By using PrescriberAI, you agree to the AI Terms of Use.
Myalept Prescribing Information
4.1 General ObesityMYALEPT is contraindicated in patients with general obesity not associated with congenital leptin deficiency. MYALEPT has not been shown to be effective in treating general obesity, and the development of anti-metreleptin antibodies with neutralizing activity has been reported in obese patients treated with MYALEPT [see
5.1 Risk for Development of Antibodies that Neutralize Endogenous Leptin and/or MYALEPTAnti-metreleptin antibodies with
5.2 LymphomaThree cases of T-cell lymphoma have been reported in the MYALEPT lipodystrophy program; all three patients had acquired generalized lipodystrophy. Two of these patients were diagnosed with peripheral T-cell lymphoma while receiving MYALEPT. Both had immunodeficiency and significant hematologic abnormalities including severe bone marrow abnormalities before the start of MYALEPT treatment. A separate case of anaplastic large cell lymphoma was reported in a patient receiving MYALEPT who did not have hematological abnormalities before treatment.
Lymphoproliferative disorders, including lymphomas, have been reported in patients with acquired generalized lipodystrophy not treated with MYALEPT. A causal relationship between MYALEPT treatment and the development and/or progression of lymphoma has not been established. Acquired lipodystrophies are associated with autoimmune disorders, and autoimmune disorders are associated with an increased risk of malignancies including lymphomas.
The benefits and risks of MYALEPT treatment should be carefully considered in patients with acquired generalized lipodystrophy and/or those with significant hematologic abnormalities (including leukopenia, neutropenia, bone marrow abnormalities, lymphoma, and/or lymphadenopathy).
5.3 MYALEPT REMS ProgramMYALEPT is available only through a restricted distribution program under a REMS, called the MYALEPT REMS Program, because of the risks associated with the development of anti-metreleptin antibodies that neutralize endogenous leptin and/or MYALEPT and the risk for lymphoma [see
Notable requirements of the MYALEPT REMS Program include the following:
- Prescribers must be certified with the program by enrolling and completing training.
- Pharmacies must be certified with the program and only dispense MYALEPT after receipt of the MYALEPT REMS Prescription Authorization Form for each new prescription.
Further information is available at
For Injection: 11.3 mg of metreleptin supplied in a vial as a sterile, white, solid, lyophilized cake (delivers 5 mg per mL of metreleptin when reconstituted with 2.2 mL of BWFI or WFI).
No formal drug interaction studies were performed.
Leptin is a cytokine and may have the potential to alter the formation of cytochrome P450 (CYP450) enzymes. This should be taken into account when prescribing concomitant drugs metabolized by CYP450 (e.g., oral contraceptives and drugs with a narrow therapeutic index). The effect of metreleptin on CYP450 enzymes may be clinically relevant for CYP450 substrates with narrow therapeutic index, where the dose is individually adjusted. Upon initiation or discontinuation of MYALEPT, in patients being treated with these types of agents, therapeutic monitoring of effect (e.g., warfarin) or drug concentration (e.g., cyclosporine or theophylline) should be performed and the individual dose of the agent adjusted as needed.
MYALEPT (metreleptin) for injection is a recombinant human leptin analog for injection that binds to and activates the leptin receptor. Metreleptin (recombinant methionyl-human leptin) is produced in
MYALEPT is supplied as a sterile, white, solid, lyophilized cake containing 11.3 mg that is reconstituted with 2.2 mL of BWFI or WFI to a final formulation of 5 mg/mL metreleptin for subcutaneous injection. Inactive ingredients are: glutamic acid (1.47 mg/mL), glycine (20 mg/mL), polysorbate 20 (0.1 mg/mL), and sucrose (10 mg/mL), pH 4.25.
Instructions for Use MYALEPT® (MAI-uh-lept) (metreleptin) for injection, for subcutaneous use Vial |
- A healthcare provider should show you how to inject MYALEPT before you use it for the first time. A healthcare provider should also watch you inject your MYALEPT dose the first time you inject it.
- Do notinject MYALEPT until your healthcare provider has shown you the right way to inject it. If you have questions or do not understand the instructions, talk to your healthcare provider or pharmacist.
- MYALEPT is onlyfor use under the skin (subcutaneous).
- Do notshare your MYALEPT needles with another person. You may give an infection to them, or get an infection from them.
If at any time during these steps you have questions:
- See the "Common Questions" tab
- Call 1-855-669-2537
- Visitwww.MYALEPT.com
You can get these supplies with a prescription from your healthcare provider, from a retail or hospital pharmacy, or the specialty pharmacy that distributes MYALEPT.
- a vial with liquid for mixing MYALEPT
- Sterile water for injection should be used in newborns and infants
- Bacteriostatic water for injection should be used for older children and adults
- a 3 mL syringe with a longer needle for mixing MYALEPT
- a vial with MYALEPT powder
- a 1 mL syringe (or smaller) with a shorter needle for injecting MYALEPT
- 2 alcohol wipes
- 1 sharps container for throwing away used needles and syringes. See "Disposing of used needles and syringes" at the end of these instructions.
- Stickers to note discard date for mixed medicine
Figure B |
- People who weigh more than 88 pounds (lbs) (40 kg) should use a 1 mL syringe to administer their injection of MYALEPT. People who weigh 88 lbs (40 kg) or less should use either a 1 mL or smaller syringe because smaller amounts of MYALEPT are needed for injection. Using the wrong size syringe can cause you to measure the wrong amount of MYALEPT.
The 1 mL (or smaller) syringe is the syringe you will use to inject MYALEPT.
Your dose of MYALEPT may change over time, depending on how MYALEPT works for you. So it is important to keep track of your dose. On the line below, write down your dose in mL and the date. Be sure to keep this up-to-date if your dose changes:
- Take 1 MYALEPT vial out of the refrigerator 10 minutes before you plan to inject to allow it to reach room temperature.
- Set 1 vial with the liquid you will need to mix MYALEPT on your work surface.
- Check the powder in the MYALEPT vial. It should be white. Do notuse MYALEPT if the powder is discolored. Throw it away and get a new one.
- Check the expiration date printed on the MYALEPT vial. Do notuse MYALEPT past the expiration date printed on the vial(see Figure D).
Figure D
Vial with liquid for mixing | Vial with powder | Alcohol wipes |
Wash your hands with soap and water. | Remove 2 alcohol wipes from their wrappers. | Use your thumb to remove the caps from the vials. | Clean the tops of the vials with one of the alcohol wipes. |
A 3 mL syringe (with longer needle) used to mix MYALEPT | Vial with liquid | Sharps disposal container |
Take the 3 mL syringe out of the plastic wrapper. Always use a new syringe. |
Pull the needle cover straight off. Do not twist the needle when removing the cover.Put the needle cover in the sharps disposal container. | Pull down the plunger to fill the syringe with air.
must first fill the syringe with air and put that air into the vial to make it easier to later fill the syringe with liquid. | Line up the top rim of the plunger with the black 2.2 mL line. |
Set the vial with the liquid on the work surface. Insert the needle into the top of the vial. | Push the plunger down all the way to fill the vial with air. |
With the needle still in the vial, turn the vial and syringe upside down. Keep the whole needle in the liquid. | Pull down the plunger until the top rim of the plunger lines up with the black 2.2 mL line. | Check to see if there is an air pocket in the syringe. If you see an air pocket, tap the side of the syringe to move the air pocket to the top of the syringe. | Push the plunger up to remove the air pocket. You must remove the air pocket to be able to fill the syringe with 2.2 mL of liquid. |
Check to see if there are large air bubbles in the syringe. If you see large air bubbles in the syringe, tap the syringe to move the air bubbles to the top. If there are a few small bubbles left, that is okay. | Push the plunger up to remove as many large air bubbles as you can. | Pull down the plunger so the top rim of the plunger lines up with the black 2.2 mL line. | Remove the needle from the vial. Be careful not to move the plunger. Keep the syringe in your hand. Do not set it down.For instructions on how to discard the used vial of liquid, read the carton that contained those vials. |
The 3 mL syringe filled with 2.2 mL of liquid (from Step 2) | Vial with powder (from Step 1) | Sharps disposal container |
Set the vial with the MYALEPT powder on the work surface. Insert the needle straight down into the center of the vial. | Then tilt the vial so that the tip of the needle is pointing toward the inside wall of the vial. | With your thumb, slowly push the plunger down all the way. The liquid should go down the inside wall of the vial. | Make sure you add the liquid slowly so that bubbles do not form in the vial.
|
While keeping the plunger all the way down, take the needle out of the vial. Throw away the syringe with the needle still attached into your sharps disposal container. Do not recap the needle. Recapping the needle can lead to a needlestick injury. | To mix the powder and liquid, move the vial gently in a circle (swirl) until the liquid is clear. Do not shake the vial. | When the medicine is mixed well, the liquid should be clear. You should not see any clumps, powder, bubbles, or foam. |
Vial of mixed MYALEPT | Alcohol wipes |
Take 1 vial of mixed MYALEPT out of the refrigerator. | Set the vial of mixed MYALEPT on the work surface for 10 to 15 minutes so that it comes to room temperature. | Wash your hands with soap and water. | Remove 2 alcohol wipes from their wrappers. |
Clean the top of the vial with the alcohol wipe. | Check that the MYALEPT is mixed well and is clear. You should not see any clumps, powder, bubbles, or foam. |
Patients greater than 40 kg should use a 1 mL syringe for administration. In pediatric patients, small volumes for administration can result in medication errors when measured incorrectly. Smaller syringe sizes may be more appropriate for pediatric patients weighing less than or equal to 25 kg. Ensure the proper size syringe is selected.
The table below shows how a dose of MYALEPT (mg) is converted to solution volume (mL) and the injection syringe marks (units) that correspond with the dose.
| DOSE OF MYALEPT | AMOUNT OF MIXED MYALEPT SOLUTION TO INJECT (TUBERCULIN SYRINGE USERS) | AMOUNT OF MIXED MYALEPT SOLUTION TO INJECT (INSULIN SYRINGE USERS) |
|---|---|---|
| 0.30 mg | 0.06 mL | 6 units |
| 0.36 mg | 0.07 mL | 7 units |
| 0.42 mg | 0.08 mL | 8 units |
| 0.48 mg | 0.09 mL | 9 units |
| 0.54 mg | 0.10 mL | 10 units |
| 0.60 mg | 0.12 mL | 12 units |
| 0.66 mg | 0.13 mL | 13 units |
| 0.72 mg | 0.14 mL | 14 units |
| 0.78 mg | 0.15 mL | 15 units |
| 0.84 mg | 0.16 mL | 16 units |
| 0.90 mg | 0.18 mL | 18 units |
| 0.96 mg | 0.19 mL | 19 units |
| 1.02 mg | 0.20 mL | 20 units |
| 1.08 mg | 0.21 mL | 21 units |
| 1.14 mg | 0.22 mL | 22 units |
| 1.20 mg | 0.24 mL | 24 units |
| 1.26 mg | 0.25 mL | 25 units |
| 1.32 mg | 0.26 mL | 26 units |
| 1.38 mg | 0.27 mL | 27 units |
| 1.44 mg | 0.28 mL | 28 units |
| 1.50 mg | 0.30 mL | 30 units |
| 1.56 mg | 0.31mL | 31 units |
| 1.62 mg | 0.32 mL | 32 units |
| 1.68 mg | 0.33 mL | 33 units |
| 1.74 mg | 0.34 mL | 34 units |
| 1.80 mg | 0.36 mL | 36 units |
| 1.86 mg | 0.37 mL | 37 units |
| 1.92 mg | 0.38 mL | 38 units |
| 1.98 mg | 0.39 mL | 39 units |
| 2.04 mg | 0.40 mL | 40 units |
| 2.10 mg | 0.42 mL | 42 units |
| 2.16 mg | 0.43 mL | 43 units |
| 2.22 mg | 0.44 mL | 44 units |
| 2.28 mg | 0.45 mL | 45 units |
| 2.34 mg | 0.46 mL | 46 units |
| 2.40 mg | 0.48 mL | 48 units |
| 2.5 mg | 0.50 mL | 50 units |
| 3.75 mg | 0.75 mL | 75 units |
| 5.00 mg | 1.00 mL | 100 units |
| 6.25 mg | 1.25 mL | 125 units |
| 7.50 mg | 1.5 mL | 150 units |
| 8.75 mg | 1.75 mL | 175 units |
| 10.00 mg | 2.00 mL | 200 units |
A (1 mL or smaller) syringe (with shorter needle) used to inject MYALEPT | Vial of mixed MYALEPT (from Step 3) | Sharps disposal container |
Remove the injection syringe from the plastic wrapper. Always use a new syringe.
Firmly grip the needle base. | Pull the needle cover straight off. Throw away the needle cover in the sharps disposal container. | Pull down the plunger until the top rim of the plunger lines up with the black line of the dose prescribed by your healthcare provider. You must first fill the syringe with air and put that air into the vial to make it easier to later fill the syringe with liquid. |
Hold the vial with the mixed MYALEPT. Insert the needle into the top of the MYALEPT vial. | Push the plunger down all the way, to fill the vial with air. |
With the needle still in the vial, turn the vial and syringe upside down. Keep the whole needle in the liquid. It is okay if the plunger moves down. | Pull down the plunger until the top rim of the plunger lines up with the black line of the dose prescribed by your healthcare provider. | Check to see if there is an air pocket in the syringe. If you see an air pocket, tap the side of the syringe to move the air pocket to the top of the syringe. | Push the plunger up to remove the air pocket. You must remove the air pocket to be able to fill the syringe with a full dose of MYALEPT. |
Check to see if there are large air bubbles in the syringe. If you see large air bubbles in the syringe, tap the side of the syringe to move the air bubbles to the top. | Push the plunger up to remove as many large air bubbles as you can. | Pull down the plunger again until the top rim of the plunger lines up with the black line of the dose prescribed by your healthcare provider. | Remove the needle from the vial. Set the vial down. Do not set the syringe down. |
Syringe filled with your | Alcohol wipe | Sharps disposal |
Choose an injection site that you will use to inject your MYALEPT. The recommended injection sites are an area of your body that has the most fat, such as the stomach (abdomen), thigh, or the back of your upper arm. If you inject other medicines you should choose a different site from where you inject MYALEPT. Do not inject MYALEPT in the same site as your other medicines. | Use an alcohol wipe to clean the injection site. Let the alcohol dry before you move on to 5c. | Pinch the skin with one hand. With the other hand, hold the syringe like a pencil. Do not insert the needle straight up and down. | Let go of the skin. Take the needle out of your skin. |
Inject MYALEPT under the skin (subcutaneous).
Throw away the used syringe with the needle still attached in your sharps disposal container. See " Disposing of used needles and syringes " at the end of this IFU.Do not recap the needle. Recapping the needle can lead to a needlestick injury. |
Unused MYALEPT mixed with sterile water for injection (newborns or infants),
MYALEPT mixed with bacteriostatic water for injection can be stored for reuse.
Store the vial of mixed MYALEPT in the refrigerator as soon as you are done. | Looking at a calendar, count 2 days after the day you mixed the MYALEPT. For example, if you mixed MYALEPT on Monday, January 2, you would throw it away after your dose on Wednesday, January 4. | Write that date on the stickers found to the right. | Place the sticker on the vial of mixed MYALEPT. |
- Put your used needles and syringes in an FDA-cleared sharps disposal container right away after use. Do notthrow away (dispose of) loose needles and syringes in your household trash.
- If you do not have an FDA-cleared sharps disposal container, you may use a household container that is:
- made of heavy-duty plastic
- can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out
- upright and stable during use
- leak-resistant, and
- properly labeled to warn of hazardous waste inside the container
- When your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. There may be state or local laws about how you should throw away used needles and syringes. For more information about safe sharps disposal, and for specific information about sharps disposal in the state you live in, go to the FDA's website at: http://www.fda.gov/safesharpsdisposal.
Questions about storing and traveling with MYALEPT | page 15 |
Questions about preparing and mixing your dose of MYALEPT | pages 15-16 |
Questions about injecting MYALEPT | page 16 |
Questions about MYALEPT supplies | page 16 |
1Q | How do I store a vial of powder (MYALEPT) and mixed MYALEPT? | |
A | The vial of powder has a white cap. The vial of mixed medicine is the vial to which you applied the sticker.
| |
2Q | How long can I leave a vial of powder or mixed MYALEPT at room temperature? | |
A | A vial of powder or MYALEPT mixed with bacteriostatic water for injection can be left at room temperature for up to 4 hours. MYALEPT mixed with sterile water for injection should be used right away. Throw away any unused mixed MYALEPT. If you are unsure about whether you can use a vial of powder or mixed MYALEPT, call 1-855-6MYALEPT. | |
3Q | What do I do with a vial of powder or mixed MYALEPT if it has been frozen or heated? | |
A | If a vial of powder or mixed MYALEPT has been frozen or heated, throw it away in the sharps disposal container. | |
4Q | What do I do with a vial of mixed MYALEPT if there is not a full dose left? | |
A | Ask your healthcare provider how to use or store a vial of mixed MYALEPT that contains less than a full dose. | |
5Q | How do I take MYALEPT if I am away from home or traveling? | |
A | To take a dose of MYALEPT if you are away from home or traveling, you must take all of your supplies with you. Do not fill a syringe or prepare a dose ahead of time and take it with you. |
6Q | What should I do if I touch the top of a vial after I have cleaned it? | |
A | Clean the top of the vial again with a new alcohol wipe. | |
7Q | What should I do if my dose is written in mg (milligrams), not mL (milliliters)? | |
A | If your dose of MYALEPT is written in mg and not mL, call your pharmacist. Your pharmacist can give you your dose in mL. Do not try to prepare a dose of MYALEPT if your dose is in mg. | |
8Q | What should I do if there are air bubbles or air pockets in the syringe? | |
A | Follow steps 2g (page 5) and 2h (page 6) to remove air bubbles or an air pocket from the syringe when filling it with liquid. Follow steps 4g and 4h (page 11) to remove air bubbles or an air pocket from the syringe when filling it with MYALEPT. | |
9Q | What if the needle comes off the syringe used to mix MYALEPT when I am trying to remove the needle cover? | |
A | With the needle cover still on the needle, twist the needle back onto the syringe. Firmly grip the syringe and pull the needle cover straight off. Do not twist the syringe or needle when pulling off the needle cover. | |
10Q | What if the needle comes off the syringe used to inject MYALEPT when I am trying to remove the needle cover? | |
A | With the needle cover still on the needle, firmly push the needle back onto the syringe. Grip the base of the needle as firmly as you can between your index finger and thumb while pulling on the needle cover. | |
11Q | What do I do if I see foam in a vial of medicine I am mixing? | |
A | If foam forms in the vial of medicine as you swirl it, let the vial sit on the work surface until the foam is gone. | |
12Q | Can I fill a syringe with a dose of mixed MYALEPT and save it to use later? | |
A | A dose of MYALEPT should be taken right after it is mixed. Do not fill a syringe or prepare a dose for later use. |
13Q | What are some tips for injecting MYALEPT? |
A | Try these tips to help you prepare for your injection with MYALEPT:
|
14Q | How do I obtain the supplies needed to inject MYALEPT? |
A | The standard supplies needed to inject MYALEPT include needles, syringes, liquid for mixing and a disposal container. Your healthcare provider will give you a prescription for these supplies which can be filled by a retail or hospital pharmacy, or the specialty pharmacy who distributes MYALEPT. |
15Q | How do I store the other supplies that are needed to prepare and inject a dose of MYALEPT? |
A | Store syringes, vials of liquid with colored caps, alcohol wipes, and sharps disposal container at room temperature or at the temperature that is written on the package they came in. Be sure to check the expiration date on the packages of your supplies before use. Do not use expired supplies. |
- Talk with your healthcare provider
- Read the Medication Guide that came with MYALEPT. The Medication Guide can help answer your questions about MYALEPT, such as what it is used for, possible side effects, and when to take it
- Visit www.MYALEPT.com or call 1-855-6MYALEPT for FREE ongoing support and services
This Instructions for Use has been approved by the U.S. Food and Drug Administration.
MYALEPT is a registered trademark and the property of the Amryt Pharma Group.
©2020 All rights reserved.
Manufactured by:
Amryt Pharmaceuticals DAC
Dublin, Ireland
US License No. 2208
PN 4086-03
Issued September 2020
Adipocytes store lipids to meet the fuel requirements of non-adipose tissues during fasting. In patients with generalized lipodystrophy, the deficiency of adipose tissue leads to hypertriglyceridemia and ectopic deposition of fat in non-adipose tissues such as liver and muscle, contributing to metabolic abnormalities including insulin resistance. Native leptin is a hormone predominantly secreted by adipose tissue that informs the central nervous system of the status of energy stores in the body. In patients with generalized lipodystrophy, leptin deficiency, resulting from the loss of adipose tissue, contributes to excess caloric intake, which exacerbates the metabolic abnormalities.
MYALEPT (metreleptin) for injection exerts its function by binding to and activating the human leptin receptor (ObR), which belongs to the Class I cytokine family of receptors that signals through the JAK/STAT transduction pathway.