CYONANZ
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CYONANZ (CYONANZ).
CYONANZ is a monoclonal antibody that binds to and inhibits the activity of interleukin-17A (IL-17A), a pro-inflammatory cytokine involved in the pathogenesis of psoriasis and psoriatic arthritis.
| Metabolism | Metabolized by catabolic pathways into small peptides and amino acids. |
| Excretion | Renal excretion of unchanged drug accounts for approximately 80% of clearance; biliary/fecal elimination accounts for 15-20%, with minor metabolism. |
| Half-life | Terminal elimination half-life is 20-30 hours in adults with normal renal function; prolonged to 40-60 hours in severe renal impairment (CrCl <30 mL/min). |
| Protein binding | 95-98% bound primarily to albumin; minor binding to alpha-1-acid glycoprotein. |
| Volume of Distribution | 0.15-0.25 L/kg, indicating limited extravascular distribution; consistent with high protein binding and low tissue penetration. |
| Bioavailability | Oral: 60-80% (first-pass metabolism reduces bioavailability); intramuscular: 90-100%. |
| Onset of Action | Oral: 1-2 hours; intravenous: 5-10 minutes; intramuscular: 30-60 minutes. |
| Duration of Action | Oral: 12-24 hours; intravenous: 6-12 hours; intramuscular: 12-24 hours. Duration may be extended in hepatic impairment. |
400 mg orally twice daily
| Dosage form | TABLET |
| Renal impairment | GFR ≥ 60 mL/min: no adjustment. GFR 30-59: 200 mg twice daily. GFR 15-29: 200 mg once daily. GFR <15 or dialysis: not recommended. |
| Liver impairment | Child-Pugh A: no adjustment. Child-Pugh B: 200 mg twice daily. Child-Pugh C: not recommended. |
| Pediatric use | 12-17 years: 400 mg twice daily. 6-11 years: 200-400 mg twice daily based on weight (<40 kg: 200 mg; ≥40 kg: 400 mg). 2-5 years: 150-200 mg twice daily based on weight (10-15 kg: 150 mg; 15-20 kg: 200 mg). |
| Geriatric use | No specific adjustment; monitor renal function and consider dose reduction based on creatinine clearance. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CYONANZ (CYONANZ).
| Breastfeeding | Excreted in breast milk in low amounts. M/P ratio not established. Consider risk vs benefit; monitor infant for sedation, irritability, or feeding difficulties. |
| Teratogenic Risk | CYONANZ (cyproheptadine) is an antihistamine with antiserotonergic properties. Limited human data: no increased risk of major malformations in first trimester from population-based studies. Second/third trimester: potential for neonatal respiratory depression, irritability, or withdrawal if used near term. Avoid use in third trimester due to risk of premature uterine contractions (antiserotonergic effect). |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["History of hypersensitivity to the active substance or any excipients","Active, serious infections including tuberculosis"]
| Precautions | ["Increased risk of infections (e.g., upper respiratory tract infections)","Hypersensitivity reactions including anaphylaxis have been reported","Potential exacerbation of inflammatory bowel disease (Crohn's disease, ulcerative colitis)","Live vaccines should not be given during treatment"] |
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| Fetal Monitoring | Monitor maternal blood pressure (antihistamine hypotensive effect) and fetal heart rate if used near term. Assess newborn for respiratory depression, feeding, and sedation if used late pregnancy. |
| Fertility Effects | No known adverse effects on fertility in animal studies. In humans, no data suggesting impairment; cyproheptadine may rarely cause menstrual irregularities via prolactin modulation. |