Orkambi contains a combination of ivacaftor and lumacaftor. It is used to treat cystic fibrosis in adults and children who are at least 1 year old.

Orkambi is for use only in patients with a specific gene mutation related to cystic fibrosis.

Before you take Orkambi, you may need a medical test to make sure you have this gene mutation.

Orkambi can cause serious side effects. High liver enzymes in the blood, which can be a sign of liver injury, have been reported in patients receiving this medicine. Your doctor will do blood tests to check your liver.

Serious drug interactions can occur when certain medicines are used together with Orkambi. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.

Orkambi is usually taken every 12 hours. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Take Orkambi with food that contains fat, such as butter, peanut butter, eggs, avocados, nuts, whole milk, cheese, yogurt, or cheese pizza. Follow your doctor's dosing instructions very carefully.

To use the oral granules: Mix the granules with 1 teaspoon of milk, juice, or soft food such as applesauce, yogurt, or pudding. The food or liquid should be at or below room temperature. Mix only 1 dose at a time, and use the mixture within 1 hour after mixing. Feed your child a high-fat food just before or just after giving the granule mixture.

Take your doses at regular intervals, 12 hours apart. This will keep a steady amount of the drug in your body at all times.

Ivacaftor and lumacaftor doses are based on age and weight in children. Children from 1 to 5 years old should take oral granules. Children 6 and older should take tablets.

You will need frequent blood tests to check your liver function. Your blood pressure may also need to be checked often.

A child using this medicine may need frequent eye exams to check for cataracts.

Store at room temperature away from moisture and heat. Keep each tablet in its daily blister strip until you are ready to take your dose.

Usual Adult Dose of Orkambi for Cystic Fibrosis:

2 tablets of lumacaftor 200 mg/ivacaftor 125 mg (lumacaftor 400 mg/ivacaftor 250 mg per dose) orally every 12 hours with fat-containing food

Comments:
-A fat containing meal or snack should be consumed just before or just after dosing. Examples include eggs, avocados, nuts, butter, peanut butter, cheese pizza, or whole-milk dairy products.
-If the patient's genotype is unknown, an FDA-cleared CF mutation test should be used to detect the presence of the F508del mutation on both alleles of the CFTR gene; safety and efficacy in patients with cystic fibrosis other than homozygous F508del mutation has not been established.

Use: For the treatment of cystic fibrosis (CF) in patients who are homozygous for the F508del mutation in the CFTR gene.

Usual Pediatric Dose of Orkambi for Cystic Fibrosis:

Age 1 through 2 years:
-Weight 7 kg to <9 kg: 1 packet of lumacaftor 75 mg/ivacaftor 94 mg granules mixed with one teaspoon (5 ml) of soft food or liquid and administered orally every 12 hours with fat-containing food
-Weight 9 kg to <14 kg: 1 packet of lumacaftor 100 mg/ivacaftor 125 mg granules mixed with one teaspoon (5 ml) of soft food or liquid and administered orally every 12 hours with fat-containing food
-Weight ≥14 kg: 1 packet of lumacaftor 150 mg/ivacaftor 188 mg granules mixed with one teaspoon (5 ml) of soft food or liquid and administered orally every 12 hours with fat-containing food

Age 2 through 5 years:
-Weight <14 kg: 1 packet of lumacaftor 100 mg/ivacaftor 125 mg granules mixed with one teaspoon (5 ml) of soft food or liquid and administered orally every 12 hours with fat-containing food
-Weight ≥14 kg: 1 packet of lumacaftor 150 mg/ivacaftor 188 mg granules mixed with one teaspoon (5 ml) of soft food or liquid and administered orally every 12 hours with fat-containing food

Age 6 through 11 years:
2 tablets of lumacaftor 100 mg/ivacaftor 125 mg (lumacaftor 200 mg/ivacaftor 250 mg per dose) taken orally every 12 hours with fat-containing food

Age 12 years and older:
2 tablets of lumacaftor 200 mg/ivacaftor 125 mg (lumacaftor 400 mg/ivacaftor 250 mg per dose) taken orally every 12 hours with fat-containing food

Comments:
-Pediatric patients 2 through 5 years of age should receive oral granules; pediatric patients over 6 years of age, should be dosed with tablets.
-A fat containing meal or snack should be consumed just before or just after dosing. Examples include eggs, avocados, nuts, butter, peanut butter, cheese pizza, or whole-milk dairy products.
-If the patient's genotype is unknown, an FDA-cleared CF mutation test should be used to detect the presence of the F508del mutation on both alleles of the CFTR gene; safety and efficacy in patients with cystic fibrosis other than homozygous F508del mutation has not been established.

Use: For the treatment of cystic fibrosis (CF) in patients 1 year or older who are homozygous for the F508del mutation in the CFTR gene.

You should not use Orkambi if you are allergic to ivacaftor or lumacaftor.

Some medicines can cause unwanted or dangerous effects when used with ivacaftor and lumacaftor. Your doctor may change your treatment plan if you also use:

• St. John's wort;

• medicine to prevent organ transplant rejection - cyclosporine, everolimus (Zortress), sirolimus, tacrolimus;

• a sedative - triazolam or midazolam;

• seizure medicine - carbamazepine, phenobarbital, phenytoin; or

• tuberculosis medicine - rifabutin, rifampin.

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

• liver disease;

• kidney disease;

• high blood pressure;

• asthma or other lung disease; or

• an organ transplant.

Tell your doctor if you are pregnant or breastfeeding.

Orkambi can make hormonal birth control less effective, including birth control pills, injections, implants, skin patches, and vaginal rings. To prevent pregnancy while using Orkambi , use a barrier form of birth control: condom, diaphragm, cervical cap, or contraceptive sponge.

Orkambi is not approved for use by anyone younger than 1 year old.

Take the medicine as soon as you can, but skip the missed dose if you are more than 6 hours late for the dose. Do not take two doses at one time.

Be sure to take a missed dose with a food that contains fat.

If you miss doses or stop taking Orkambi for more than 1 week, call your doctor before you start taking the medicine again. You may need a different dose.

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

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 Orkambi: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• shortness of breath, tightness in your chest; or

• liver problems - nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common Orkambi side effects may include:

• breathing problems;

• feeling tired;

• nausea, gas, diarrhea;

• rash;

• flu symptoms;

• changes in your menstrual periods; or

• cold symptoms such as runny or stuffy nose, sinus pain, sore throat.

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.

During your first week of using Orkambi, your doctor may adjust your dose if you also use other medicines, especially:

• an antibiotic - clarithromycin, erythromycin, telithromycin; or

• antifungal medicine - itraconazole, ketoconazole, posaconazole, voriconazole.

This list is not complete. Other drugs may inteact with ivacaftor and lumacaftor, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.