Omacetaxine Mepesuccinate (Synribo®)

How to Take Omacetaxine Mepesuccinate

Omacetaxine mepesuccinate is given by a subcutaneous (SQ, SubQ) injection, like the way insulin is given. How often you receive the medication will be decided by your provider.

Follow instructions from your care team on how to administer the medication. You or your caregiver should wear gloves and protective eyewear while giving the medication. If you get the medication on your skin, wash with soap and water. If you get it in your eyes, flush your eyes with water and call your healthcare provider right away. Do not eat or drink while handling this medication, and always wash your hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. If you miss a dose, skip that dose and give the next dose at the regularly scheduled time. Do not take 2 doses to make up for a missed dose.

Storage and Handling

The medication will be pre-mixed in single-dose syringes by your healthcare team. Transport the medication as instructed by your provider. You can store vials in the refrigerator for up to 6 days or at room temperature for up to 12 hours. When stored in the refrigerator, keep away from food and drink. Keep the vials out of the reach of children and pets.

Do not reuse or recap syringes or needles. Do not throw the vials, syringes, or needles in the household trash. Dispose of all used needles and syringes in a puncture-proof disposable container with a lid. The FDA provides further information about the disposal of vials, syringes, and needles.

If the medication is spilled, use the supplies provided to clean up the spill. Do not touch the spill unless you are wearing gloves and protective eyewear. Use an absorbent pad to wipe up the spill. Wash the area with soap and water, and use a paper towel to dry. Dispose of all materials in a biohazard container and report the spill to your provider.

Where do I get this medication?

Some cancer medications are only available through specialty pharmacies. Your provider or pharmacist will start this process. Your insurance plan may also affect where you can get your medication.  Call your prescription plan provider to find out which specialty pharmacies are in-network.

Insurance Information

This medication may be covered by your prescription plan. If you qualify, you may be able to get financial help through patient assistance programs (PAP). Co-pay cards may also be available to lower your out-of-pocket cost if you have commercial (not Medicare/Medicaid/Tricare) insurance.
Your pharmacist, social worker, or navigator can help find resources for financial support.

Possible Side Effects of Omacetaxine Mepesuccinate

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

Low Platelet Count (Thrombocytopenia)

Platelets are blood cells that help your blood clot. Thrombocytopenia is when your platelet count is lower than normal, and you are at a higher risk of bleeding. Tell your providers if you have any bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If your count gets too low, you may receive platelets from a donor.

• Do not use a razor (an electric razor is fine).
• Do not do activities that can cause injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) like Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and others. These can raise the risk of bleeding. Talk to your providers before using over-the-counter medications and supplements during treatment.
• Do not floss or use toothpicks, and use a soft-bristle toothbrush to brush your teeth.

Infection and Low White Blood Cell Count (Leukopenia or Neutropenia)

This medication can cause serious infections, with or without a decrease in white blood cell counts.

White blood cells (WBC) help your body fight infection. While you have cancer treatment, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

•    Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
•    Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
•    When working outside, wear clothes that protect you like long pants and gloves.
•    Do not handle pet waste.
•    Keep all cuts and scratches clean.
•    Shower or bathe daily.
•    Brush your teeth at least twice a day.
•    Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
•    Ask your providers before scheduling dental appointments or procedures.
•    Ask your providers before you or someone you live with has any vaccines. 

Low Red Blood Cell Count (Anemia)

Anemia is when your red blood cell count is lower than normal. Red blood cells carry oxygen to the tissues in your body. When your red cell count is low, you may feel tired or weak. Tell your providers if you have shortness of breath, trouble breathing, or pain in your chest. If your count gets too low, you may receive a blood transfusion.

Diarrhea

Diarrhea is when you pass three or more stools in a day. Your providers can suggest medications to relieve diarrhea. Do not take any medications to manage your diarrhea without talking to your provider first, as your stool may need to be tested. To manage it, try eating foods that are low in fiber and bland, like white rice and boiled or baked chicken. Try not to eat raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is a type of fiber found in some foods that helps absorb (soak up) fluid. Foods high in soluble fiber are applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice, foods made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Stay hydrated by drinking 8 to 10 glasses of non-alcoholic, non-caffeinated fluid each day.

For medications with serious diarrhea complications
Diarrhea can be a serious side effect that can lead to dehydration (when you do not have enough fluid in your body). Tell your healthcare provider if you have diarrhea.

Nausea and/or Vomiting

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty, spicy, or acidic foods like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.

Call your provider if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

Fatigue

Fatigue can cause exhaustion, feeling worn out, and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.

Injection Site Reactions

Pain, redness, or swelling may occur at the injection site. This typically lasts less than 10-15 minutes. Rotating the site of the injections may help reduce injection site discomfort.

Important but Less Common Side Effects

• GI Bleed & Stroke:This medication can cause bleeding. This bleeding can happen in the GI tract and in the brain (stroke), especially if you have low platelet counts. Symptoms of gastrointestinal (GI) bleeding are bright red blood in your stool or black stool, coughing up blood, vomiting blood, vomit that looks like coffee grounds, fever, severe pain in the abdomen (belly), or new abdominal swelling. Signs of a stroke include numbness or weakness on one side of the body, trouble talking, confusion, or mental status changes. If you experience any of these, go to the emergency room.
• High Blood Sugar: This medication can cause high blood sugar in patients with and without diabetes. You will have their blood sugar checked with blood tests. If you have diabetes and your blood sugars are higher than normal, talk to your provider. Tell your provider if you have any of these symptoms. Symptoms can be:
  • Feeling more thirsty.
  • More frequent urination.
  • Feeling hungrier.
  • Blurry vision.
  • Headaches.
  • Breath smelling like fruit.

Reproductive Concerns

There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. If you can become pregnant, you will need to use effective birth control for 6 months after the last dose of this medication, even if your menstrual cycle has stopped or changed. If you can get someone pregnant, you will need to use effective birth control for 3months after the last dose of this medication, even if you believe you are not producing sperm. You should not breastfeed during treatment and for 2 weeks after the last dose of this medication.