Methoxsalen

Oral
Intravenous
Extracorporeal
Class
DNA crosslinking agents
Subclass
Alkylating agents
Substance name
Methoxsalen
Brand names
Uvadex®
Common formulations
Capsule
Indications for use
Labeled indications
Adults
•
Symptomatic relief of psoriasis (severe, recalcitrant, disabling)
Safety risks
Contraindications
Who have a history of a light-sensitive disease/skin photosensitivity disorder such as SLE, erythropoietic protoporphyria, variegate porphyria, xeroderma pigmentosum, and albinism
A history of melanoma
Warnings and precautions
Cataracts
•
Use caution with ocular disease.
Photosensitivity of skin
•
Use caution receiving concomitant therapy with other topical or systemic photosensitizing agents.
Thromboembolism
•
Use caution with cardiac disease.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use with caution. Monitor serum concentrations. Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Although data are lacking in patients with varying degrees of renal impairment, no reduction of dose or prolongation of the time required to use UV light protection were reported in renal transplant recipients with poor renal function who have undergone photopheresis treatment with methoxsalen.
eGFR 10-20 mL/min/1.73 m²
•
Use with extreme caution. Monitor serum concentrations. Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Although data are lacking in patients with varying degrees of renal impairment, no reduction of dose or prolongation of the time required to use UV light protection were reported in renal transplant recipients with poor renal function who have undergone photopheresis treatment with methoxsalen.
eGFR < 10 mL/min/1.73 m²
•
Use with extreme caution. Monitor serum concentrations. Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Although data are lacking in patients with varying degrees of renal impairment, no reduction of dose or prolongation of the time required to use UV light protection were reported in renal transplant recipients with poor renal function who have undergone photopheresis treatment with methoxsalen.
Renal replacement therapy
Continuous renal replacement
•
Reduce dose.
Intermittent hemodialysis
•
Reduce dose.
Peritoneal dialysis
•
Reduce dose.
Hepatic impairment
Any severity
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B2, D
•
Avoid use. Evidence of fetal harm in humans. Methoxsalen may cause fetal harm if administered during pregnancy, based on data from animal studies.
•
Methoxsalen soft gelatin capsules are listed as FDA pregnancy category C; methoxsalen for extracorporeal administration with photopheresis is listed as FDA pregnancy category D.
•
Females of reproductive potential should avoid pregnancy during methoxsalen therapy.
•
If methoxsalen is used during pregnancy or if pregnancy occurs during methoxsalen therapy, the woman should be apprised of the potential hazard to the fetus. Fetal toxicities (e.g., fetal death, decreased fetal weight, and skeletal malformations/variations) were observed following the administration of methoxsalen (80 to 160 mg/kg/day) in pregnant rats.
Breastfeeding
Acceptable for use during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Hyperkeratosis
Common 1-10%
•
Cataract, generalized pruritus, nausea
Unknown frequency
•
Acneiform lesions, bronchospasm, depression, hypotension, ↑ liver enzymes, melanoma, myelodysplastic/myeloproliferative disease, pemphigus vulgaris, fever, headache, insomnia, malaise, nervousness, systemic lupus erythematosus, skin bullae, skin cancer, skin erythema
Interactions
Drug(s)
Check Interactions
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