The medicine Orfadin contains Nitisinone, an FDA-approved drug to treat patients with hereditary tyrosinemia type 1 (HT-1) in combination with dietary restriction of tyrosine and phenylalanine. Nitisinone is a competitive inhibitor drug of 4-hydroxyphenyl-pyruvate dioxygenase, an enzyme upstream of fumarylacetoacetate hydrolase (FAH) in the tyrosine catabolic pathway.
Dosage and administration
The drug Nitisinone comes in the standard strengths of 2 mg, 5 mg, 10 mg, and 20 mg capsules to administer orally.
Following are the administration and dosage instructions:
- The recommended initial dosage of Nitisinone is 0.5 mg/kg orally twice daily.
- One should titrate the dose for individual patients based on biochemical and clinical responses.
- One should adjust the dose of Nitisinone capsules individually.
- Healthcare professionals should monitor plasma and urine succinylacetone concentrations, liver function parameters, and alpha-fetoprotein levels.
- If succinylacetone is still detectable one month after the start of nitisinone treatment, increase the Nitisinone dosage to 0.75 mg/kg twice daily.
- The patient may need a maximum dosage of 1 mg/kg orally twice daily based on evaluating all biochemical parameters.
- If the biochemical response is satisfactory, the dosage should be adjusted only according to body weight gain.
- In addition to the tests above, during the initiation of therapy or if there is a deterioration in the patient’s condition, it may be necessary to follow all available biochemical parameters more closely.
- Elevated tyrosine levels
- Thrombocytopenia (deficiency of platelets)
- Leukopenia (decrease in white blood cells)
- Conjunctivitis (inflammation in the eye)
- Corneal opacity
- Keratitis (inflammation in the cornea)
- Photophobia
- Eye pain
- Blepharitis (inflammation of eyelids)
- Cataracts
- Granulocytopenia (less no. of a type of white blood cells)
- Epistaxis (bleeding nose)
- Pruritus (skin allergy)
- Exfoliative dermatitis
- Dry skin
- Maculopapular rash
- Alopecia (baldness)