U.S. Full Prescribing Information, including Boxed WARNING

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CAMZYOS® Dosing Guide

The CAMZYOS Dosing Guide provides considerations to assist doctors in determining the appropriate dose for each patient at key points in their treatment with CAMZYOS. The dosing guide follows the FDA-approved labeling, which can be viewed here.

Prior to initiating CAMZYOS:

  • Confirm absence of pregnancy and usage of effective contraception in females of reproductive potential. Advise females of reproductive potential to use effective contraception until 4 months after the last dose. Use a contraceptive not affected by CAMZYOS’ CYP 450 enzyme induction or add nonhormonal contraception1
  • Assess left ventricular ejection fraction (LVEF) by echocardiogram (echo). Do not initiate treatment in patients with LVEF <55%1
  • In order to prescribe CAMZYOS, you must be certified in the CAMZYOS Risk Evaluation and Mitigation Strategy (REMS) program. If you are not certified, you can learn more here

Following initiation:

  • Patients may develop heart failure while taking CAMZYOS. Regular LVEF and Valsalva LVOT gradient assessment is required for careful dose titration to achieve an appropriate target Valsalva LVOT gradient while maintaining LVEF ≥50% and avoiding heart failure symptoms1

CAMZYOS Interactive Dosing Guide

Information on concomitant administration of weak CYP2C19 or moderate CYP3A4 inhibitors with CAMZYOS can be found here.

RESULT

Consider Contraindications and Drug-Drug Interactions prior to and throughout treatment. Please see Important Safety Information for Contraindications, Risk of Heart Failure or Loss of Response due to Drug Interactions,
and Drug Interactions.

Please refer to the FDA-approved labeling for more dosing information.

  • Delay dose increases when there is intercurrent illness (eg, serious infection) or arrhythmia (eg, atrial fibrillation or other uncontrolled tachyarrhythmia) that may impair systolic function. Consider interruption of CAMZYOS in patients with an intercurrent illness1
  • CAMZYOS can be taken without regard to food. If a dose is missed, it should be taken as soon as possible, and the next scheduled dose should be taken at the usual time the following day. Exact timing of dosing during the day is not essential, but 2 doses should not be taken on the same day. CAMZYOS capsules should be taken whole. Advise patients not to break, open, or chew the capsules1

LVEF=left ventricular ejection fraction; LVOT=left ventricular outflow tract.

Full Dosing Schematic
A PDF showing initiation, maintenance, and other milestones of CAMZYOS dosing

The Echocardiogram Scheduling Tool is available to help estimate the date ranges for a patient’s echocardiograms, as required by the CAMZYOS REMS Program. Delayed or missed visits may lead to interruption or discontinuation of treatment. To use the tool, visit CAMZYOSechotool.com.

Please review for additional information.

  • CAMZYOS is primarily metabolized by CYP2C19 and, to a lesser extent, by CYP3A4 and CYP2C9. Concomitant use of CAMZYOS with drugs that interact with these enzymes may lead to life-threatening drug interactions, such as heart failure or loss of effectiveness
  • The use of inducers and inhibitors of CYP2C19 and moderate to strong inducers and inhibitors of CYP3A4 may affect the exposures of CAMZYOS
  • Please see the table below for detailed descriptions of drug interactions, prevention and management strategies, and their clinical impact

Established and Potentially Significant Pharmacokinetic Drug Interactions with CAMZYOS1

Category Drug type Prevention or management Clinical impact
Impact of other drugs on CAMZYOS

Moderate to strong
CYP2C19 inhibitors
or
Strong CYP3A4 inhibitors

Moderate to strong CYP2C19
inducers
or
Moderate to strong CYP3A4
inducers

Weak CYP2C19 inhibitors
or
Moderate CYP3A4 inhibitors

Concomitant use is contraindicated.

Concomitant use is contraindicated.

  • Initiate CAMZYOS at the recommended starting dose of 5 mg orally once daily in patients who are on stable therapy with a weak CYP2C19 or moderate CYP3A4 inhibitor
  • Down-titrate CAMZYOS one level in patients who are on CAMZYOS treatment and intend to initiate a weak CYP2C19 or moderate CYP3A4 inhibitor. Schedule a clinical and echocardiographic assessment 4 weeks after inhibitor initiation. Up-titration should not occur until 12 weeks after the initiation of the inhibitor
  • Avoid the concomitant initiation of weak CYP2C19 inhibitors and moderate CYP3A4 inhibitors in patients who are on stable treatment with 2.5 mg of CAMZYOS because a lower dose is not available

Concomitant use increases CAMZYOS exposure, which may increase the risk of heart failure due to systolic dysfunction.

  • Concomitant use decreases CAMZYOS exposure, which may reduce the efficacy of CAMZYOS
  • The risk of heart failure due to systolic dysfunction may increase with discontinuation of these inducers as the levels of induced enzyme normalizes

Concomitant use increases CAMZYOS exposure, which may increase the risk of adverse drug reactions.
Impact of CAMZYOS on other drugs

CYP3A4, CYP2C9,
and
CYP2C19 substrates
  • Closely monitor patients when CAMZYOS is used in combination with CYP3A4, CYP2C9, or CYP2C19 substrates, where decreases in the plasma concentrations of these drugs may reduce their activity
  • Advise patients to use a contraceptive method that is not affected by CYP450 enzyme induction (eg, an intrauterine system) or to add nonhormonal contraception (eg, condoms) during concomitant use and for 4 months after the last dose of CAMZYOS
  • CAMZYOS is an inducer of CYP3A4, CYP2C9, and CYP2C19
  • Concomitant use with CYP3A4, CYP2C9, or CYP2C19 substrates may reduce the plasma concentration of these drugs
  • Concomitant use of CAMZYOS with hormonal contraceptives (progestin and ethinyl estradiol), which are CYP3A4 substrates, may decrease exposures of ethinyl estradiol and progestin and lead to contraceptive failure or an increase in breakthrough bleeding

Impact of drugs
that reduce cardiac contractility

Drugs that reduce cardiac contractility

If concomitant therapy with a negative inotrope is initiated, or if the dose of a negative inotrope is increased, monitor LVEF closely until stable doses and clinical response have been achieved.
  • Expect additive negative inotropic effects of CAMZYOS and other drugs that reduce cardiac contractility
  • Avoid concomitant use of CAMZYOS in patients on disopyramide, ranolazine, verapamil with a beta blocker, or diltiazem with a beta blocker as these medications and combinations increase the risk of left ventricular systolic dysfunction and heart failure symptoms and clinical experience is limited

Advise patients of the potential for drug interactions, including with over-the-counter medications (such as omeprazole, esomeprazole, or cimetidine). Advise patients to inform their healthcare providers of all concomitant products prior to and during treatment with CAMZYOS.1

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Important Safety
Information
WARNING: RISK OF HEART FAILURE

CAMZYOSTM (mavacamten) reduces left ventricular ejection fraction (LVEF) and can cause heart failure due to systolic dysfunction.

Echocardiogram assessments of LVEF are required prior to and during treatment with CAMZYOS. Initiation of CAMZYOS in patients with LVEF <55% is not recommended. Interrupt CAMZYOS if LVEF is <50% at any visit or if the patient experiences heart failure symptoms or worsening clinical status.

Concomitant use of CAMZYOS with certain cytochrome P450 inhibitors or discontinuation of certain cytochrome P450 inducers may increase the risk of heart failure due to systolic dysfunction; therefore, the use of CAMZYOS is contraindicated with the following:

  • Moderate to strong CYP2C19 inhibitors or strong CYP3A4 inhibitors
  • Moderate to strong CYP2C19 inducers or moderate to strong CYP3A4 inducers

Because of the risk of heart failure due to systolic dysfunction, CAMZYOS is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the CAMZYOS REMS PROGRAM.

CONTRAINDICATIONS

CAMZYOS is contraindicated with concomitant use of:

  • Moderate to strong CYP2C19 inhibitors or strong CYP3A4 inhibitors
  • Moderate to strong CYP2C19 inducers or moderate to strong CYP3A4 inducers
WARNINGS AND PRECAUTIONS

Heart Failure

CAMZYOS reduces systolic contraction and can cause heart failure or totally block ventricular function. Patients who experience a serious intercurrent illness (e.g., serious infection) or arrhythmia (e.g., atrial fibrillation or other uncontrolled tachyarrhythmia) are at greater risk of developing systolic dysfunction and heart failure.

Assess the patient’s clinical status and LVEF prior to and regularly during treatment and adjust the CAMZYOS dose accordingly. New or worsening arrhythmia, dyspnea, chest pain, fatigue, palpitations, leg edema, or elevations in N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be signs and symptoms of heart failure and should also prompt an evaluation of cardiac function.

Asymptomatic LVEF reduction, intercurrent illnesses, and arrhythmias require additional dosing considerations.

Initiation of CAMZYOS in patients with LVEF <55% is not recommended. Avoid concomitant use of CAMZYOS in patients on disopyramide, ranolazine, verapamil with a beta blocker, or diltiazem with a beta blocker as these medications and combinations increase the risk of left ventricular systolic dysfunction and heart failure symptoms and clinical experience is limited.

CYP 450 Drug Interactions Leading to Heart Failure or Loss of Effectiveness

CAMZYOS is primarily metabolized by CYP2C19 and CYP3A4 enzymes. Concomitant use of CAMZYOS and drugs that interact with these enzymes may lead to life-threatening drug interactions such as heart failure or loss of effectiveness.

Advise patients of the potential for drug interactions, including with over-the-counter medications (such as omeprazole, esomeprazole, or cimetidine). Advise patients to inform their healthcare provider of all concomitant products prior to and during CAMZYOS treatment.

CAMZYOS Risk Evaluation and Mitigation Strategy (REMS) Program

CAMZYOS is only available through a restricted program called the CAMZYOS REMS Program because of the risk of heart failure due to systolic dysfunction. Notable requirements of the CAMZYOS REMS Program include the following:

  • Prescribers must be certified by enrolling in the REMS Program.
  • Patients must enroll in the REMS Program and comply with ongoing monitoring requirements.
  • Pharmacies must be certified by enrolling in the REMS Program and must only dispense to patients who are authorized to receive CAMZYOS.
  • Wholesalers and distributors must only distribute to certified pharmacies.

Further information is available at www.CAMZYOSREMS.com or by telephone at 1-833-628-7367.

Embryo-Fetal Toxicity

CAMZYOS may cause fetal toxicity when administered to a pregnant female, based on animal studies. Confirm absence of pregnancy in females of reproductive potential prior to treatment and advise patients to use effective contraception during treatment with CAMZYOS and for 4 months after the last dose. CAMZYOS may reduce the effectiveness of combined hormonal contraceptives (CHCs). Advise patients using CHCs to use an alternative contraceptive method that is not affected by CYP 450 enzyme induction or to add nonhormonal contraception. Advise females of reproductive potential about the potential risk to the fetus with maternal exposure to CAMZYOS during pregnancy.

ADVERSE REACTIONS

In the EXPLORER-HCM trial, adverse reactions occurring in >5% of patients and more commonly in the CAMZYOS group than in the placebo group were dizziness (27% vs 18%) and syncope (6% vs 2%). There were no new adverse reactions identified in VALOR-HCM.

Effects on Systolic Function

In the EXPLORER-HCM trial, mean (SD) resting LVEF was 74% (6) at baseline in both treatment groups. Mean (SD) absolute change from baseline in LVEF was -4% (8) in the CAMZYOS group and 0% (7) in the placebo group over the 30-week treatment period. At Week 38, following an 8-week interruption of trial drug, mean LVEF was similar to baseline for both treatment groups. In the EXPLORER-HCM trial, 7 (6%) patients in the CAMZYOS group and 2 (2%) patients in the placebo group experienced reversible reductions in LVEF <50% (median 48%: range 35-49%) while on treatment. In all 7 patients treated with CAMZYOS, LVEF recovered following interruption of CAMZYOS.

DRUG INTERACTIONS

Potential for Other Drugs to Affect Plasma Concentrations of CAMZYOS

CAMZYOS is primarily metabolized by CYP2C19 and to a lesser extent by CYP3A4 and CYP2C9. Inducers and inhibitors of CYP2C19 and moderate to strong inhibitors or inducers of CYP3A4 may affect the exposures of CAMZYOS.

Impact of Other Drugs on CAMZYOS:

  • Moderate to Strong CYP2C19 Inhibitors or Strong CYP3A4 Inhibitors: Concomitant use increases CAMZYOS exposure, which may increase the risk of heart failure due to systolic dysfunction. Concomitant use is contraindicated.
  • Moderate to Strong CYP2C19 Inducers or Moderate to Strong CYP3A4 Inducers: Concomitant use decreases CAMZYOS exposure, which may reduce CAMZYOS’ efficacy. The risk of heart failure due to systolic dysfunction may increase with discontinuation of these inducers as the levels of induced enzyme normalizes. Concomitant use is contraindicated.
  • Weak CYP2C19 Inhibitors or Moderate CYP3A4 Inhibitors: Concomitant use with a weak CYP2C19 inhibitor or a moderate CYP3A4 inhibitor increases CAMZYOS exposure, which may increase the risk of adverse drug reactions. Initiate CAMZYOS at the recommended starting dose of 5 mg orally once daily in patients who are on stable therapy with a weak CYP2C19 inhibitor or a moderate CYP3A4 inhibitor. Reduce dose of CAMZYOS by one level (i.e., 15 to 10 mg, 10 to 5 mg, or 5 to 2.5 mg) in patients who are on CAMZYOS treatment and intend to initiate a weak CYP2C19 inhibitor or a moderate CYP3A4 inhibitor. Schedule clinical and echocardiographic assessment 4 weeks after inhibitor initiation, and do not up-titrate CAMZYOS until 12 weeks after inhibitor initiation. Avoid initiation of concomitant weak CYP2C19 and moderate CYP3A4 inhibitors in patients who are on stable treatment with 2.5 mg of CAMZYOS because a lower dose is not available.

Potential for CAMZYOS to Affect Plasma Concentrations of Other Drugs

CAMZYOS is an inducer of CYP3A4, CYP2C9, and CYP2C19. Concomitant use with CYP3A4, CYP2C19, or CYP2C9 substrates may reduce plasma concentration of these drugs. Closely monitor when CAMZYOS is used in combination with CYP3A4, CYP2C19, or CYP2C9 substrates where decreases in the plasma concentration of these drugs may reduce their activity.

Hormonal Contraceptives: Progestin and ethinyl estradiol are CYP3A4 substrates. Concomitant use of CAMZYOS may decrease exposures of ethinyl estradiol and progestin, which may lead to contraceptive failure or an increase in breakthrough bleeding. Advise patients to use a contraceptive method that is not affected by CYP 450 enzyme induction (e.g., intrauterine system) or add nonhormonal contraception (such as condoms) during concomitant use and for 4 months after the last dose of CAMZYOS.

Drugs That Reduce Cardiac Contractility

Expect additive negative inotropic effects of CAMZYOS and other drugs that reduce cardiac contractility. Avoid concomitant use of CAMZYOS in patients on disopyramide, ranolazine, verapamil with a beta blocker, or diltiazem with a beta blocker as these medications and combinations increase the risk of left ventricular systolic dysfunction and heart failure symptoms and clinical experience is limited.

If concomitant therapy with a negative inotrope is initiated, or if the dose of a negative inotrope is increased, monitor LVEF closely until stable doses and clinical response have been achieved.

SPECIFIC POPULATIONS

Pregnancy

CAMZYOS may cause fetal harm when administered to a pregnant female. Advise pregnant females about the potential risk to the fetus with maternal exposure to CAMZYOS during pregnancy. There is a pregnancy safety study for CAMZYOS. If CAMZYOS is administered during pregnancy, or if a patient becomes pregnant while receiving CAMZYOS or within 4 months after the last dose of CAMZYOS, healthcare providers should report CAMZYOS exposure by contacting Bristol Myers Squibb at 1-800-721-5072 or www.bms.com.

Lactation

The presence of CAMZYOS in human or animal milk, the drug’s effects on the breastfed infant, or the effects on milk production are unknown. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for CAMZYOS and any potential adverse effects on the breastfed child from CAMZYOS or from the underlying maternal condition.

Females and Males of Reproductive Potential

Confirm absence of pregnancy in females of reproductive potential prior to initiation of CAMZYOS. Advise females of reproductive potential to use effective contraception during treatment with CAMZYOS and for 4 months after the last dose. Use of CAMZYOS may reduce the effectiveness of CHCs. Advise patients using CHCs to use an alternative contraceptive method or add nonhormonal contraception.

INDICATION

CAMZYOS is indicated for the treatment of adults with symptomatic New York Heart Association (NYHA) class II-III obstructive hypertrophic cardiomyopathy (HCM) to improve functional capacity and symptoms.

CAMZYOS is available in 2.5 mg, 5 mg, 10 mg, and 15 mg capsules.

Please see U.S. Full Prescribing Information, including Boxed WARNING.
 

Reference:

  1. CAMZYOS [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2023.
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Reference:

  1. CAMZYOS [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2023.
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