Isturisa is a cortisol synthesis inhibitor.

Isturisa is used in adults to treat Cushing's disease that cannot be treated with pituitary surgery.

Isturisa is also used in patients who have had pituitary surgery, but the surgery did not cure their Cushing’s disease.

Isturisa can cause serious side effects, such as heartbeat problems or decreased adrenal gland hormones. Call your doctor at once if you have irregular heartbeats, stomach pain, vomiting, loss of appetite, tiredness, or feeling light-headed.

Tell your healthcare provider if you take medicines used to treat certain heart problems.

Before taking this medicine

To make sure Isturisa is safe for you, tell your doctor if you have ever had:

• a heart rhythm disorder;

• long QT syndrome (in you or a family member);

• congestive heart failure;

• high blood pressure;

• an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

• fluid retention; or

• liver disease.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether osilodrostat will harm an unborn baby. However, having Cushing's disease during pregnancy may cause complications such as diabetes or eclampsia (dangerously high blood pressure that can lead to medical problems in both mother and baby). The benefit of treating Cushing's disease may outweigh any risks to the baby.

Do not breastfeed while using Isturisa, and for at least 1 week after your last dose.

Isturisa is not approved for use by anyone younger than 18 years old.

Take Isturisa exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

You may take Isturisa with or without food.

Your doctor will check your heart function using an electrocardiograph or ECG (sometimes called an EKG). Your next dose may be delayed based on the results of your ECG or other medical tests.

Do not change your dose or dosing schedule without your doctor's advice.

Store Isturisa tablets at room temperature away from moisture and heat.

Usual Adult Dose of Isturisa for Cushing's Syndrome:

INITIAL DOSE: 2 mg orally 2 times a day
TITRATION: Initially, titrate the dose by 1 to 2 mg 2 times a day, no more frequently than every 2 weeks based on the rate of cortisol changes, individual tolerability and patient improvement. If a patient tolerates 10 mg 2 times a day and continues to have elevated 24-hour urine free cortisol (UFC) levels above upper normal limit, the dose can be titrated further by 5 mg 2 times a day every 2 weeks. Monitor cortisol levels from at least two 24-hour urine free cortisol collections every 1 to 2 weeks until adequate response is maintained.
MAINTENANCE DOSE: Should be individualized and determined by titration based on cortisol levels and patient's symptoms. Maintenance dose varies between 2 and 7 mg 2 times a day.
Maximum maintenance dose: 30 mg orally 2 times a day; when maintenance dose is achieved, monitor cortisol levels at least every 1 to 2 months or as indicated.

Use: For the treatment of adult patients with Cushing's disease for whom pituitary surgery is not an option or has not been curative

To make sure Isturisa is safe for you, tell your doctor if you have ever had:

• a heart rhythm disorder;

• long QT syndrome (in you or a family member);

• congestive heart failure;

• high blood pressure;

• an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

• fluid retention; or

• liver disease.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether osilodrostat will harm an unborn baby. However, having Cushing's disease during pregnancy may cause complications such as diabetes or eclampsia (dangerously high blood pressure that can lead to medical problems in both mother and baby). The benefit of treating Cushing's disease may outweigh any risks to the baby.

Do not breastfeed while using Isturisa, and for at least 1 week after your last dose.

Isturisa is not approved for use by anyone younger than 18 years old.

Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, stomach pain, extreme tiredness, feeling light-headed, or fainting.

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Get emergency medical help if you have signs of an allergic reaction to Isturisa: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);

• swelling in your feet or ankles, feeling short of breath;

• decreased adrenal gland hormones - nausea, vomiting, stomach pain, loss of appetite, feeling tired or light-headed, muscle or joint pain, skin discoloration, craving salty foods;

• increased adrenal gland hormones - hunger, weight gain, swelling, skin discoloration, slow wound healing, sweating, acne, increased body hair, tiredness, mood changes, muscle weakness, missed menstrual periods, sexual changes; or

• low potassium level - leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling.

Common Isturisa side effects may include:

• nausea;

• feeling tired;

• headache; or

• swelling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Isturisa can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Other drugs may interact with osilodrostat, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.