increased risk of skin rash, elevated liver enzymes (AST and ALT), and elevated creatine phosphokinase.
The exposure-response relationship for overall response rate based on RAPNO-LGG (Response Assessment in Pediatric Neuro-Oncology), and RANO-LGG (Response Assessment in Neuro-Oncology) were not clinically significant over the dosage range of 290 to 476 mg/m2 (0.76-1.25 times the approved recommended dosage) [see Dosage and Administration (2.3) and Clinical Studies (14)].
SPL UNCLASSIFIED SECTION
Cardiac Electrophysiology
At the recommended OJEMDA dosage of 380 mg/m2 orally once weekly (not to exceed 600 mg), a mean increase in the QT interval >20 milliseconds was not observed.
12.3 Pharmacokinetics
PHARMACOKINETICS SECTION
Tovorafenib pharmacokinetic parameters are presented as mean (CV%) unless otherwise indicated. Tovorafenib steady state maximum concentration (Cmax) is 6.9 µg/mL (23%) and the area under the concentration-time curve (AUC) is 508 µg*h/mL (31%). Time to reach steady state of tovorafenib is 12 days (33%). Tovorafenib exposure increases in a dose-proportional manner. No clinically significant tovorafenib accumulation occurs.
SPL UNCLASSIFIED SECTION
Absorption
Tovorafenib median (minimum, maximum) time to achieve peak plasma concentration (Tmax) is 3 hours (1.5, 4 hours), following a single dose with tablets or oral suspension.
SPL UNCLASSIFIED SECTION
Effect of Food
No clinically significant differences in tovorafenib Cmax and AUC were observed following administration of tablets with a high-fat meal (approximately 859 total calories, 54% fat) compared to fasted conditions, but the Tmax was delayed to 6.5 hours.
SPL UNCLASSIFIED SECTION
Distribution
Tovorafenib apparent volume of distribution is 60 L/m2 (23%). Tovorafenib is 97.5% bound to human plasma proteins in vitro.
SPL UNCLASSIFIED SECTION
Elimination
Tovorafenib terminal half-life is approximately 56 hours (33%) and the apparent clearance is 0.7 L/h/m2 (31%).
SPL UNCLASSIFIED SECTION
Metabolism
Tovorafenib is primarily metabolized by aldehyde oxidase and CYP2C8 in vitro. CYP3A, CYP2C9, and CYP2C19 metabolize tovorafenib to a minor extent.
SPL UNCLASSIFIED SECTION
Excretion
Following a single oral dose of radiolabeled tovorafenib, 65% of the total radiolabeled dose was recovered in the feces (8.6% unchanged) and 27% of the dose was recovered in the urine (0.2% unchanged).
SPL UNCLASSIFIED SECTION
Specific Populations
No clinically significant differences of tovorafenib were observed based on age (range: 1 to 94 years), sex, race (White, Black, Asian), mild hepatic impairment [bilirubin ≤ upper limit of normal (ULN) and AST > ULN or bilirubin > 1 to 1.5× ULN and any AST], and mild-to-moderate renal impairment (eGFR) ≥ 30 mL/min/1.73 m2 calculated by Schwartz equation or MDRD equation.
SPL UNCLASSIFIED SECTION
Drug Interaction Studies
SPL UNCLASSIFIED SECTION
Clinical Studies and Model-Informed Approaches
SPL UNCLASSIFIED SECTION
CYP3A Substrates: Midazolam (CYP3A4 substrate) steady-state Cmax and AUC are predicted to decrease by at least 20% following coadministration with tovorafenib.
SPL UNCLASSIFIED SECTION
In Vitro Studies
SPL UNCLASSIFIED SECTION
CYP450 Enzymes: Tovorafenib inhibits CYP2C8, CYP2C9, CYP2C19 and CYP3A, but does not inhibit CYP1A2, CYP2B6, and CYP2D6 at clinically relevant concentrations.
Tovorafenib induces CYP3A, CYP2C8, CYP1A2, CYP2B6, CYP2C9 and CYP2C19 at clinically relevant concentrations.
SPL UNCLASSIFIED SECTION
Transporter Systems: Tovorafenib is not a substrate of BCRP, P-glycoprotein (P-gp), OATP1B1 and OATP1B3. Tovorafenib has not been evaluated as a substrate of OAT1, OAT3, MATE1, MATE2-K and OCT2. Tovorafenib inhibits BCRP at clinically relevant concentrations.
13 NONCLINICAL TOXICOLOGY
NONCLINICAL TOXICOLOGY SECTION
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY SECTION
Tovorafenib was not carcinogenic in the 6-month study in transgenic rasH2 mice that received oral doses up to 100 mg/kg/day.
Tovorafenib was not mutagenic in the in vitro bacterial reverse mutation (Ames) assay. Tovorafenib was not genotoxic in cultured human lymphocytes without metabolic activation. Tovorafenib induced chromosomal aberrations in cultured human lymphocytes with metabolic activation at a single concentration in vitro. Tovorafenib was not genotoxic in an in vivo rat bone marrow micronucleus assay.
In a fertility and early embryonic development study in rats, animals were administered tovorafenib doses of 37.5, 75, or 150 mg/kg/day orally. Female animals, paired with untreated males, were dosed for 14 days prior to pairing, during the mating period, and up to Gestation Day 6. Tovorafenib decreased the number of pregnancies, corpora lutea, and live embryos, as well as increased post-implantation losses at all doses. The dose of 37.5 mg/kg/day is approximately 0.8-fold the human exposure at the recommended dose based on AUC.
In repeat- dose toxicology studies in rats of up to 3 months duration, tovorafenib-related findings in female rats included reversible increased thickness of the vaginal mucosa, increased size and/or numbers of corpora hemorrhagicum and hemorrhage, and non-reversible cystic follicles, decreased corpora lutea, and interstitial cell hyperplasia were observed in ovaries at doses ≥ 50 mg/kg once every other day (approximately 0.4-fold the human exposure at the recommended dose based on AUC). In male rats, tovorafenib reduced weights of epididymis and testes, which correlated with reversible tubular degeneration/atrophy of the testes and reduced epididymal sperm at doses ≥ 50 mg/kg once every other day (approximately 0.3-fold the human exposure at the recommended dose based on AUC).
13.2 Animal Toxicology and/or Pharmacology
ANIMAL PHARMACOLOGY & OR TOXICOLOGY SECTION
In vitro, tovorafenib increased phosphorylation of ERK at clinically relevant concentrations in cells with neurofibromatosis Type 1-loss of function (NF1-LOF) suggesting activation, rather than inhibition, of the MAP kinase pathway. In an NF1 genetically engineered mouse model of plexiform neurofibroma without BRAF alteration, tovorafenib did not have antitumor activity, and while not statistically significant, an increase in tumor volume was noted in 2/12 mice (approximately 17%).
14 CLINICAL STUDIES
CLINICAL STUDIES SECTION
The efficacy of OJEMDA was evaluated in a multicenter, open-label, single-arm clinical trial (FIREFLY-1; NCT04775485). Eligible patients (N=76) were required to have a relapsed or refractory pediatric low-grade glioma (LGG) harboring an activating BRAF alteration based on local laboratory testing. Patients were also required to have at least one measurable lesion as defined by RANO 2010 criteria. All patients had received at least one line of prior systemic therapy and had documented evidence of radiographic progression. Patients with tumors harboring additional activating molecular alteration(s) (e.g., IDH1/2 mutations, FGFR mutations, etc.) or patients with known or suspected diagnosis of neurofibromatosis type 1 (NF1) were excluded.
Patients received OJEMDA approximately 420 mg/m2 orally once weekly (range: 290 to 476 mg/m2, 0.76-1.25 times the approved recommended dosage) according to body surface area with a maximum dose of 600 mg until disease progression or unacceptable toxicity. Although the OJEMDA dosages administered in FIREFLY-1 were between 290 mg/m2 to 476 mg/m2, the recommended OJEMDA dosage is 380 mg/m2 orally once weekly because this dosage was determined to be safe and effective for the treatment of patients 6 months of age and older with relapsed or refractory pediatric LGG harboring a BRAF fusion or rearrangement, or BRAF V600 mutation [see Dosage and Administration (2.3)].
Tumor assessments were performed every 12 weeks.
The major efficacy outcome measure was overall response rate (ORR), defined as the proportion of patients with complete response (CR), partial response (PR), or minor response (MR) by blinded independent central review based on RAPNO-LGG (Response Assessment in Pediatric Neuro-Oncology) criteria. Additional efficacy outcome measures were duration of response, time to response, and ORR by independent review based on RANO-LGG (2011) criteria.
The efficacy population included 76 patients who had measurable disease at baseline and who received OJEMDA. The median age was 8.5 years (range 2 to 21 years); 53% were male; 61% White, 7% Asian, 2.6% Black or African American, 3.9% multiple races, 8% other race, 18% where race was not reported; 3.9% were Hispanic or Latino, and 93% had Karnofsky/Lansky performance status of 80 to 100. Patients received a median of 3 prior systemic regimens (range: 1 to 9). Forty-five patients (59%) received prior treatment with a MAP kinase pathway inhibitor. The most common tumor locations were the optic pathway (51%), deep midline structures (12%), brain stem (8%), cerebellum (7%), and cerebral hemisphere (5%). Fifty-six patients (74%) had a KIAA1549:BRAF fusion, twelve patients (16%) had a V600E mutation, and eight patients (11%) had a BRAF alteration classified as "other" including BRAF duplication or BRAF rearrangement. Efficacy results are shown in Table 10.
Among responders, the median time to response was 5.4 months (range 1.6, 17.5). In exploratory analyses of BRAF alteration status, the ORR was 53% among patients with BRAF fusion or rearrangement (n=64), and 50% among patients with BRAF V600E mutation (n=12), respectively. In exploratory analyses of prior therapies, the ORR was 51% among patients who had received prior MAPK-targeted therapy (n=45), and 55% among patients who had not received prior MAPK-targeted therapy (n=31).
Based on RANO-LGG (2011) criteria (n=76), the ORR was 54% [95% CI: (42, 65)], including 23 patients with PR and 18 patients with MR.
16 HOW SUPPLIED/STORAGE AND HANDLING
HOW SUPPLIED SECTION
SPL UNCLASSIFIED SECTION
OJEMDA tablets:
100 mg: orange, film-coated, oval tablets debossed with "100" on one side and "D101" on the opposite side and supplied as follows:
Weekly dose
Each carton contains
Each blister card contains
NDC
400 mg
4 blister cards
four 100 mg tablets
NDC 82950-001-16
500 mg
4 blister cards
five 100 mg tablets
NDC 82950-001-20
600 mg
4 blister cards
six 100 mg tablets
NDC 82950-001-24
Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature].
Dispense product in the original package. Tablets should not be removed from blister cards until immediately before use.
STORAGE AND HANDLING SECTION
OJEMDA for oral suspension:
25 mg/mL: white to off white powder in a clear glass bottle, co-packaged with a press-in bottle adaptor and a 20 mL oral dosing syringe (NDC# 82950-012-01).
Each mL of reconstituted, strawberry flavored tovorafenib suspension contains 25 mg of tovorafenib. Each bottle delivers 300 mg of tovorafenib in 12 mL.
Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature].
Do not use if safety seal under cap is broken or missing.
Suspension must be used immediately after reconstitution.
Discard the bottle (including any unused portion) and syringe after dosing.
17 PATIENT COUNSELING INFORMATION
INFORMATION FOR PATIENTS SECTION
Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use).
SPL UNCLASSIFIED SECTION
Hemorrhage
Advise patients that OJEMDA can cause bleeding and to contact their healthcare provider for signs or symptoms of bleeding [see Warnings and Precautions (5.1)].
SPL UNCLASSIFIED SECTION
Skin Toxicities
Advise patients that OJEMDA can cause skin toxicities and to contact their healthcare provider for worsening or intolerable rash [see Warnings and Precautions (5.2)].
SPL UNCLASSIFIED SECTION
Photosensitivity
Advise patients that OJEMDA can cause photosensitivity. Advise patients to limit direct ultraviolet exposure during treatment with OJEMDA. Recommend that patients use precautionary measures such as use of sunscreen, sunglasses, and/or protective clothing during treatment with OJEMDA [see Warnings and Precautions (5.2)].
SPL UNCLASSIFIED SECTION
Hepatotoxicity
Advise patients that OJEMDA can cause liver toxicity and to contact their healthcare provider for signs or symptoms of liver dysfunction. Advise patients that serial testing of serum liver tests (ALT, AST, bilirubin) is recommended during treatment with OJEMDA [see Warnings and Precautions (5.3)].
SPL UNCLASSIFIED SECTION
Effect on Growth
Advise patients and caregivers that treatment with OJEMDA may cause a reduction in growth velocity, and that growth will be monitored during treatment with OJEMDA [see Warnings and Precautions (5.4)].
Advise females to inform their healthcare provider of a known or suspected pregnancy during treatment with OJEMDA.
Advise females of reproductive potential to use effective nonhormonal contraception during treatment and for 28 days after discontinuation of treatment with OJEMDA.
Advise male patients with female partners of reproductive potential to use effective nonhormonal contraception during treatment with OJEMDA and for 2 weeks after the last dose.
SPL UNCLASSIFIED SECTION
Lactation
Advise women not to breastfeed during treatment with OJEMDA and for 2 weeks after the last dose of OJEMDA [see Use in Specific Populations (8.2)].
SPL UNCLASSIFIED SECTION
Infertility
Advise males and females of reproductive potential of the potential risk for impaired fertility with OJEMDA [see Nonclinical Toxicology (13.1)].
SPL UNCLASSIFIED SECTION
Dosing and Administration
Inform patients and caregivers on how to take OJEMDA and what to do for missed or vomited doses [see Dosage and Administration (2.4)].
Day One Biopharmaceuticals, Inc. Brisbane CA 94005
Manufactured by (tablets): Quotient Sciences – Philadelphia LLC 3 Chelsea Parkway, Suite 305 Boothwyn PA 19061
Manufactured by (oral suspension): Quotient Sciences – Philadelphia LLC 3080 McCann Farm Dr. Garnet Valley, PA 19060
DAY101-USPI-082025v04
SPL PATIENT PACKAGE INSERT SECTION
This Patient Information has been approved by the U.S. Food and Drug Administration. DAY101-PPI-082025v04
Revised: 08/2025
PATIENT INFORMATION
OJEMDA (oh-JEM-dah) (tovorafenib) tablets, for oral use
OJEMDA (oh-JEM-dah) (tovorafenib) for oral suspension
What is OJEMDA? OJEMDA is a prescription medicine used to treat certain types of brain tumors (cancers) called gliomas in people 6 months and older:
that is a pediatric low-grade glioma (LGG), and
that has come back after previous treatment or has not responded to previous treatment and
that has a certain type of abnormal BRAF gene.
Your healthcare provider will perform a test to make sure that OJEMDA is right for you. It is not known if OJEMDA is safe and effective in children younger than 6 months of age.
Before taking or giving OJEMDA, tell your healthcare provider about all of your or your child's medical conditions, including if you:
have bleeding problems
have skin problems
have liver problems
are pregnant or plan to become pregnant. OJEMDA can harm your unborn baby. Females who are able to become pregnant:
Your healthcare provider will do a test to see if you are pregnant before starting treatment with OJEMDA.
You should use effective nonhormonal birth control (contraception) during treatment with OJEMDA and for 28 days after your last dose of OJEMDA.
Birth control methods that contain hormones (such as birth control pills, injections, or transdermal systems) may not work as well during treatment with OJEMDA and you could become pregnant. You should use another nonhormonal, effective method of birth control during treatment with OJEMDA.
Talk to your healthcare provider about birth control methods that may be right for you during this time.
Tell your healthcare provider right away if you become pregnant or think you might be pregnant during treatment with OJEMDA.
Males with female partners who are able to become pregnant should use effective nonhormonal birth control (contraception) during treatment with OJEMDA and for 2 weeks after your last dose of OJEMDA.
are breastfeeding or plan to breastfeed. It is not known if OJEMDA passes into your breast milk. Do not breastfeed during treatment and for 2 weeks after your last dose of OJEMDA. Talk to your healthcare provider about the best way to feed your baby during this time.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking certain other medicines can affect how OJEMDA works and may increase your risk of side effects. OJEMDA may also affect how other medicines work. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get any new medicine.
How should I take or give OJEMDA?
Take or give OJEMDA exactly as your healthcare provider tells you to. Do not change your or your child's dose or stop taking OJEMDA unless your healthcare provider tells you.
Your healthcare provider may change your or your child's dose of OJEMDA, temporarily stop, or completely stop your treatment with OJEMDA if you develop certain side effects.
Your healthcare provider will either prescribe you or your child OJEMDA tablets or OJEMDA for oral suspension.
Take or give OJEMDA 1 time each week.
Take or give OJEMDA with or without food.
If you miss a weekly dose of OJEMDA by:
3 days or less, take or give the missed dose as soon as you remember. Take or give the next dose of OJEMDA on the next regularly scheduled day.
more than 3 days, skip the missed dose and take or give the next dose of OJEMDA on the next regularly scheduled day.
If vomiting happens right after taking a dose of OJEMDA, take or give the dose again. If you are not sure if you should take or give another dose, contact your healthcare provider.
OJEMDA tablets:
Swallow tablets whole with water. Do not chew, cut, or crush the tablets.
OJEMDA for oral suspension:
See the Instructions for Use for instructions on how to prepare, measure and take or give a dose of OJEMDA for oral suspension. If you have any questions, talk to your healthcare provider or pharmacist.
The OJEMDA oral suspension can be taken or given by mouth, or through a feeding tube (minimum 12 French).
Your or your child's dose may require preparing 2 bottles of OJEMDA for oral suspension.
What should I avoid while taking OJEMDA?
Limit the amount of time you spend in sunlight. OJEMDA can make your skin sensitive to the sun (photosensitivity). Use sun protection measures, such as sunscreen, sunglasses and wear protective clothes that cover your skin during your treatment with OJEMDA.
What are the possible side effects of OJEMDA? OJEMDA may cause serious side effects, including:
bleeding problems (hemorrhage) are common during treatment with OJEMDA and can also be serious. Tell your healthcare provider if you develop any signs or symptoms of bleeding, including:
headache, dizziness or feeling weak
coughing up blood or blood clots
vomiting blood or your vomit looks like "coffee grounds"
red or black stools that look like tar
skin reactions, including sensitivity to sunlight (photosensitivity). OJEMDA can cause skin reactions that can become severe. Tell your healthcare provider if you get new or worsening skin reactions, including:
liver problems. Your healthcare provider will do blood tests to check your liver function before and during treatment with OJEMDA. Tell your healthcare provider right away if you develop any of the following symptoms:
yellowing of your skin or your eyes
dark or brown (tea-colored) urine
nausea or vomiting
loss of appetite
feeling tired
bruising
bleeding
pain in your upper right stomach area
slowed growth in children. Growth will be checked routinely during treatment with OJEMDA.
The most common side effects of OJEMDA include:
rash
hair color changes
feeling tired
viral infection
vomiting
headache
The most common severe abnormal blood tests include:
fever
dry skin
constipation
nausea
acne
upper respiratory tract infection
decreased phosphate
decreased red and white blood cells
increased creatine phosphokinase
increase in liver function test
decreased albumin
decreased potassium
decreased sodium
OJEMDA may cause fertility problems in males and females, which may affect your ability to have children. Talk to your healthcare provider if this is a concern for you. These are not all the possible side effects of OJEMDA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to Day One Biopharmaceuticals at 1-877-204-2820.
How should I store OJEMDA? OJEMDA tablets:
Store OJEMDA tablets at room temperature between 68˚F to 77˚F (20˚C to 25˚C).
Keep OJEMDA tablets in its original package. Tablets should not be removed from blister cards until right before use.
OJEMDA for oral suspension:
Store the glass bottle containing OJEMDA for oral suspension at room temperature between 68˚F to 77˚F (20˚C to 25˚C).
Do not use OJEMDA for oral suspension if the safety seal under the cap is broken or missing.
Throw away your bottle(s), including any unused or expired OJEMDA for oral suspension, and oral dosing syringe after taking or giving a dose.
Keep OJEMDA and all medicines out of the reach of children.
General information about the safe and effective use of OJEMDA. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use OJEMDA for a condition for which it was not prescribed. Do not give OJEMDA to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for more information about OJEMDA that is written for health professionals.
What are the ingredients in OJEMDA? Active ingredient: tovorafenib Inactive ingredients: Tablet: copovidone, colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, and orange film coating (hypromellose, polyethylene glycol 8000, titanium dioxide, ferric oxide yellow, ferric oxide red). For oral suspension: artificial strawberry flavor, colloidal silicon dioxide, copovidone, maltodextrin, mannitol, microcrystalline cellulose, simethicone, sodium lauryl sulfate, and sucralose.
INSTRUCTIONS FOR USE OJEMDA (oh-JEM-dah) (tovorafenib) for oral suspension
This Instructions for Use has been approved by the U.S. Food and Drug Administration.
Revised: 08/2025
This Instructions for Use contains information on how to prepare, measure, and take or give a dose of OJEMDA for oral suspension.
Important information you need to know before preparing, measuring, and taking or giving a dose of OJEMDA for oral suspension.
Read this Instructions for Use carefully before you prepare, measure, and take or give a dose of OJEMDA for oral suspension for the first time and each time you get a refill. There may be new information. This information does not take the place of talking with your or your child's healthcare provider about your or your child's medical treatment or condition.
Your healthcare provider or pharmacist should show you how to prepare, measure, and take or give a dose of OJEMDA for oral suspension correctly. Talk to your healthcare provider or pharmacist if you have questions.
Take or give OJEMDA for oral suspension exactly as your healthcare provider tells you to.
You will receive the OJEMDA prescription in a box that contains a bottle with powder, a 20 mL oral dosing syringe, and a bottle adaptor. Contact your healthcare provider or pharmacist if you do not have one or more of these items.
The bottle is made of glass. Do not use the bottle if it is broken or damaged. Contact your healthcare provider or pharmacist for a new bottle.
Check the expiration date on the bottle and box. Contact your pharmacist if the expiration date has passed. Expired or unused product can be thrown away (disposed of) in your household trash.
Only use room temperature water for preparing OJEMDA for oral suspension.
Each dose of OJEMDA for oral suspension must be given within 15 minutes after the medicine has been prepared.
Each bottle of OJEMDA for oral suspension is for single use only.
ENFIT syringe and ENFIT adaptor (if taking or giving OJEMDA oral suspension through a feeding tube)
Always use the oral dosing syringe provided to make sure that you correctly measure your prescribed dose.
The 20 mL oral dosing syringe is marked to help you correctly measure your prescribed dose of OJEMDA for oral suspension. The barrel of the oral dosing syringe has markings in milliliters (mL).
Add exactly 14 mL of room temperature water to the bottle to prepare the OJEMDA for oral suspension. Only 12 mL of OJEMDA oral suspension will be taken or given from each prepared bottle.
Note: Your prescribed dose of OJEMDA for oral suspension may require preparing 2 bottles of the powder to give your prescribed dose of OJEMDA for oral suspension. If 2 bottles are required:
always add exactly 14 mL of room temperature water to each bottle, and
prepare, take or give the dose of OJEMDA for oral suspension from the first bottle and then repeat the same steps to prepare, take or give the dose of OJEMDA for oral suspension from the second bottle.
OJEMDA for oral suspension can be taken or given by mouth using the 20 mL oral dosing syringe, or through a feeding tube with a minimum size of 12 French using an ENFIT syringe.
If you are taking or giving OJEMDA for oral suspension by mouth, follow Section A, Steps 1 to 19.
If taking or giving OJEMDA for oral suspension by a feeding tube, follow Section B, Steps 20 to 25.
Section A: Preparing, measuring, and taking or giving a dose of OJEMDA for oral suspension
Step 1. Wash and dry your hands before preparing, measuring, and taking or giving a dose of OJEMDA for oral suspension.
Step 2. Place your supplies on a clean, flat work surface.
Step 3. Fill a cup half-way with room temperature water. Do not use cold water.
Figure
Step 4. Remove air from the oral dosing syringe. Pull the plunger up into the oral dosing syringe as far as it will go, and then push the plunger back down into the oral dosing syringe as far as it will go. This will help to remove all the air inside.
Figure
Step 5. Place the oral dosing syringe tip in the water. Pull up on the plunger to draw water into the oral dosing syringe to the 14 mL mark. Note: Add exactly 14 ml of water to the bottle with powder.
Figure
Step 6. Remove the oral dosing syringe from the cup. Turn the oral dosing syringe tip upward and check for air bubbles. If large air bubbles appear in the oral dosing syringe, push the water back into the cup and then pull up on the plunger again to draw up the water to the 14 mL mark. Repeat Step 6 until there are no large air bubbles present. Small air bubbles are ok. Set the oral dosing syringe aside.
Figure
Step 7. Open the bottle with powder by pushing down firmly on the cap and turning it to the left (counter-clockwise).
Do not throw away the cap.
Remove the Safety seal.
Do not use the bottle with powder if the safety seal under the cap is broken or missing. Call your healthcare provider or pharmacist if the safety seal is broken.
Figure
Step 8. Insert the tip of the oral dosing syringe into the opening of the bottle. Push down on the plunger and inject 14 mL of water into the bottle.
Remove the tip of the emptied oral dosing syringe from the bottle and set it aside.
Right away, replace the cap back onto the bottle by pushing down while twisting the cap to the right (clockwise).
Shake the bottle well for 60 seconds in all directions.
Figure
Step 9: Turn bottle upside down to check for any powder stuck to the inside of the bottle.
If you still see powder in the bottle, continue to shake the bottle for another 15 seconds until you no longer see the powder inside the bottle.
Do not shake the bottle for more than 2 minutes total time.
Check the bottle to make sure all of the powder is no longer visible.
If you still see powder in the bottle, contact your healthcare provider or pharmacist and ask for a new bottle.
Figure
Step 10. Turn the bottle upside down again and swirl for 30 seconds.
Place the bottle on a flat, clean, work surface.
Remove the cap and check that no solids are stuck in the bottle neck.
If you see solids in the bottle neck, recap the bottle, turn the bottle upside down, and swirl for an additional 15 seconds.
Allow the bottle to sit for 60 seconds to allow most of the foam to settle.
Note: Foaming in the bottle will reduce the amount of OJEMDA for oral suspension.
Figure
Step 11. Open the bottle by firmly pressing down on the cap and turning it to the left (counterclockwise). Do not throw away the cap. Firmly insert the bottle adaptor into the bottle by pushing it tightly into the top of the bottle. The top edge of the bottle adaptor should be even with the bottle top. Do not remove the bottle adaptor after it is inserted into the bottle.
Figure
Step 12. Check your or your child's dose in milliliters (mL) as prescribed by your healthcare provider. Pick up the oral dosing syringe again. Each mark on the oral dosing syringe is equal to 1 mL. Draw air into the oral dosing syringe by pulling the plunger out to your prescribed dose. For example, if your prescribed dose is 12 mL, you would draw the oral dosing syringe by pulling the plunger out to the 12 mL mark.
Figure
Step 13. Insert the tip of the oral dosing syringe into the bottle adaptor.
The tip of the oral dosing syringe should fit snugly into the hole of the bottle adaptor.
Keep the oral dosing syringe attached to the bottle. With the oral dosing syringe in place and holding the bottle where the oral dosing syringe tip inserts into bottle adaptor, swirl the oral suspension for 30 seconds.
Figure
Step 14. Inject the air from the oral dosing syringe into the bottle. Hold the oral dosing syringe in place and turn the bottle upside down. To measure the prescribed dose, keep the tip of the oral dosing syringe facing up and pull down on the plunger until the top of the plunger lines up with the prescribed dose in mLs.
Figure
Step 15. While the syringe is still in the bottle, remove any air bubbles in the oral dosing syringe by gently pushing the OJEMDA oral suspension back into the bottle and then pulling down on the plunger again to draw up your prescribed dose. Repeat Step 15 until you see that few or no air bubbles remain or if you draw up the wrong dose in the oral dosing syringe. Note: Only use up to 12 mL of OJEMDA oral suspension from each prepared bottle.
If the prescribed dose is more than 12 mL (300 mg), split the dose as equally as possible between each prepared bottle.
For example, if your dose is 13 mL, draw 6 mL from the first prepared bottle, and 7 mL from the second prepared bottle.
Figure
Step 16: Leave the tip of the oral dosing syringe in the bottle adaptor and carefully turn the bottle upright. Put the bottle onto your flat work surface again. Slowly remove the oral dosing syringe tip from the bottle adaptor by gently pulling straight up. Do not hold the oral dosing syringe by the plunger because the plunger may come out.
Figure
Step 17: Check again to be sure the top of the black stopper on the barrel of the oral dosing syringe is at your prescribed mL dose mark. If you do not have the correct prescribed mL dose, repeat Steps 15 to 17. If you are taking or giving a dose of OJEMDA for oral suspension by mouth, continue to Step 18. If you are taking or giving a dose of OJEMDA for oral suspension through a feeding tube, go to Section B. OJEMDA for oral suspension must be given within 15 minutes after prepared for use.
Step 18. You or your child should sit upright to take or give a dose of OJEMDA oral suspension. Place the tip of the oral dosing syringe towards the inside of the cheek in your or your child's mouth.
Slowly push the medicine into the mouth by pressing down on the plunger.
Do not forcefully push the plunger. This may cause choking.
Allow the child to swallow while giving OJEMDA. You or your child may drink liquids right away after swallowing the OJEMDA for oral suspension.
Be sure to take or give the entire dose of OJEMDA for oral suspension.
If 2 bottles of OJEMDA for oral suspension are required to take or give your prescribed dose, repeat Section A, Steps 1 to 18 for the second bottle.
Throw away the prepared OJEMDA for oral suspension if it is not taken or given within 15 minutes.
Figure
Step 19: See Section C for instructions on "How to throw away used bottles, expired or unused OJEMDA for oral suspension, and oral dosing syringes"
Section B: Taking or giving a dose of OJEMDA or oral suspension through a feeding tube
Before giving a dose of OJEMDA for oral suspension through a feeding tube, read the following information and talk to your or your child's healthcare provider before continuing to STEP 20:
OJEMDA for oral suspension may be given through a feeding tube, as directed by your healthcare provider.
Only use a feeding tube with a minimum size of 12 French.
Always use the 20 mL oral dosing syringe (included in the box) to prepare each dose of OJEMDA for oral suspension in the bottle.
Always use a 20 mL ENFIT syringe and an ENFIT adaptor (neither included in the box) to measure and give each dose of OJEMDA for oral suspension through the feeding tube.
Step 20. Flush the feeding tube according to the manufacturer's instructions before giving a dose of OJEMDA for oral suspension.
Step 21: Follow Steps 1 to 11 in Section A to prepare the OJEMDA oral suspension using the 20 mL oral dosing syringe. Follow Steps 12 to 17 in Section A to draw up your or your child's dose of OJEMDA for oral suspension using the ENFIT syringe and ENFIT adaptor.
Step 22: Connect the 20 mL ENFIT syringe containing OJEMDA for oral suspension to the feeding tube.
Step 23: Apply steady pressure to the plunger to give the entire dose of OJEMDA for oral suspension through the feeding tube.
Step 24: Flush the feeding tube after giving each dose of OJEMDA for oral suspension according to the manufacturer's instructions. If 2 bottles are required, repeat Step 21 and give the remainder of the dose right away.
Step 25: Go to Section C for instructions on "How to throw away used bottles, expired or unused OJEMDA for oral suspension, and oral dosing syringes"
Section C: How to throw away used bottles, expired or unused OJEMDA for oral suspension, and oral dosing syringes
Throw away your used bottle(s), expired or unused OJEMDA for oral suspension, and oral dosing syringe(s) in your household trash.
Do not re-use the oral dosing syringe(s).
How should I store OJEMDA?
Store the glass bottle containing OJEMDA for oral suspension at room temperature between 68˚F to 77˚F (20˚C to 25˚C).
Keep OJEMDA for oral suspension, the oral dosing syringe, and all medicines out of the reach of children.
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