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Clinical Pharmacology

What is the Pharmacokinetics profile of FACTIVE?

FACTIVE is rapidly absorbed after oral administration, achieving its peak plasma concentration around 1 hour after dosing.1 Because it has a relatively long half-life of 7-8 hours,2 it is compatible with a once-daily dosing schedule. There is no accumulation of FACTIVE after multiple dosing over several days.2

Between 25-40% of the oral dose of FACTIVE can be detected unchanged in the urine.3 Dosage adjustments are unlikely to be necessary in patients with mild-to moderate renal or hepatic impairment.

The pharmacokinetics of FACTIVE are not significantly affected by age or by food intake.3

[Pharmacokinetics of FACTIVE3]

AUC/MIC90 ratios can be used to indicate the likely efficacy of a quinolone antibiotic just as T>MIC can be used to predict the likely efficacy of a β-lactam antibiotic: the higher the AUC/MIC90 ratio, the more effective the quinolone is likely to be. FACTIVE has a superior AUC/MIC90 ratio against streptococci compared with other quinolones.3 As shown the study below, FACTIVE has the highest AUIC, an indicator correlated with clinical outcomes and efficacy.

[24h AUC/MIC90 Ratio on S pneumoniae*†‡4,5,6 ]

The study shows that FACTIVE distributes in respiratory organ with higher concentration compared to other quinolones.7

[Conc./MIC90 in Respiratory Organ7]

Cost-effectiveness of FACTIVE

Due to shorter dosage regimen, the highest AUIC, and lower reoccurrence rate, some studies proved that FACTIVE is cost-effective. A long-term outcomes in AECB (GLOBE study) and CAP patients support the clinical and financial benefits of using antibiotics with high AUICs. 8,9

[Cost-effectiveness of oral FACTIVE in CAP8]

*1st level: antimicrobial acquisition
  2nd level: 1st plus preparation, dispensing, and administration costs, and treatment of antimicrobial-related adverse events and clinical failures
  3rd level: 1+2st level plus per diem costs for hospital stay related to study drug administration

The cost-effectiveness of oral gemifloxacin was studied by Dr. Ambrose group, compared with IV followed by oral cefuroxime with or without macrolide. And it was observed that Factive has lower median cost per expected success.

[Cost-effectiveness in GLOBE study (AECB)*9]

*‘…….the mean direct cost per patient receiving gemifloxacin was $127 less than with clarithromycin.’
*‘…….mean total costs (direct plus indirect) per patient were $329 less for patients receiving gemifloxacin.’

The cost-effectiveness of FACTIVE therapy in AECB was investigated in the Gemifloxacin Long-term Outcomes in GLOBE study and Factive proved to lower mean total treatment cost.

References

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Important Safety Information

THE SAFETY AND EFFECTIVENESS OF FACTIVE IN CHILDREN, ADOLESCENTS (<18 YEARS OF AGE), PREGNANT WOMEN, AND LACTATING WOMEN HAVE NOT BEEN ESTABLISHED.

FACTIVE is contraindicated in patients with a history of hypersensitivity to gemifloxacin, fluoroquinolone antibiotic agents, or any of the product components. Serious hypersensitivity and/or anaphylactic reactions have been reported in patients receiving fluoroquinolone therapy, including FACTIVE. Hypersensitivity reactions reported in patients receiving fluoroquinolone therapy have occasionally been fatal. These reactions may include serious, sometimes fatal skin reactions such as toxic epidermal necrolysis or Stevens-Johnson Syndrome; effects on the liver, including hepatitis, jaundice, and acute hepatic necrosis or failure; renal toxicities including interstitial nephritis and/or acute renal insufficiency or failure; and hematologic effects, including agranulocytosis, thrombocytopenia, and other hematologic abnormalities. These reactions may occur following the first dose or multiple doses. FACTIVE should be discontinued immediately at the first sign of an immediate type I hypersensitivity skin rash or any other manifestation of hypersensitivity reaction.

Fluoroquinolones, including FACTIVE, are associated with an increased risk of tendinitis and tendon rupture in all ages. This risk is further increased in older patients usually over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart, or lung transplants. Call your healthcare professional right away at the first sign of tendon pain, swelling, or inflammation. You should stop taking FACTIVE until tendinitis or tendon rupture have been ruled out, and avoid exercise and using the affected area.

Fluoroquinolones may prolong the QT interval in some patients. FACTIVE should be avoided in patients with a history of prolongation of the QTc interval, patients with uncorrected electrolyte disorders (hypokalemia or hypomagnesemia), and patients receiving Class IA or Class III antiarrhythmic agents.

Rare cases of peripheral neuropathy have been reported in patients receiving quinolones.

In clinical studies with FACTIVE, central nervous system (CNS) effects have been reported infrequently. As with other fluoroquinolones, FACTIVE should be used with caution in patients with known or suspected CNS diseases. If CNS reactions occur, FACTIVE should be discontinued and appropriate measures instituted.

Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibiotic agents, including FACTIVE. If diarrhea occurs, evaluate for CDAD and treat appropriately.

In clinical trials, rash occurred more often with FACTIVE than therapy with comparator agents (2.8% vs. 0.6%). Increasing incidence of rash was associated with younger age (especially below 40), female gender, use of hormone replacement therapy, and longer duration of therapy.

Moderate to severe photosensitivity/phototoxicity reactions can be associated with the use of quinolones after sun or UV light exposure. Excessive exposure to the sun or UV light should be avoided.

Magnesium- and/or aluminum-containing antacids, products containing ferrous sulfate (iron), multivitamin preparations containing zinc or other cations, or Videx® (didanosine) chewable/buffered tablets or the pediatric powder for oral solution should not be taken within 3 hours before or 2 hours after FACTIVE. Sucralfate should not be taken within 2 hours of FACTIVE.

In clinical trials, the most common adverse drug reactions (≥2%) were diarrhea, rash, nausea, headache, abdominal pain, vomiting, and dizziness.

This product is available by prescription only.

* Videx® is a registered trademark of Bristol-Myers Squibb Company.

For US residents,
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

For Non-US residents,
You are encouraged to report negative side effects of prescription drugs, please click here or call 82-2-6924-3620.

Please note that the information contained on this site is intended for international health care providers and may not be appropriate for your country of origin. Please see the full FACTIVE prescribing information for your country for approved product indications, dosing, and important safety considerations. Click on the "Global Countries" tab above to learn how to obtain country-specific prescribing information.

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