ORAL CANCER TREATMENT EDUCATION EFLORNITHINE Name of your medication Generic name — eflornithine (ee FLOR ni theen) Brand name — IWILFIN® (EYE will fin) Common uses Eflornithine is used to reduce the risk of relapse in adult and pediatric patients with high-risk neuroblastoma who have demonstrated at least a partial response to prior multiagent, multimodality therapy, including anti-GD2 immunotherapy. Eflornithine may also be used for other treatments. Dose and schedule Taking eflornithine as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. o Your dose is based on many factors, including your height and weight, overall health and diagnosis. o Eflornithine tablets can be taken with or without food, but at the same time twice daily. o Eflornithine tablets can be swallowed whole, chewed, or crushed. If you are unable to swallow eflornithine, speak with your care team about how to safely crush or chew the tablet(s). o If you miss a dose of eflornithine: • A missed dose of eflornithine should be administered as soon as possible. If the next dose is due within 7 hours, the missed dose should be skipped. • Do not take two doses at one time. • If vomiting occurs after taking eflornithine, an additional dose should not be administered. Continue with the next scheduled dose. • Be sure to write down if you miss a dose and let your care provider know about any missed doses. Drug and food interactions o There are no known significant drug–drug interactions with eflornithine. Storage and handling Handle eflornithine with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. o Store eflornithine at room temperature (68°F to 77°F) in a dry location away from light. o Keep eflornithine out of reach of children and pets. o Leave eflornithine in the provided packaging until it is ready to be taken. Page 1 ORAL CANCER TREATMENT EDUCATION EFLORNITHINE o Whenever possible, you should give eflornithine to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the eflornithine to you, they also need to follow these steps. 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. (Gloves are not necessary if you give the drug to yourself.) 3. Gently transfer the eflornithine from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. o If a daily pill box or pill reminder will be used, contact your care team before using: • The person filling the box or reminder should wear gloves (gloves are not necessary if you are filling the box or reminder). • When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. o If you have any unused eflornithine, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of eflornithine. o If you are traveling, put your eflornithine’s packaging in a separate sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Side Effects of Eflornithine Below are common side effects that have been known to happen in about one-third or more of patients taking eflornithine; these are listed on the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Otitis media (ear infection) Serious side effects Management • Wash your hands often, especially before eating and after using the bathroom. • Avoid people with fevers, flu, or other infections. • Report symptoms of an ear infection such as ear pain, ear drainage, muffled hearing, or fever to your provider. o Eflornithine may cause myelosuppression, which is a condition where you have fewer red blood cells, white blood cells, or platelets than normal. You will have regular blood tests to monitor your blood cell counts. Talk to your care team before any scheduled procedures while on eflornithine. o Eflornithine may be harmful to your liver. Seek medical attention if you notice yellowing of the skin or whites of your eyes, dark or brown urine, bleeding, or bruising. o Eflornithine may cause hearing loss. Talk to your care team if you notice any change in your hearing or ringing in your ears. You may need to undergo a repeat audiogram (hearing test). Page 2 ORAL CANCER TREATMENT EDUCATION EFLORNITHINE If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: Handling body fluids and waste Because eflornithine remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take eflornithine, it is important to adhere to the following instructions every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. o Toilet and septic systems: • You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low-flow toilet, close the lid and flush twice to ensure that all waste has been discarded. • If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. • Wash hands with soap and water after using the toilet. o If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. o If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. o Wash any skin that has been exposed to body waste or eflornithine with soap and water. o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Pregnancy, sexual activity, and contraception o Women should not become pregnant and men should not get a partner pregnant while taking eflornithine. Males and females of childbearing age and potential should use effective contraception during therapy and for a minimum of 1 week after the last dose of eflornithine. o Effective contraception could include 1 or more of the following: oral contraceptive, barrier methods, etc. o Do not breastfeed while taking eflornithine and for 1 week after the last dose of eflornithine. o Please inform your care provider if you become pregnant. o It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care team for assistance. Obtaining medication o Talk with your care provider about the process for obtaining your eflornithine. Page 3 ORAL CANCER TREATMENT EDUCATION EFLORNITHINE Additional resources Product website: https://www.iwilfin.com Product prescribing information: https://www.iwilfin.com/wp-content/uploads/2023/12/iwilfin_PI-and-PPI_letter.pdf Additional instructions Updated – February 5, 2024 Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Cancer Treatment Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2024 by Hematology/Oncology Pharmacy Association. All rights reserved. Page 4