Metvixia [DSC]:
Actinic keratoses: Topical: Apply up to 1 g to prepared actinic keratoses, occlude for 3 hours, followed by red light illumination; repeat in 1 week. Note: If multiple lesions being treated, 1 g should not be exceeded for all lesions combined per treatment session.
Metvix c-PDT [Canadian product]:
Actinic keratosis (thin or nonhyperkeratotic and nonpigmented): Topical: Apply up to a maximum of 2 g for all lesions combined per treatment session, occlude treated lesions for 3 hours, followed by red light illumination. Assess patient after 3 months and if needed may administer one additional treatment session. Use without subsequent red light illumination is not recommended.
Basal cell carcinoma (superficial): Topical: Apply up to a maximum of 2 g for all lesions combined per treatment session, occlude treated lesions for 3 hours, followed by red light illumination. Repeat in 1 week. Following second treatment session, assess patient after 3 months and if needed may administer up to 2 additional treatment sessions (separated by 1 week). Use without subsequent red light illumination is not recommended.
Metvix DL-PDT [Canadian product]:
Actinic keratosis (thin or nonhyperkeratotic and nonpigmented): Topical: Apply up to a maximum of 2 g for all lesions combined per treatment session, followed by daylight exposure (no occlusion is recommended). Assess patient after 3 months and if needed may administer one additional treatment session.
There are no dosage adjustments provided in manufacturer's labeling (has not been studied).
There are no dosage adjustments provided in manufacturer's labeling (has not been studied).
Refer to adult dosing.
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Cream, External:
Metvix: 16.8% (60 mL) [contains cetostearyl alcohol, edetate (edta) disodium, methylparaben, peanut oil, propylparaben]
Prepare lesions using a small dermal curette to remove scales and crusts and roughen the surface of the lesion. Wearing nitrile gloves (latex and vinyl gloves do not provide enough protection) and using a spatula, apply a layer of methyl aminolevulinate cream about 1 mm thick topically to prepared lesion and the surrounding 5 mm of normal skin. Multiple lesions may be treated during the same treatment session; do not exceed a treatment field area of 80 x 180 mm. Do not exceed a total of 1 g of Metvixia cream or 2 g Metvix cream [Canadian product] per treatment session.
When used in conjunction with c-PDTL: Occlude the site(s) with a nonabsorbent dressing for 3 hours (minimum 2.5 hours, maximum 4 hours), then remove. Remove excess cream with saline and illuminate with red light following lamp manufacturer's instructions. Following illumination of site, the treated area should be kept covered and away from bright indoor light and sunlight from 48 hours. If red light treatment is interrupted or stopped it may be restarted. However, if for any reason, red light illumination is not done, the cream should be removed within 3 hours (from time of initial application) and the area protected from sunlight or prolonged/intense light for 48 hours. Use in conjunction with Atkilite CL 128 lamp.
When used in conjunction with DL-PDT: Metvix [Canadian product]: Prior to preparing the lesions, sunscreen (≥ SPF 30), that does not include filters which may inhibit absorption of visible light (eg, titanium dioxide, zinc oxide, iron oxide), should be applied to all sun exposed areas including the treatment areas. Occlusion of the treatment site(s) is not necessary. Patients should go outside immediately after therapy or within 30 minutes; remain in daylight for 2 continuous hours, then remove cream with soap and water.
Metvixia [DSC]: Actinic keratosis: Conventional photodynamic therapy (c-PDT) to be used in conjunction with red light illumination for the treatment of thin and moderately thick, nonhyperkeratotic, nonpigmented actinic keratoses of the face and scalp in immunocompetent patients.
Limitations of use: Safety and efficacy have not been established for treatment of cutaneous malignancies or for skin lesions other than nonhyperkeratotic face and scalp actinic keratoses using PDT with methyl aminolevulinate cream; safety and efficacy of methyl aminolevulinate cream have not been established in patients with immunosuppression, porphyria, or pigmented actinic keratosis; has not been tested on patients with inherited or acquired coagulation defects; use without subsequent red light illumination is not recommended.
Metvix [Canadian product]:
Actinic keratosis: c-PDT to be used in conjunction with red light illumination or as daylight-photodynamic therapy (DL-PDT) for the treatment of thin or nonhyperkeratotic and nonpigmented actinic keratosis of the face and scalp when other therapies are less appropriate.
Basal cell carcinoma, superficial: c-PDT to be used in conjunction with red light illumination for the treatment of biopsy-confirmed primary superficial basal cell carcinoma outside the H-zone of the face (eg, ears and nose) when other therapies are less appropriate.
Methyl aminolevulinate may be confused with aminolevulinic acid
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Pain and burning begin during illumination and generally resolve completely within a few minutes or hours, but may last up to a few days. Erythema and other signs generally resolve within a few days up to 3 weeks.
>10%:
Central nervous system: Local discomfort (≤86%; severe: ≤20%)
Dermatologic: Burning sensation of skin (≤86%; severe: ≤20%), skin pain (≤86%; severe: ≤20%), erythema (63%; severe 6%), crusted skin (≤29%), skin blister (≤29%), skin erosion (≤29%), pruritus (22%), exfoliation of skin (14%)
Local: Skin edema (≤18%)
Ophthalmic: Eyelid edema (≤18%)
1% to 10%:
Central nervous system: Localized warm feeling (4%)
Dermatologic: Dermal hemorrhage (2%), hyperpigmentation (2%), skin tightness (2%)
Local: Application site discharge (2%)
<1%, postmarketing, and/or case reports: Angioedema, contact dermatitis, eczema, facial edema, infection (application site), keratitis, macular edema, squamous cell carcinoma of skin, urticaria, vitreous detachment
Known sensitivity to methyl aminolevulinate or any component of the formulation, including peanut and almond oil (has not been tested in patients with peanut allergy); individuals with cutaneous photosensitivity; allergy to porphyrins
Canadian labeling: Additional contraindications (not in US labeling): Morpheaform basal cell carcinoma.
Concerns related to adverse effects:
• Photosensitivity: Treatment sites will become photosensitive and should be protected from sunlight or bright indoor light (eg, examination lamps, operating room lamps, tanning beds, or lights at close proximity) and protected from extreme cold with adequate clothing or by remaining indoors between application of cream and red light illumination and for 48 hours after treatment. Sunscreens will not protect against photosensitivity reactions caused by visible light. After illumination, treated sites should be kept covered and away from light for at least 48 hours.
Disease-related concerns:
• Coagulation defects: Has not been tested on individuals with coagulation defects (acquired or inherited).
• Immune deficiency: Has not been tested on patients with immunosuppression.
• Pigmented actinic keratosis: Has not been tested on patients with pigmented keratosis.
• Porphyria: Has not been tested on patients with porphyria.
Concurrent drug therapy issues:
• Photosensitizing agents: Concomitant use of other known photosensitizing agents may increase the degree of photosensitivity reaction.
Other warnings/precautions:
• Appropriate use: For external use only. Do not apply to eyes or mucous membranes. Should be applied by a qualified health professional. Has not been studied for >1 course of treatment (2 application sessions separated by 1 week). Assess lesion response 3 months after the last treatment session.
None known.
There are no known significant interactions.
Animal reproduction studies have not been conducted with methyl aminolevulinate cream.
It is not known if methyl aminolevulinate is excreted in breast milk. Because many drugs are secreted in human milk, caution should be exercised when Metvixia Cream is administered to a nursing mother. If methyl aminolevulinate cream is used in a nursing mother, a decision should be made whether or not to stop nursing.
Methyl aminolevulinate (prodrug) is metabolically converted to photoactive porphyrins (PAPs), which accumulate in the skin lesions resulting in photosensitization. When exposed to light of appropriate wavelength and energy, the accumulated PAPs produce a photodynamic reaction, releasing oxygen singlets which result in local cytotoxicity.
Peak fluorescence intensity: 3 hours after application
Cream (Metvixia External)
16.8% (2 g): $189.48
Disclaimer: The pricing data provide a representative AWP and/or AAWP price from a single manufacturer of the brand and/or generic product, respectively. The pricing data should be used for benchmarking purposes only, and as such should not be used to set or adjudicate any prices for reimbursement or purchasing functions. Pricing data is updated monthly.
