Ekterly dosage: Form, strengths, and how to take it

What is the standard Ekterly dosage?

Ekterly comes as a 300-milligram (mg) oral tablet.

Dosage for an acute HAE attack

• Starting dose: Take 600 mg (two 300 mg tablets) by mouth at the earliest sign of an HAE attack.
• Second dose (if needed): If your symptoms do not improve, or if they worsen or return, you may take a second dose of 600 mg (two 300 mg tablets). It’s important to wait at least 3 hours after your first dose before taking a second dose.

When to take Ekterly

Unlike daily preventive treatments, Ekterly is an on-demand medication. It’s meant to be taken at the first signs of an HAE attack, rather than on a set daily schedule.

Early warning signs of an HAE attack

For the best results, take your starting dose as soon as you recognize the early signs of an HAE attack. Early warning signs can appear hours or days before visible swelling occurs. These signs may include:

• a tingling sensation under the skin
• localized tightness or pressure in the skin or abdomen
• unusual or sudden fatigue
• mild abdominal cramping or nausea
• a non-itchy, reddish ring-like rash (erythema marginatum)

Timing between doses

After taking your first dose, start a 3-hour timer. If you’re still experiencing symptoms after 3 hours, it’s safe to take a second 600-mg dose.

However, the maximum recommended dose is 1,200 mg in 24 hours. If the second dose isn’t effective for managing your symptoms, seek immediate medical attention.

What factors can affect your dosage?

Your doctor may adjust your Ekterly dose or recommend a different treatment based on other health conditions or medications you take.

Medications (CYP3A4 inhibitors and inducers)

Ekterly is broken down in the liver by an enzyme called CYP3A4. Certain medications can change how quickly your body processes Ekterly:

• Moderate CYP3A4 inhibitors: These drugs slow down how Ekterly is processed, raising drug levels in your body. If you take a moderate inhibitor, your dose is reduced to 300 mg (one tablet) at the start of an attack, with an optional second 300 mg dose at least 3 hours later. Examples of CYP3A4 inhibitors include:
  • grapefruit
  • fluconazole, ketoconazole
  • protease inhibitors, like ritonavir
  • cimetidine
  • azithromycin and clarithromycin
• Strong CYP3A4 inhibitors or inducers: Avoid taking Ekterly if you take strong inhibitors (which raise drug levels significantly) or strong-to-moderate inducers (which lower drug levels and make Ekterly less effective). Examples include:
  • phenytoin (Dilantin)
  • phenobarbital
  • oxcarbazepine (Oxtellar XR)
  • rifampin (Rifadin)
  • carbamazepine (Tegretol)
  • St. John’s Wort

Liver health

Because the liver processes Ekterly, liver function plays a role in determining your dosage:

• Moderate liver impairment (Child-Pugh Class B): Your doctor will likely lower your starting dose to 300 mg (one tablet), with a second 300 mg dose allowed after at least 3 hours if needed.
• Severe liver impairment (Child-Pugh Class C): Your doctor will likely not prescribe Ekterly.

What you can do next

• Review your medication list: Share a complete list of prescription drugs, over-the-counter medications, and supplements with your doctor or pharmacist to check for CYP3A4 interactions.
• Discuss your liver history: Tell your healthcare team if you have a history of liver problems so they can set the safest starting dose for you.
• Learn your early attack signs: Keep track of early warning symptoms like tingling or tightness so you can take Ekterly as early as possible.
• Track your dose timing: Note the exact time you take your first dose so you know when it is safe to take a second dose if needed.