Cobenfy(KarXT)的用药指南

Cobenfy (KarXT) aims to reduce some of the side effects of traditional antipsychotic drugs while exerting its efficacy, and it needs to be used under the guidance of a professional physician.

Cobenfy (KarXT) Medication Guide

1. Dosage and dosing schedule

(1). Initiation and titration: The recommended starting dose is 50mg/20mg (zetamroline/trospium chloride), twice daily. After taking it for at least 2 days, increase to 100mg/20mg twice daily and maintain for at least 5 days.

(2) Target dose: Based on the patient's tolerance and treatment response, the dose can be further increased to 125mg/30mg twice a day, which is the maximum recommended dose.

(3) Key usage: It must be taken on an empty stomach, that is, at least 1 hour before a meal or at least 2 hours after a meal.

(4) Note on dosage form: This product is a capsule, which should be swallowed whole and must not be opened, chewed or crushed.

2. Important safety information and monitoring

(1) Liver function: Liver enzymes (such as ALT, AST) and bilirubin levels should be detected before starting treatment and when clinically necessary.

(2) Heart rate: The heart rate needs to be evaluated before and during treatment, because this product may cause an increase in heart rate.

(3) Contraindications: Patients with the following conditions are absolutely prohibited from using it: urinary retention, moderate or severe liver damage, gastric retention, history of allergy to this product or trospium chloride, and untreated angle-closure glaucoma.

The pictures come from public channels (such as the official website of the FDA, the official website of the original drug manufacturer, etc.) and are for reference only.

Cobenfy (KarXT) dose adjustment strategy

1. Adjustment based on tolerance

During the dose escalation process (such as increasing from 100mg/20mg to 125mg/30mg), if the patient cannot tolerate the adverse reactions of the higher dose (such as severe gastrointestinal reactions, significant heart rate increase, etc.), the patient should maintain or adjust back to the previous lower dose level.

2. Dose management of adverse reactions

When intolerable adverse reactions occur, doctors should consider reducing the dose or suspending administration.

Cobenfy (KarXT) medication for special populations

1. Elderly patients (≥65 years old)

(1) Dosage adjustment: The recommended starting dose is 50mg/20mg twice a day, and a slower dose titration rate is recommended.

(2) Maximum dose limit: The maximum recommended dose for elderly patients is 100mg/20mg twice daily, and higher doses of 125mg/30mg should not be used.

(3) Risk attention: Because elderly patients (especially men, often accompanied by benign prostatic hyperplasia) are at a higher risk of urinary retention and anticholinergic adverse reactions (such as constipation, dizziness), enhanced monitoring is required.

2. Patients with renal insufficiency

(1) Mild renal insufficiency (eGFR60 to <90mL/min): conventional recommended doses can be used, but it is necessary to be aware that drug exposure in the body will increase, and adverse reactions should be closely monitored.

(2) Moderate or severe renal insufficiency (eGFR<60mL/min): This product is not recommended. Because trospium chloride is primarily excreted by the kidneys, the risk of accumulation in these patients is significantly increased, exacerbating anticholinergic side effects (such as dry mouth, constipation, urinary tract infection, and urinary retention).

3. Patients with hepatic insufficiency

(1) Mild hepatic insufficiency (Child-Pugh A grade): Not recommended. Because the exposure to zetanrol is significantly increased, resulting in an increased risk of adverse reactions.

(2), Moderate or severe hepatic insufficiency (Child-Pugh Class B and C): Use is prohibited.

4. Pregnant and lactating women

(1) Pregnant women: There is no data on its use in pregnant women. Physicians should inform patients that pregnancy registries exist to assess the outcomes of psychiatric medication use during pregnancy and may encourage patients to register.

(2) Lactation period: There is a lack of data on whether the drug enters human milk. When using it, the benefits of breastfeeding should be weighed against the potential risks of the drug to the baby.

5. Pediatric patients

The safety and effectiveness of Cobenfy in pediatric patients under 18 years of age have not been determined.