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ORKAMBI
lumacaftor and ivacaftor · Granule
Overview
Active ingredients
Source: NDC DirectoryForms, strengths and routes
Source: NDC DirectoryPharmacologic classes are listed in the class section below.
Pharmacologic class
Source: NDC Directory| Class | Type | Browse |
|---|---|---|
| Chloride Channel Activation Potentiators [MoA] | MoA | 4 members — no class page |
| Cystic Fibrosis Transmembrane Conductance Regulator Potentiator [EPC] | EPC | 4 members — no class page |
| Cytochrome P450 2B6 Inducers [MoA] | MoA | All 44 members |
| Cytochrome P450 2C19 Inducers [MoA] | MoA | All 37 members |
| Cytochrome P450 2C8 Inducers [MoA] | MoA | All 21 members |
| Cytochrome P450 2C8 Inhibitors [MoA] | MoA | All 56 members |
| Cytochrome P450 2C9 Inducers [MoA] | MoA | All 46 members |
| Cytochrome P450 2C9 Inhibitors [MoA] | MoA | All 34 members |
| Cytochrome P450 3A Inducers [MoA] | MoA | All 37 members |
| Cytochrome P450 3A Inhibitors [MoA] | MoA | All 89 members |
| P-Glycoprotein Inducers [MoA] | MoA | 4 members — no class page |
| P-Glycoprotein Inhibitors [MoA] | MoA | All 105 members |
Regulatory status
Source: Drugs@FDANDC Directory| Product | Trade name | Form | Strength | Ingredient | Status | TE | Flags |
|---|---|---|---|---|---|---|---|
| 211358-001 | ORKAMBI | GRANULE | IVACAFTOR; LUMACAFTOR | Prescription | — | RLD | |
| 211358-002 | ORKAMBI | GRANULE | IVACAFTOR; LUMACAFTOR | Prescription | — | RLD RS | |
| 211358-003 | ORKAMBI | GRANULE | IVACAFTOR; LUMACAFTOR | Prescription | — | RLD |
Therapeutic equivalence
Source: Orange BookCodes beginning with “A” indicate products the FDA considers therapeutically equivalent. Codes beginning with “B” indicate bioequivalence has not been established. See methodology.
Patents and exclusivity
Source: Orange Book| Patent | Expires | Product | Substance | Use code | Submitted |
|---|---|---|---|---|---|
| 7973038 | November 8, 2026 | 001 | No | U-2374 | September 6, 2018 |
| 8741933 | November 8, 2026 | 001 | No | U-2374 | September 6, 2018 |
| 9216969 | November 8, 2026 | 001 | No | September 6, 2018 | |
| 8741933 | November 8, 2026 | 002 | No | U-2374 | September 6, 2018 |
| 7973038 | November 8, 2026 | 002 | No | U-2374 | September 6, 2018 |
| 9216969 | November 8, 2026 | 002 | No | September 6, 2018 | |
| 7973038 | November 8, 2026 | 003 | No | U-3424 | September 26, 2022 |
| 8741933 | November 8, 2026 | 003 | No | U-3424 | September 26, 2022 |
| 9216969 | November 8, 2026 | 003 | No | September 26, 2022 | |
| 9931334 | December 28, 2026 | 001 | No | U-2376 | September 6, 2018 |
| 9670163 | December 28, 2026 | 001 | No | U-2376 | September 6, 2018 |
| 8410274 | December 28, 2026 | 001 | No | September 6, 2018 | |
| 8754224 | December 28, 2026 | 001 | Yes | September 6, 2018 | |
| 9670163 | December 28, 2026 | 002 | No | U-2376 | September 6, 2018 |
| 9931334 | December 28, 2026 | 002 | No | U-2376 | September 6, 2018 |
| 8754224 | December 28, 2026 | 002 | Yes | September 6, 2018 | |
| 8410274 | December 28, 2026 | 002 | No | September 6, 2018 | |
| 9670163 | December 28, 2026 | 003 | No | U-3429 | September 26, 2022 |
| 9931334 | December 28, 2026 | 003 | No | U-3429 | September 26, 2022 |
| 8410274 | December 28, 2026 | 003 | No | September 26, 2022 | |
| 8754224 | December 28, 2026 | 003 | Yes | September 26, 2022 | |
| 7973038*PED | May 8, 2027 | 001 | No | — | |
| 8741933*PED | May 8, 2027 | 001 | No | — | |
| 9216969*PED | May 8, 2027 | 001 | No | — | |
| 7973038*PED | May 8, 2027 | 002 | No | — | |
| 8741933*PED | May 8, 2027 | 002 | No | — | |
| 9216969*PED | May 8, 2027 | 002 | No | — | |
| 9216969*PED | May 8, 2027 | 003 | No | — | |
| 7973038*PED | May 8, 2027 | 003 | No | — | |
| 8741933*PED | May 8, 2027 | 003 | No | — | |
| 7495103 | May 20, 2027 | 001 | Yes | September 6, 2018 | |
| 7495103 | May 20, 2027 | 002 | Yes | September 6, 2018 | |
| 7495103 | May 20, 2027 | 003 | Yes | September 26, 2022 | |
| 8410274*PED | June 28, 2027 | 001 | No | — | |
| 8754224*PED | June 28, 2027 | 001 | No | — | |
| 9931334*PED | June 28, 2027 | 001 | No | — | |
| 9670163*PED | June 28, 2027 | 001 | No | — | |
| 8410274*PED | June 28, 2027 | 002 | No | — | |
| 8754224*PED | June 28, 2027 | 002 | No | — | |
| 9670163*PED | June 28, 2027 | 002 | No | — | |
| 9931334*PED | June 28, 2027 | 002 | No | — | |
| 9670163*PED | June 28, 2027 | 003 | No | — | |
| 9931334*PED | June 28, 2027 | 003 | No | — | |
| 8410274*PED | June 28, 2027 | 003 | No | — | |
| 8754224*PED | June 28, 2027 | 003 | No | — | |
| 8324242 | August 5, 2027 | 001 | No | U-2374 | September 6, 2018 |
| 8324242 | August 5, 2027 | 002 | No | U-2374 | September 6, 2018 |
| 8324242 | August 5, 2027 | 003 | No | U-3424 | September 26, 2022 |
| 7495103*PED | November 20, 2027 | 001 | No | — | |
| 7495103*PED | November 20, 2027 | 002 | No | — | |
| 7495103*PED | November 20, 2027 | 003 | No | — | |
| 8324242*PED | February 5, 2028 | 001 | No | — | |
| 8324242*PED | February 5, 2028 | 002 | No | — | |
| 8324242*PED | February 5, 2028 | 003 | No | — | |
| 9150552 | December 4, 2028 | 001 | No | U-2375 | September 6, 2018 |
| 10597384 | December 4, 2028 | 001 | Yes | U-2778 | April 23, 2020 |
| 12065432 | December 4, 2028 | 001 | No | U-3983 | September 18, 2024 |
| 8653103 | December 4, 2028 | 001 | No | September 6, 2018 | |
| 10597384 | December 4, 2028 | 002 | Yes | U-2778 | April 23, 2020 |
| 9150552 | December 4, 2028 | 002 | No | U-2375 | September 6, 2018 |
| 12065432 | December 4, 2028 | 002 | No | U-3983 | September 18, 2024 |
| 8653103 | December 4, 2028 | 002 | No | September 6, 2018 | |
| 9150552 | December 4, 2028 | 003 | No | U-3427 | September 26, 2022 |
| 12065432 | December 4, 2028 | 003 | No | U-3983 | September 18, 2024 |
| 10597384 | December 4, 2028 | 003 | Yes | U-3430 | September 26, 2022 |
| 8653103 | December 4, 2028 | 003 | No | September 26, 2022 | |
| 8653103*PED | June 4, 2029 | 001 | No | — | |
| 9150552*PED | June 4, 2029 | 001 | No | — | |
| 12065432*PED | June 4, 2029 | 001 | No | — | |
| 10597384*PED | June 4, 2029 | 001 | No | — | |
| 8653103*PED | June 4, 2029 | 002 | No | — | |
| 9150552*PED | June 4, 2029 | 002 | No | — | |
| 12065432*PED | June 4, 2029 | 002 | No | — | |
| 10597384*PED | June 4, 2029 | 002 | No | — | |
| 10597384*PED | June 4, 2029 | 003 | No | — | |
| 12065432*PED | June 4, 2029 | 003 | No | — | |
| 8653103*PED | June 4, 2029 | 003 | No | — | |
| 9150552*PED | June 4, 2029 | 003 | No | — | |
| 8846718 | July 2, 2029 | 001 | No | U-2375 | September 6, 2018 |
| 8846718 | July 2, 2029 | 002 | No | U-2375 | September 6, 2018 |
| 8846718 | July 2, 2029 | 003 | No | U-3427 | September 26, 2022 |
| 12458635 | August 13, 2029 | 001 | No | U-4335 | November 26, 2025 |
| 11564916 | August 13, 2029 | 001 | No | U-3526 | February 28, 2023 |
| 10646481 | August 13, 2029 | 001 | No | June 11, 2020 | |
| 12458635 | August 13, 2029 | 002 | No | U-4335 | November 26, 2025 |
| 11564916 | August 13, 2029 | 002 | No | U-3526 | February 28, 2023 |
| 10646481 | August 13, 2029 | 002 | No | June 11, 2020 | |
| 12458635 | August 13, 2029 | 003 | No | U-4335 | November 26, 2025 |
| 11564916 | August 13, 2029 | 003 | No | U-3526 | February 28, 2023 |
| 10646481 | August 13, 2029 | 003 | No | September 26, 2022 | |
| 9192606 | September 29, 2029 | 001 | No | U-2397 | September 6, 2018 |
| 9192606 | September 29, 2029 | 002 | No | U-2397 | September 6, 2018 |
| 9192606 | September 29, 2029 | 003 | No | U-3428 | September 26, 2022 |
| 8846718*PED | January 2, 2030 | 001 | No | — | |
| 8846718*PED | January 2, 2030 | 002 | No | — | |
| 8846718*PED | January 2, 2030 | 003 | No | — | |
| 10646481*PED | February 13, 2030 | 001 | No | — | |
| 12458635*PED | February 13, 2030 | 001 | No | — | |
| 11564916*PED | February 13, 2030 | 001 | No | — | |
| 10646481*PED | February 13, 2030 | 002 | No | — | |
| 12458635*PED | February 13, 2030 | 002 | No | — | |
| 11564916*PED | February 13, 2030 | 002 | No | — | |
| 10646481*PED | February 13, 2030 | 003 | No | — | |
| 12458635*PED | February 13, 2030 | 003 | No | — | |
| 11564916*PED | February 13, 2030 | 003 | No | — | |
| 9192606*PED | March 29, 2030 | 001 | No | — | |
| 9192606*PED | March 29, 2030 | 002 | No | — | |
| 9192606*PED | March 29, 2030 | 003 | No | — | |
| 8716338 | September 20, 2030 | 001 | No | U-2396 | September 6, 2018 |
| 8507534 | September 20, 2030 | 001 | Yes | September 6, 2018 | |
| 8716338 | September 20, 2030 | 002 | No | U-2396 | September 6, 2018 |
| 8507534 | September 20, 2030 | 002 | Yes | September 6, 2018 | |
| 8716338 | September 20, 2030 | 003 | No | U-3426 | September 26, 2022 |
| 8507534 | September 20, 2030 | 003 | Yes | September 26, 2022 | |
| 8993600 | December 11, 2030 | 001 | No | September 6, 2018 | |
| 8993600 | December 11, 2030 | 002 | No | September 6, 2018 | |
| 8993600 | December 11, 2030 | 003 | No | September 26, 2022 | |
| 8716338*PED | March 20, 2031 | 001 | No | — | |
| 8507534*PED | March 20, 2031 | 001 | No | — | |
| 8716338*PED | March 20, 2031 | 002 | No | — | |
| 8507534*PED | March 20, 2031 | 002 | No | — | |
| 8507534*PED | March 20, 2031 | 003 | No | — | |
| 8716338*PED | March 20, 2031 | 003 | No | — | |
| 8993600*PED | June 11, 2031 | 001 | No | — | |
| 8993600*PED | June 11, 2031 | 002 | No | — | |
| 8993600*PED | June 11, 2031 | 003 | No | — |
| Code | Expires | Product |
|---|---|---|
| M-14 | December 13, 2027 | 001 |
| M-14 | December 13, 2027 | 002 |
| M-14 | December 13, 2027 | 003 |
| PED | June 13, 2028 | 001 |
| PED | June 13, 2028 | 002 |
| PED | June 13, 2028 | 003 |
| ODE-408 | September 2, 2029 | 001 |
| ODE-408 | September 2, 2029 | 002 |
| ODE-408 | September 2, 2029 | 003 |
| PED | March 2, 2030 | 001 |
| PED | March 2, 2030 | 002 |
| PED | March 2, 2030 | 003 |
Approval history
Source: Drugs@FDA| Type | No. | Action | Status | Date | Review |
|---|---|---|---|---|---|
| Supplement | 8 | Labeling | Approved | March 17, 2026 | Standard |
| Supplement | 7 | Labeling | Approved | September 25, 2025 | Standard |
| Supplement | 6 | Efficacy | Approved | December 13, 2024 | Priority |
| Supplement | 5 | Labeling | Approved | August 3, 2023 | Standard |
| Supplement | 4 | Efficacy | Approved | September 2, 2022 | Priority |
| Original application | 1 | Type 3 - New Dosage Form | Approved | August 7, 2018 | Priority |
Review documents
- 0 · Supplement · March 24, 2026
- 0 · Supplement · March 19, 2026
- 0 · Supplement · September 26, 2025
- 0 · Supplement · September 26, 2025
- 0 · Supplement · December 16, 2024
- 0 · Supplement · December 16, 2024
- 0 · Supplement · December 16, 2024
- 0 · Supplement · August 4, 2023
- 0 · Supplement · August 4, 2023
- 0 · Supplement · September 7, 2022
- 0 · Supplement · September 6, 2022
- 0 · Original application · August 10, 2018
- 0 · Original application · August 9, 2018
- 0 · Original application · August 7, 2018
Prescribing information
Source: openFDA Drug LabelingReproduced verbatim from the Structured Product Labeling submitted to the FDA (effective 20260324). This is the manufacturer's labelling text, not a summary and not advice.
Recent Major Changes
openFDA Drug LabelingWarnings and Precautions, Intracranial Hypertension ( 5.4 ) 09/2025 Warnings and Precautions, Neuropsychiatric Events, Including Suicidal Thoughts and Behaviors ( 5.5 ) 03/2026
Indications and Usage
openFDA Drug Labeling1 INDICATIONS AND USAGE ORKAMBI is indicated for the treatment of cystic fibrosis (CF) in patients aged 1 year and older who are homozygous for the F508del mutation in the CFTR gene. If the patient's genotype is unknown, an FDA-cleared CF mutation test should be used to detect the presence of the F508del mutation on both alleles of the CFTR gene. ORKAMBI is a combination of ivacaftor, a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator, and lumacaftor, indicated for the treatment of cystic fibrosis (CF) in patients aged 1 year and older who are homozygous for the F508del mutation in the CFTR gene. If the patient's genotype is unknown, an FDA-cleared CF mutation test should be used to detect the presence of the F508del mutation on both alleles of the CFTR gene. ( 1 ) Limitations of Use: The efficacy and safety of ORKAMBI have not been established in patients with CF other than those homozygous for the F508del mutation. ( 1 ) Limitations of Use The efficacy and safety of ORKAMBI have not been established in patients with CF other than those homozygous for the F508del mutation .
Dosage and Administration
openFDA Drug Labeling2 DOSAGE AND ADMINISTRATION Age Group Weight Dose Administration 1 through 2 years 7 kg to <9 kg 1 packet of lumacaftor 75 mg/ivacaftor 94 mg granules Mixed with one teaspoon (5 mL) of soft food or liquid and administered orally every 12 hours with fat-containing food 9 kg to <14 kg 1 packet of lumacaftor 100 mg/ivacaftor 125 mg granules ≥14 kg 1 packet of lumacaftor 150 mg/ivacaftor 188 mg granules 2 through 5 years <14 kg 1 packet of lumacaftor 100 mg/ivacaftor 125 mg granules ≥14 kg 1 packet of lumacaftor 150 mg/ivacaftor 188 mg granules 6 through 11 years - 2 tablets of lumacaftor 100 mg/ivacaftor 125 mg (lumacaftor 200 mg/ivacaftor 250 mg per dose) Taken orally every 12 hours with fat-containing food 12 years and older - 2 tablets of lumacaftor 200 mg/ivacaftor 125 mg (lumacaftor 400 mg/ivacaftor 250 mg per dose) Reduce dosage in patients with moderate or severe hepatic impairment. ( 2.2 , 8.6 , 12.3 ) When initiating ORKAMBI in patients taking strong CYP3A inhibitors, reduce ORKAMBI dosage for the first week of treatment. ( 2.3 , 7.1 , 12.3 ) 2.1 Recommended Dosage in Adults and Pediatric Patients Aged 1 Year and Older The recommended dosage of ORKAMBI in adults and pediatric patients aged one year and older is based on patient's age and weight as described in Table 1. Table 1: Recommended Oral Dosage of ORKAMBI in Patients Aged 1 Year and Older Age Group Weight ORKAMBI Daily Dose (every 12 hours) Morning Dose Evening Dose 1 through 2 years 7 kg to <9 kg 1 packet of lumacaftor 75 mg/ivacaftor 94 mg oral granules 1 packet of lumacaftor 75 mg/ivacaftor 94 mg oral granules 9 kg to <14 kg 1 packet of lumacaftor 100 mg/ivacaftor 125 mg oral granules 1 packet of lumacaftor 100 mg/ivacaftor 125 mg oral granules ≥14 kg 1 packet of lumacaftor 150 mg/ivacaftor 188 mg oral granules 1 packet of lumacaftor 150 mg/ivacaftor 188 mg oral granules 2 through 5 years <14 kg 1 packet of lumacaftor 100 mg/ivacaftor 125 mg oral granules 1 packet of lumacaftor 100 mg/ivacaftor 125 mg oral granules ≥14 kg 1 packet of lumacaftor 150 mg/ivacaftor 188 mg oral granules 1 packet of lumacaftor 150 mg/ivacaftor 188 mg oral granules 6 through 11 years - 2 tablets of lumacaftor 100 mg/ivacaftor 125 mg (lumacaftor 200 mg/ivacaftor 250 mg per dose) 2 tablets of lumacaftor 100 mg/ivacaftor 125 mg (lumacaftor 200 mg/ivacaftor 250 mg per dose) 12 years and older - 2 tablets of lumacaftor 200 mg/ivacaftor 125 mg (lumacaftor 400 mg/ivacaftor 250 mg per dose) 2 tablets of lumacaftor 200 mg/ivacaftor 125 mg (lumacaftor 400 mg/ivacaftor 250 mg per dose) Administration Instructions for ORKAMBI Oral Granules The entire content of each packet of oral granules should be mixed with one teaspoon (5 mL) of age-appropriate soft food or liquid and the mixture completely consumed. Some examples of soft foods or liquids include puréed fruits or vegetables, flavored yogurt or pudding, applesauce, water, milk, breast milk, infant formula or juice. Food should be at room temperature or below. Each packet is for single use only. Once mixed, the product has been shown to be stable for one hour, and therefore should be ingested during this period. Administration with Fat-Containing Food for ORKAMBI Tablets and Oral Granules A fat-containing meal or snack should be consumed just before or just after dosing for all formulations. Examples of appropriate fat-containing foods include eggs, avocados, nuts, butter, peanut butter, cheese pizza, breast milk, infant formula, whole-milk dairy products (such as whole milk, cheese, and yogurt), etc. Missed Dose If a patient misses a dose and remembers the missed dose within 6 hours, the patient should take the dose with fat-containing food. If more than 6 hours elapsed after the recommended dosing time, the patient should skip that dose and resume the normal schedule for the following dose. A double dose should not be taken to make up for the forgotten dose [see Clinical Pharmacology (12.3) and Patient Counseling Information (17) ] . 2.2 Dosa …
Dosage Forms and Strengths
openFDA Drug Labeling3 DOSAGE FORMS AND STRENGTHS Tablets: 100 mg lumacaftor and 125 mg ivacaftor; supplied as pink, oval-shaped, film-coated, fixed-dose combination tablets containing 100 mg of lumacaftor and 125 mg of ivacaftor. Each tablet is printed with the characters "1V125" in black ink on one side and plain on the other. Tablets: 200 mg lumacaftor and 125 mg ivacaftor; supplied as pink, oval-shaped, film-coated, fixed-dose combination tablets containing 200 mg of lumacaftor and 125 mg of ivacaftor. Each tablet is printed with the characters "2V125" in black ink on one side and plain on the other. Oral granules: Unit-dose packets containing lumacaftor 75 mg/ivacaftor 94 mg or lumacaftor 100 mg/ivacaftor 125 mg or lumacaftor 150 mg/ivacaftor 188 mg per packet; supplied as small, white to off-white granules in unit-dose packets. Tablets: lumacaftor 100 mg and ivacaftor 125 mg; lumacaftor 200 mg and ivacaftor 125 mg. ( 3 ) Oral granules: Unit-dose packets of lumacaftor 75 mg and ivacaftor 94 mg; lumacaftor 100 mg and ivacaftor 125 mg; lumacaftor 150 mg and ivacaftor 188 mg. ( 3 )
Contraindications
openFDA Drug Labeling4 CONTRAINDICATIONS None. None. ( 4 )
Warnings and Cautions
openFDA Drug Labeling5 WARNINGS AND PRECAUTIONS Use in patients with advanced liver disease: ORKAMBI should be used with caution in these patients and only if the benefits are expected to outweigh the risks. If ORKAMBI is used in these patients, they should be closely monitored after the initiation of treatment and the dosage should be reduced. Liver function decompensation, including liver failure leading to death, has been reported in CF patients with pre-existing cirrhosis with portal hypertension. ( 2.2 , 5.1 , 6.1 ) Liver-related events: Elevated transaminases (ALT/AST) have been observed in some cases associated with elevated bilirubin. Measure serum transaminases and bilirubin before initiating ORKAMBI, every 3 months during the first year of treatment, and annually thereafter. For patients with a history of ALT, AST, or bilirubin elevations, more frequent monitoring should be considered. Interrupt dosing in patients with ALT or AST >5 × upper limit of normal (ULN), or ALT or AST >3 × ULN with bilirubin >2 × ULN. Following resolution, consider the benefits and risks of resuming dosing. ( 5.2 , 6.1 ) Hypersensitivity reactions: Angioedema and anaphylaxis have been reported with ORKAMBI in the postmarketing setting. Initiate appropriate therapy in the event of a hypersensitivity reaction. ( 5.3 ) Intracranial hypertension: Intracranial hypertension (IH) has been reported in the postmarketing setting with the use of ORKAMBI. If an unusual headache or visual disturbances occur during treatment, and IH is suspected, interrupt ORKAMBI and refer for prompt medical evaluation. ( 5.4 ) Neuropsychiatric events, including suicidal thoughts and behaviors : Serious neuropsychiatric events, including symptoms of anxiety, depression, suicidal ideation and behavior, and sleep disturbances, have been reported in the postmarketing setting for ORKAMBI or drugs containing the same or similar active ingredients. Monitor patients closely for new or worsening symptoms. Consider the risks and benefits for the individual patient to determine if therapy with ORKAMBI should be interrupted at the occurrence of neuropsychiatric symptoms. ( 5.5 ) Respiratory events: Chest discomfort, dyspnea, and respiration abnormal were observed more commonly during initiation of ORKAMBI. Clinical experience in patients with percent predicted FEV 1 (ppFEV 1 ) 5 × upper limit of normal (ULN) when not associated with elevated bilirubin. Dosing should also be interrupted in patients with ALT or AST elevations >3 × ULN when associated with bilirubin elevations >2 × ULN. Following resolution of transaminase elevations, consider the benefits and risks of resuming dosing [see Adverse Reactions (6.1) ] . 5.3 Hypersensitivity Reactions, Including Anaphylaxis Hypersensitivity reactions, including cases of angioedema and anaphylaxis, have been reported in the postmarketing setting [see Adverse Reactions (6.2) ] . If signs or symptoms of serious hypersensitivity reactions develop during treatment, discontinue ORKAMBI and institute appropriate therapy. Consider the benefits and risks for the individual patient to determine whether to resume treatment with ORKAMBI. 5.4 Intracranial Hypertension Cases of intracranial hypertension (IH) have been reported in the postmarketing setting with the use of ORKAMBI [see Adverse Reactions (6.2) ] . Clinical manifestations of IH include headache, blurred vision, diplopia, and potential vision loss; papilledema can be found on fundoscopy. If an unusual headache or visual disturbances occur during treatment, and IH is suspected, interrupt ORKAMBI and refer for prompt medical evaluation. Consider the benefits and risks for the individual patient to determine whether to resume treatment with ORKAMBI. Patients should be monitored until IH resolution and for recurrence. Patients with elevated vitamin A levels may be at increased risk. 5.5 Neuropsychiatric Events, Including Suicidal Thoughts and Behaviors Serious neuropsychiatric events, including symptoms of anxiety, …
Adverse Reactions
openFDA Drug Labeling6 ADVERSE REACTIONS The following adverse reactions are discussed in greater detail in other sections of the label: Use in Patients with Advanced Liver Disease [see Warnings and Precautions (5.1) ] Liver-related Events [see Warnings and Precautions (5.2) ] Hypersensitivity Reactions, Including Anaphylaxis [see Warnings and Precautions (5.3) ] Intracranial Hypertension [see Warnings and Precautions (5.4) ] Neuropsychiatric Events, Including Suicidal Thoughts and Behaviors [see Warnings and Precautions (5.5) ] Respiratory Events [see Warnings and Precautions (5.6) ] Effect on Blood Pressure [see Warnings and Precautions (5.7) ] Cataracts [see Warnings and Precautions (5.9) ] The most common adverse reactions to ORKAMBI (occurring in ≥5% of patients with CF homozygous for the F508del mutation in the CFTR gene) were dyspnea, nasopharyngitis, nausea, diarrhea, upper respiratory tract infection, fatigue, respiration abnormal, blood creatine phosphokinase increased, rash, flatulence, rhinorrhea, influenza. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Vertex Pharmaceuticals Incorporated at 1-877-634-8789 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The overall safety profile of ORKAMBI is based on the pooled data from 1108 patients with CF aged 12 years and older who are homozygous for the F508del mutation in the CFTR gene and who received at least one dose of study drug in two double-blind, placebo-controlled, Phase 3 clinical trials, each with 24 weeks of treatment (Trials 1 and 2). In addition, the following clinical trials have been conducted: A 24-week, open-label trial (Trial 3) in 58 patients with CF aged 6 through 11 years homozygous for the F508del-CFTR mutation. A 24-week, placebo-controlled trial (Trial 4) in 204 patients aged 6 through 11 years homozygous for the F508del-CFTR mutation. A 24-week, open-label trial (Trial 5) in 46 patients aged 12 years and older homozygous for the F508del-CFTR mutation and with advanced lung disease (ppFEV 1 8, >5, and >3 × ULN elevations were similar between patients treated with ORKAMBI and those who received placebo. Three patients who received ORKAMBI had liver-related serious adverse reactions, including two reported as transaminase elevations and one as hepatic encephalopathy, compared to none in the placebo group. Of these three, one had elevated transaminases (>3 × ULN) associated with bilirubin elevation >2 × ULN. Following discontinuation or interruption of ORKAMBI, transaminases decreased to 8, >5, and >3 × ULN was 5%, 9%, and 19%. No patients had total bilirubin levels >2 × ULN. Lumacaftor/ivacaftor dosing was maintained or successfully resumed after interruption in all patients with transaminase elevations, except one patient who discontinued treatment permanently. During the 24-week, placebo-controlled, clinical trial in 204 patients aged 6 through 11 years (Trial 4), the incidence of maximum transaminase (ALT or AST) levels >8, >5, and >3 × ULN was 1%, 5%, and 13% in the lumacaftor/ivacaftor patients, and 2%, 3%, and 8% in the placebo-treated patients. No patients had total bilirubin levels >2 × ULN. Two patients in the lumacaftor/ivacaftor group and two patients in the placebo group discontinued treatment permanently due to transaminase elevations. During the 24-week, open-label, clinical trial in 60 patients aged 2 through 5 years (Trial 6), the incidence of maximum transaminase (ALT or AST) levels >8, >5, and >3 × ULN was 8.3% (5/60), 11.7% (7/60), and 15.0% (9/60). No patients had total bilirubin levels >2 × ULN. Three patients discontinued lumacaftor/ivacaftor treatment permanently due to transaminase elevations. During the 24-week, open-label, clinical trial in 46 …
Drug Interactions
openFDA Drug Labeling5.8 Drug Interactions Substrates of CYP3A Lumacaftor is a strong inducer of CYP3A. Administration of ORKAMBI may decrease systemic exposure of medicinal products that are substrates of CYP3A, which may decrease therapeutic effect. Co-administration with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index is not recommended. ORKAMBI may substantially decrease hormonal contraceptive exposure, reducing their effectiveness and increasing the incidence of menstruation-associated adverse reactions, e.g., amenorrhea, dysmenorrhea, menorrhagia, menstrual irregular (27% in women using hormonal contraceptives compared with 3% in women not using hormonal contraceptives). Hormonal contraceptives, including oral, injectable, transdermal, and implantable, should not be relied upon as an effective method of contraception when co-administered with ORKAMBI [see Adverse Reactions (6.1) , Drug Interactions (7.3 , 7.11) , and Clinical Pharmacology (12.3) ] . Strong CYP3A Inducers Ivacaftor is a substrate of CYP3A4 and CYP3A5 isoenzymes. Use of ORKAMBI with strong CYP3A inducers, such as rifampin, significantly reduces ivacaftor exposure, which may reduce the therapeutic effectiveness of ORKAMBI. Therefore, co-administration with strong CYP3A inducers (e.g., rifampin, St. John's wort [ Hypericum perforatum ]) is not recommended [see Drug Interactions (7.2) and Clinical Pharmacology (12.3) ] .
7 DRUG INTERACTIONS See Full Prescribing Information for a complete list. ( 2.3 , 7 , 12.3 ) Potential for Other Drugs to Affect Lumacaftor/Ivacaftor 7.1 Inhibitors of CYP3A Co-administration of lumacaftor/ivacaftor with itraconazole, a strong CYP3A inhibitor, did not impact the exposure of lumacaftor, but increased ivacaftor exposure by 4.3-fold. Due to the induction effect of lumacaftor on CYP3A, at steady-state, the net exposure of ivacaftor is not expected to exceed that when given in the absence of lumacaftor at a dose of 150 mg every 12 hours (the approved dose of ivacaftor monotherapy). Therefore, no dosage adjustment is necessary when CYP3A inhibitors are initiated in patients currently taking ORKAMBI. However, when initiating ORKAMBI in patients taking strong CYP3A inhibitors, reduce the ORKAMBI dosage as recommended for the first week of treatment to allow for the steady-state induction effect of lumacaftor. Following this period, continue with the recommended daily dose [see Dosage and Administration (2.3) ] . Examples of strong CYP3A inhibitors include: ketoconazole, itraconazole, posaconazole, and voriconazole. telithromycin, clarithromycin. No dosage adjustment is recommended when used with moderate or weak CYP3A inhibitors. 7.2 Inducers of CYP3A Co-administration of lumacaftor/ivacaftor with rifampin, a strong CYP3A inducer, had minimal effect on the exposure of lumacaftor, but decreased ivacaftor exposure (AUC) by 57%. This may reduce the effectiveness of ORKAMBI. Therefore, co-administration with strong CYP3A inducers, such as rifampin, rifabutin, phenobarbital, carbamazepine, phenytoin, and St. John's wort ( Hypericum perforatum ), is not recommended [see Warnings and Precautions (5.8) and Clinical Pharmacology (12.3) ] . No dosage adjustment is recommended when used with moderate or weak CYP3A inducers. Potential for Lumacaftor/Ivacaftor to Affect Other Drugs 7.3 CYP3A Substrates Lumacaftor is a strong inducer of CYP3A. Co-administration of lumacaftor with ivacaftor, a sensitive CYP3A substrate, decreased ivacaftor exposure by approximately 80%. Administration of ORKAMBI may decrease systemic exposure of medicinal products which are substrates of CYP3A, thereby decreasing the therapeutic effect of the medicinal product. Co-administration of ORKAMBI is not recommended with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index [see Warnings and Precautions (5.8) and Clinical Pharmacology (12.3) ] such as: Benzodiazepines : midazolam, triazolam (consider an alternative to these benzodiazepin …
Use in Specific Populations
openFDA Drug Labeling8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Risk Summary There are limited and incomplete human data from clinical trials and postmarketing reports on use of ORKAMBI or its individual components, lumacaftor or ivacaftor, in pregnant women to inform a drug-associated risk. In animal reproduction studies, oral administration of lumacaftor to pregnant rats and rabbits during organogenesis demonstrated no adverse effects on fetal development at doses that produced maternal exposures up to approximately 8 (rats) and 5 (rabbits) times the exposure at the maximum recommended human dose (MRHD). Oral administration of ivacaftor to pregnant rats and rabbits during organogenesis demonstrated no adverse effects on fetal development at doses that produced maternal exposures up to approximately 7 (rats) and 45 (rabbits) times the exposure at the MRHD. No adverse developmental effects were observed after oral administration of either lumacaftor or ivacaftor to pregnant rats from organogenesis through lactation at doses that produced maternal exposures approximately 8 and 5 times the exposures at the MRHD, respectively (see Data ) . There are no animal reproduction studies with concomitant administration of lumacaftor and ivacaftor. The background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Data Animal Data Lumacaftor In an embryo-fetal development (EFD) study, pregnant rats were administered lumacaftor at oral doses of 500, 1000, or 2000 mg/kg/day during the period of organogenesis from gestation days 7-17. Lumacaftor did not affect fetal development or survival at exposures up to 8 times the MRHD (on an AUC basis at maternal oral doses up to 2000 mg/kg/day). In an EFD study, pregnant rabbits were administered lumacaftor at oral doses of 50, 100, or 200 mg/kg/day during the period of organogenesis from gestation days 7-19. Lumacaftor did not affect fetal development or survival at exposures up to 5 times the MRHD (on an AUC basis at maternal oral doses up to 200 mg/kg/day). Maternal toxicity as evidenced by decreased body weight, decreased food consumption, and clinical signs was observed at 100 and 200 mg/kg/day without any adverse fetal effects. In a pre- and post-natal development study in pregnant female rats administered lumacaftor at 250, 500, or 1000 mg/kg/day from gestation day 6 through lactation day 20, lumacaftor had no effects on delivery or growth and development of offspring at exposures up to 8 times the MRHD (on an AUC basis at maternal oral doses up to 1000 mg/kg/day). Placental transfer of lumacaftor was observed in pregnant rats and rabbits. Ivacaftor In an EFD study, pregnant rats were administered ivacaftor at oral doses of 50, 100, or 200 mg/kg/day during the period of organogenesis from gestation days 7-17. Ivacaftor did not affect fetal survival at exposures up to 7 times the MRHD (based on summed AUCs for ivacaftor and its metabolites at maternal oral doses up to 200 mg/kg/day). Maternal toxicity (i.e., decreased mean body weight and body weight gain) was observed at 100 and 200 mg/kg/day (5 and 7 times the exposure at the MRHD, respectively) and was associated with a decrease in fetal body weights at a maternal dose of 200 mg/kg/day (7 times the MRHD). In an EFD study, pregnant rabbits were administered ivacaftor at oral doses of 25, 50, or 100 mg/kg/day during the period of organogenesis from gestation days 7-19. Ivacaftor did not affect fetal development or survival at exposures up to 45 times the MRHD (on an ivacaftor AUC basis at maternal oral doses up to 100 mg/kg/day). Maternal toxicity (i.e., death, decreased food consumption, decreased mean body weight and body weight gain, decreased clinical condition, abortions) was observed at doses greater than or equal to 50 mg/kg/day (approximately 15 …
Mechanism of Action
openFDA Drug Labeling12.1 Mechanism of Action The CFTR protein is a chloride channel present at the surface of epithelial cells in multiple organs. The F508del mutation results in protein misfolding, causing a defect in cellular processing and trafficking that targets the protein for degradation and therefore reduces the quantity of CFTR at the cell surface. The small amount of F508del-CFTR that reaches the cell surface is less stable and has low channel-open probability (defective gating activity) compared to wild-type CFTR protein. Lumacaftor improves the conformational stability of F508del-CFTR, resulting in increased processing and trafficking of mature protein to the cell surface. Ivacaftor is a CFTR potentiator that facilitates increased chloride transport by potentiating the channel-open probability (or gating) of the CFTR protein at the cell surface. In vitro studies have demonstrated that both lumacaftor and ivacaftor act directly on the CFTR protein in primary human bronchial epithelial cultures and other cell lines harboring the F508del-CFTR mutation to increase the quantity, stability, and function of F508del-CFTR at the cell surface, resulting in increased chloride ion transport. In vitro responses do not necessarily correspond to in vivo pharmacodynamic response or clinical benefit.
Description
openFDA Drug Labeling11 DESCRIPTION The active ingredients in ORKAMBI tablets are lumacaftor, which has the following chemical name: 3-[6-({[1-(2,2-difluoro-1,3-benzodioxol-5-yl)cyclopropyl]carbonyl}amino)-3-methylpyridin-2-yl]benzoic acid, and ivacaftor, a CFTR potentiator, which has the following chemical name: N -(2,4-di-tert-butyl-5-hydroxyphenyl)-1,4-dihydro-4-oxoquinoline-3-carboxamide. The molecular formula for lumacaftor is C 24 H 18 F 2 N 2 O 5 and for ivacaftor is C 24 H 28 N 2 O 3 . The molecular weights for lumacaftor and ivacaftor are 452.41 and 392.49, respectively. The structural formulas are: lumacaftor ivacaftor Lumacaftor is a white to off-white powder that is practically insoluble in water (0.02 mg/mL). Ivacaftor is a white to off-white powder that is practically insoluble in water (<0.05 μg/mL). ORKAMBI is available as a pink, oval-shaped, film-coated tablet for oral administration containing 200 mg of lumacaftor and 125 mg of ivacaftor. Each ORKAMBI tablet contains 200 mg of lumacaftor and 125 mg of ivacaftor, and the following inactive ingredients: cellulose, microcrystalline; croscarmellose sodium; hypromellose acetate succinate; magnesium stearate; povidone; and sodium lauryl sulfate. The tablet film coat contains carmine, FD&C Blue #1, FD&C Blue #2, polyethylene glycol, polyvinyl alcohol, talc, and titanium dioxide. The printing ink contains ammonium hydroxide, iron oxide black, propylene glycol, and shellac. ORKAMBI is also available as a pink, oval-shaped, film-coated tablet for oral administration containing 100 mg of lumacaftor and 125 mg of ivacaftor. Each ORKAMBI tablet contains 100 mg of lumacaftor and 125 mg of ivacaftor, and the following inactive ingredients: cellulose, microcrystalline; croscarmellose sodium; hypromellose acetate succinate; magnesium stearate; povidone; and sodium lauryl sulfate. The tablet film coat contains carmine, FD&C Blue #1, FD&C Blue #2, polyethylene glycol, polyvinyl alcohol, talc, and titanium dioxide. The printing ink contains ammonium hydroxide, iron oxide black, propylene glycol, and shellac. ORKAMBI is also available as white to off-white granules for oral administration and enclosed in a unit-dose packet containing lumacaftor 75 mg/ivacaftor 94 mg, lumacaftor 100 mg/ivacaftor 125 mg or lumacaftor 150 mg/ivacaftor 188 mg per packet. Each unit-dose packet of ORKAMBI oral granules contains lumacaftor 75 mg/ivacaftor 94 mg, lumacaftor 100 mg/ivacaftor 125 mg or lumacaftor 150 mg/ivacaftor 188 mg per packet and the following inactive ingredients: cellulose, microcrystalline; croscarmellose sodium; hypromellose acetate succinate; povidone; and sodium lauryl sulfate. Chemical Structure Chemical Structure
Overdosage
openFDA Drug Labeling10 OVERDOSAGE There have been no reports of overdose with ORKAMBI. The highest repeated dose was lumacaftor 1000 mg once daily/ivacaftor 450 mg q12h administered to 49 healthy subjects for 7 days in a trial evaluating the effect of ORKAMBI on electrocardiograms (ECGs). Adverse events reported at an increased incidence of ≥5% compared to the lumacaftor 600 mg/ivacaftor 250 mg dosing period and placebo included: headache (29%), transaminase increased (18%), and generalized rash (10%). No specific antidote is available for overdose with ORKAMBI. Treatment of overdose consists of general supportive measures including monitoring of vital signs and observation of the clinical status of the patient.
How Supplied / Storage and Handling
openFDA Drug Labeling16 HOW SUPPLIED/STORAGE AND HANDLING ORKAMBI (lumacaftor 200 mg/ivacaftor 125 mg) is supplied as pink, oval-shaped tablets; each tablet contains 200 mg of lumacaftor and 125 mg of ivacaftor, printed with "2V125" in black ink on one side and plain on the other, and is packaged as follows: 112–count tablet box containing a 4-week supply (4 weekly cartons of 7 daily blister strips with 4 tablets per strip). NDC 51167-809-01 ORKAMBI (lumacaftor 100 mg/ivacaftor 125 mg) is supplied as pink, oval-shaped tablets; each tablet contains 100 mg of lumacaftor and 125 mg of ivacaftor, printed with "1V125" in black ink on one side and plain on the other, and is packaged as follows: 112–count tablet box containing a 4-week supply (4 weekly cartons of 7 daily blister strips with 4 tablets per strip). NDC 51167-700-02 ORKAMBI (lumacaftor/ivacaftor) oral granules are supplied as small white to off-white granules and enclosed in unit-dose packets as follows: 56-count carton (contains 56 unit-dose packets of lumacaftor 75 mg/ivacaftor 94 mg per packet) NDC 51167-122-01 56-count carton (contains 56 unit-dose packets of lumacaftor 100 mg/ivacaftor 125 mg per packet) NDC 51167-900-01 56-count carton (contains 56 unit-dose packets of lumacaftor 150 mg/ivacaftor 188 mg per packet) NDC 51167-500-02 Store at 20°C - 25°C (68°F - 77°F); excursions permitted to 15°C - 30°C (59°F - 86°F) [see USP Controlled Room Temperature].
Adverse event reports
Source: openFDA FAERSAttributed to this product's most-reported active ingredient: IVACAFTOR. Combination products with more than six active ingredients are not attributed, because a report count summed across a long ingredient list measures the list, not the medicine.
Packaging and NDCs
Source: NDC Directory| Package NDC | Product NDC | Labeler | Description | Marketing start |
|---|---|---|---|---|
| 51167-122-01 | 51167-122 | Vertex Pharmaceuticals Incorporated | 56 PACKET in 1 CARTON (51167-122-01) / 1 GRANULE in 1 PACKET | September 2, 2022 |
| 51167-500-02 | 51167-500 | Vertex Pharmaceuticals Incorporated | 56 PACKET in 1 CARTON (51167-500-02) / 1 GRANULE in 1 PACKET | August 7, 2018 |
| 51167-900-01 | 51167-900 | Vertex Pharmaceuticals Incorporated | 56 PACKET in 1 CARTON (51167-900-01) / 1 GRANULE in 1 PACKET | August 7, 2018 |
| 51167-122 | 51167-122 | Vertex Pharmaceuticals Incorporated | — | September 2, 2022 |
| 51167-500 | 51167-500 | Vertex Pharmaceuticals Incorporated | — | August 7, 2018 |
| 51167-900 | 51167-900 | Vertex Pharmaceuticals Incorporated | — | August 7, 2018 |
Sources for this page
| Dataset | Agency | Used for |
|---|---|---|
| NDC Directory | FDA | Identity, ingredients, strengths, forms, routes, labelers, packages |
| Drugs@FDA | FDA | Application, sponsor, submissions, review documents, marketing status |
| Orange Book | FDA | Therapeutic equivalence codes, reference drug flags, patents, exclusivity |
| Drug Labeling | FDA / NLM | Prescribing information reproduced above |
| FAERS | FDA | Adverse event report counts |
Generated September 25, 2026 · 13 sections on this page.