Akeega (Abiraterone/Niraparib)

Description

Akeega, combining niraparib and abiraterone acetate, is an oral medication that targets prostate cancer. As a dual-action tablet, it uses two different mechanisms: niraparib serves as a PARP inhibitor, while abiraterone acetate works as a CYP17 inhibitor. Together, they disrupt cancer cell DNA repair and hormone production, which are necessary for prostate cancer cell survival. Akeega is indicated for adults with BRCA-mutated metastatic castration-resistant prostate cancer. It uses a dual-action approach to manage this aggressive form of cancer when used alongside prednisone.

Directions

Akeega is taken as a once-daily oral tablet, typically consumed in combination with 10 mg of prednisone. Patients typically take the prescribed dosage of 200 mg niraparib/1,000 mg abiraterone acetate daily, preferably at the same time each day. Take Akeega as directed by the healthcare provider until disease progression or if any severe side effects develop. Avoid eating food two hours before and one hour after taking Akeega.

Ingredients

Akeega combines two active ingredients: niraparib and abiraterone acetate.

Contraindications

No contraindications are listed on the FDA label. However, avoid taking this medication if you have a known hypersensitivity to niraparib, abiraterone acetate, or any excipients in the formulation.

Cautions

• Before starting Akeega, inform your healthcare provider about:
• Other medications
• Any medical conditions you may have
• Reproductive plans, such as if your partner is pregnant or intends to become pregnant. Akeega may have effects on an unborn baby.

• There's a risk of developing myelodysplastic syndrome or acute myeloid leukemia, particularly with niraparib, a component of Akeega. This could be serious and even fatal. Regular monitoring for signs of blood toxicity is vital, and if either condition is confirmed, you should stop using Akeega.
• It's important to frequently check your complete blood counts. This should be done weekly for the first month, bi-weekly for the next two months, monthly for the rest of the year, and afterward as needed.
• Akeega might cause high blood pressure, low potassium levels, and fluid retention. Especially in the first two months, weekly monitoring is recommended. If you have conditions affected by these symptoms, be particularly vigilant.
• Liver damage, including severe and fatal cases, has been reported. Regular liver function tests are important, and treatment may need to be adjusted based on these results.
• Watch for signs of adrenocortical insufficiency, such as unusual fatigue, muscle weakness, and weight loss. In times of stress, an increased dosage of corticosteroids might be necessary.
• If you're taking diabetes medications, especially thiazolidinediones or repaglinide, be aware that Akeega can cause severe low blood sugar. Regular blood glucose monitoring and possibly adjusting your diabetes medication are important.
• There's an increased risk of fractures and mortality when Akeega is combined with radium Ra 223 dichloride. This combination is not recommended.
• Posterior reversible encephalopathy syndrome, a serious condition, has been observed in patients taking niraparib. If diagnosed with this syndrome, stop using Akeega.
• Akeega can be harmful to unborn babies. If your partner could become pregnant, using effective contraception is crucial during treatment.

Side Effects

Akeega is known to cause various side effects, but not everyone experiences them. Commonly reported are muscle and bone pain, leg or feet swelling, bleeding, tiredness, breath shortness, urinary infections, liver function changes, reduced appetite, cough, constipation, vomiting, sleep difficulties, high blood pressure, dizziness, weight changes, nausea, COVID-19 symptoms, and irregular heartbeat.

More severe side effects requiring immediate medical attention include low blood potassium, fluid retention, high blood pressure, heart issues, and significant liver problems like liver failure, noticeable through skin or eye yellowing and dark urine. Additional serious concerns are adrenal issues, low blood sugar (particularly in diabetic patients), increased bone fracture risks, and posterior reversible encephalopathy syndrome, which affects the brain. Contact a healthcare provider right away if any of these serious side effects develop.

References:

1. Akeega (Abiraterone/Niraparib) Product Monograph. Horsham, PA: Janssen Biotech; 2023.
2. Akeega (Abiraterone/Niraparib) Drug Label Information. Horsham, PA: Janssen Biotech; 2023.

About Dr. Gerardo Sison (Page Author)

An honors graduate of the University of Florida, Dr. Sison started his pharmacy career in a community setting, extending his services to hospitals and clinics over time. He has also worked in medication therapy management, advising patients on proper medication use for their chronic health conditions. Read More....