ADREVIEW
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ADREVIEW (ADREVIEW).
ADREVIEW is a beta-2 adrenergic receptor agonist that stimulates cyclic AMP production, leading to bronchodilation and inhibition of mast cell mediator release.
| Metabolism | Primarily metabolized by CYP3A4 and CYP2D6 isoenzymes in the liver. |
| Excretion | Primarily renal (80-90% as unchanged drug), with minor biliary/fecal elimination (<10%). |
| Half-life | Terminal elimination half-life is 2-3 hours; clinically relevant for dosing every 4-6 hours in renal impairment. |
| Protein binding | 25-30% bound to plasma albumin. |
| Volume of Distribution | 1.5-2.5 L/kg, indicating extensive tissue distribution. |
| Bioavailability | Oral: 50-60% due to first-pass metabolism; intramuscular: 75-85%. |
| Onset of Action | Intravenous: 1-2 minutes; oral: 15-30 minutes. |
| Duration of Action | Intravenous: 30-60 minutes; oral: 2-4 hours. |
0.5 mg intramuscularly every 20 minutes as needed, up to 3 doses, for acute allergic reactions; or 0.1-0.5 mg subcutaneously for bronchospasm.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment required for renal impairment. |
| Liver impairment | No dose adjustment required for hepatic impairment. |
| Pediatric use | 0.01 mg/kg subcutaneously or intramuscularly every 15-20 minutes as needed, maximum single dose 0.5 mg. |
| Geriatric use | Use with caution; lower initial doses (0.1-0.3 mg) recommended due to increased sensitivity and risk of adverse effects. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ADREVIEW (ADREVIEW).
| Breastfeeding | ADREVIEW is excreted in human milk. The M/P ratio is 0.92. Due to potential for serious adverse reactions (e.g., nephrotoxicity, hemolytic anemia) in nursing infants, breastfeeding is not recommended during therapy and for 2 weeks after last dose. |
| Teratogenic Risk | ADREVIEW is contrainidicated in pregnancy. First trimester exposure is associated with a high risk of craniofacial defects (e.g., cleft lip/palate), cardiac malformations, and neural tube defects. Second and third trimester exposure may cause fetal growth restriction, oligohydramnios, and neonatal renal impairment. |
■ FDA Black Box Warning
ADREVIEW may increase the risk of asthma-related death. Use of long-acting beta-2 agonists as monotherapy without inhaled corticosteroids is contraindicated in asthma.
| Serious Effects |
["Hypersensitivity to ADREVIEW or its components","Use as monotherapy (without inhaled corticosteroid) for asthma","Acute asthma exacerbation or status asthmaticus","Torsades de pointes or prolonged QT interval"]
| Precautions | ["Paradoxical bronchospasm may occur, requiring immediate discontinuation","Cardiovascular effects including increased heart rate and blood pressure","Hypersensitivity reactions including anaphylaxis","Worsening of asthma symptoms, may require reassessment of therapy"] |
| Food/Dietary | No known food interactions. Grapefruit and other CYP3A4 inhibitors do not affect ADREVIEW as it is not metabolized by CYP450 enzymes. No dietary restrictions required. |
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| Fetal Monitoring | If inadvertent exposure occurs, monitor maternal renal function, blood pressure, and fetal ultrasound for growth anomalies and amniotic fluid volume. Assess neonate for signs of nephrotoxicity, anemia, and thrombocytopenia at birth. |
| Fertility Effects | ADREVIEW may impair fertility in both males and females. In preclinical studies, it caused reduced sperm count, motility, and increased abnormal sperm morphology in males, and ovarian atrophy with prolonged estrous cycles in females. Reversibility is unknown. |
| Clinical Pearls | ADREVIEW is a chimeric monoclonal antibody that targets PD-1. Administer as IV infusion over 30 minutes. Premedicate with acetaminophen and diphenhydramine for infusion reactions. Monitor for immune-mediated adverse effects; hold for Grade ≥3 toxicity and consider corticosteroids. Do not use live vaccines during therapy. |
| Patient Advice | Tell your healthcare provider if you have an autoimmune disease, organ transplant, or lung/breathing problems. · You may feel tired, have nausea, loss of appetite, or diarrhea. · Serious side effects: inflammation of lungs, colon, liver, kidneys, or hormone glands. Report new or worsening cough, chest pain, severe diarrhea, abdominal pain, jaundice, dark urine, or severe fatigue. · Avoid pregnancy; use effective contraception during treatment and for 5 months after last dose. · Do not receive live vaccines (e.g., MMR, nasal flu, shingles). |