Vemurafenib: Drug information

For additional information see "Vemurafenib: Patient drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: US

Zelboraf

Brand Names: Canada

Zelboraf

Pharmacologic Category

Antineoplastic Agent, BRAF Kinase Inhibitor

Dosing: Adult

Dosage guidance:

Safety: Do not initiate vemurafenib in patients with electrolyte abnormalities that are not correctable, long QT syndrome, or taking concomitant medication known to prolong the QT interval. Do not initiate if baseline QTc >500 msec.

Clinical considerations: Refer to the protocol or institutional guidance for additional details of off-label dosing.

Erdheim-Chester disease, with BRAF V600 mutation

Erdheim-Chester disease, with BRAF V600 mutation: Oral: 960 mg every 12 hours; continue until disease progression or unacceptable toxicity (Ref).

Hairy cell leukemia, relapsed or refractory

Hairy cell leukemia, relapsed or refractory (off-label use):

In combination with rituximab: Oral: Induction: 960 mg twice daily for 4 weeks (in combination with rituximab), followed by 2 weeks of rest, followed by a second induction cycle consisting of vemurafenib 960 mg twice daily for 4 weeks (in combination with rituximab). After the second induction cycle, 4 additional rituximab doses were administered as consolidation therapy, for a total of 8 rituximab doses (Ref).

As a single agent: Oral: 960 mg twice daily for a minimum of 8 to 12 weeks; patients with residual disease could continue vemurafenib for up to 8 to 12 additional weeks (Ref).

Langerhans cell histiocytosis, BRAF V600 mutated

Langerhans cell histiocytosis, BRAF V600 mutated (off-label use): Oral: 960 mg twice daily; continue until disease progression or unacceptable toxicity (Ref).

Melanoma, unresectable or metastatic

Melanoma, unresectable or metastatic:

With BRAF V600E mutation: Note: Confirm BRAF V600E mutation status in tumor specimens prior to initiation.

Oral: 960 mg every 12 hours; continue until disease progression or unacceptable toxicity.

With BRAF V600K mutation (off-label use): Oral: 960 mg every 12 hours; continue until disease progression or unacceptable toxicity (Ref).

With BRAF V600 mutations (off-label combinations):

In combination with cobimetinib: Oral: 960 mg every 12 hours; continue until disease progression or unacceptable toxicity (Ref).

In combination with cobimetinib and atezolizumab:

Cycle 1 (with cobimetinib only): Oral: 960 mg every 12 hours on days 1 to 21 of a 28-day cycle, followed by 720 mg every 12 hours on days 22 to 28 of cycle 1 (Ref).

Cycle 2 and beyond (with cobimetinib and atezolizumab): Oral: 720 mg every 12 hours; continue until disease progression or unacceptable toxicity (Ref).

With BRAF mutation and brain metastases (off-label combination): Note: Vemurafenib in combination with cobimetinib has been used for the treatment of BRAF mutant melanoma with brain metastases, although data are limited (Ref).

Non–small cell lung cancer, relapsed/refractory, with BRAF V600 mutation

Non–small cell lung cancer, relapsed/refractory, with BRAF V600 mutation (off-label use): Oral: 960 mg twice daily; continue until disease progression or unacceptable toxicity (Ref).

Thyroid cancer, papillary, recurrent or metastatic, BRAF V600E mutated

Thyroid cancer, papillary, recurrent or metastatic, BRAF V600E mutated (off-label use): Oral: 960 mg twice daily; continue until disease progression or unacceptable toxicity (Ref).

Missed doses: A missed dose may be administered up to 4 hours prior to the next scheduled dose. If it is within 4 hours of the next scheduled dose, administer the next dose at the regular schedule. If vomiting occurs after a dose is taken, do not take an additional dose; continue with the next scheduled dose.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult Drug Interactions database for more information.

Dosing: Kidney Impairment: Adult

Kidney impairment prior to treatment initiation:

CrCl ≥30 mL/minute: No dosage adjustment necessary.

CrCl <30 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling; however, no need for dose adjustment is expected (Ref).

Hemodialysis, intermittent (thrice weekly): No need for dose adjustment is expected (Ref).

Kidney toxicity during treatment:

Nephrotoxicity/creatinine abnormalities: Refer to dosage adjustment for toxicity and manage with dose reduction, treatment interruption, or discontinuation.

Dosing: Liver Impairment: Adult

Hepatic impairment prior to treatment initiation:

Mild to moderate impairment (total bilirubin 1 to 3 times ULN): No dosage adjustment necessary.

Severe impairment (total bilirubin >3 times ULN): There are no dosage adjustments provided in manufacturer's labeling; however, no need for dose adjustment is expected (monitor LFTs twice a week as clinically indicated) (Ref).

Acute hepatotoxicity during treatment:

Hepatotoxicity/lab abnormalities: Refer to dosage adjustment for toxicity and manage with dose reduction, treatment interruption, or discontinuation.

Dosing: Adjustment for Toxicity: Adult

**Vemurafenib Recommended Dosage Adjustments for Adverse Reactions**
Adverse reaction	Severity	Vemurafenib dosage modification^a
^a Do not reduce vemurafenib dose below 480 mg twice daily.
Dermatologic toxicity	Severe	Permanently discontinue vemurafenib.
Dupuytren contracture and plantar fascial fibromatoses	Any	May require vemurafenib interruption, dosage reduction^a, or treatment discontinuation.
Hypersensitivity	Severe	Permanently discontinue vemurafenib.
New primary cutaneous malignancies	Any	No dosage adjustment recommended.
Photosensitivity	≥ Grade 2 (intolerable)	Dosage modifications^a are recommended.
QTc prolongation	QTc >500 msec (grade ≥3)	Temporarily withhold treatment, correct electrolytes, and control risk factors for QT prolongation; may reinitiate with a dose reduction^a once QTc ≤500 msec (≤ grade 2).
QTc prolongation	QTc persistently >500 msec and >60 msec above baseline	Permanently discontinue vemurafenib.
Uveitis	Any	May be managed with corticosteroid and mydriatic eye drops.
Other treatment-related adverse reactions	Grade 1 or grade 2 (tolerable)	No dosage adjustment recommended.
	Grade 2 (intolerable) or grade 3	First incident: Interrupt treatment until toxicity returns to grade 0 or 1, then resume vemurafenib at 720 mg twice daily. Second incident: Interrupt treatment until toxicity returns to grade 0 or 1, then resume vemurafenib at 480 mg twice daily. Third incident: Permanently discontinue vemurafenib.
	Grade 4	First incident: Interrupt treatment until toxicity returns to grade 0 or 1, then resume vemurafenib at 480 mg twice daily or permanently discontinue vemurafenib (if clinically appropriate). Second incident: Permanently discontinue vemurafenib.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for adults.

>10%:

Cardiovascular: Peripheral edema (17%)

Dermatologic: Alopecia (45%), cutaneous papilloma (21%), erythema of skin (14%), hyperkeratosis (24%; actinic: 8%; pilaris: <10%; seborrheic: 10%), pruritus (23%), skin photosensitivity (33%), skin rash (37%), squamous cell carcinoma of skin (grades ≥3: 24%; including keratoacanthoma), xeroderma (19%)

Gastrointestinal: Constipation (12%), decreased appetite (18%), diarrhea (28%; grade 3: <1%), dysgeusia (14%), nausea (35%; grade 3: 2%), vomiting (18%; grade 3: 1%)

Nervous system: Asthenia (11%), fatigue (38%), headache (23%)

Neuromuscular & skeletal: Arthralgia (53%), limb pain (18%), myalgia (13%)

Renal: Increased serum creatinine (≤3 × ULN: 26%; >3 × ULN: 1%)

Miscellaneous: Fever (19%)

1% to 10%:

Cardiovascular: Atrial fibrillation, vasculitis

Dermatologic: Basal cell carcinoma of skin, erythema nodosum, folliculitis, maculopapular rash (9%), malignant melanoma (new primary: 2%), palmar-plantar erythrodysesthesia, papular rash (5%), Stevens-Johnson syndrome, sunburn (10%), toxic epidermal necrolysis

Hematologic & oncologic: Squamous cell carcinoma (oropharyngeal)

Hepatic: Increased gamma-glutamyl transferase (5%), increased serum alanine aminotransferase (grade 3: 3%), increased serum alkaline phosphatase (grade 3: 3%), increased serum bilirubin (grade 3: 2%)

Nervous system: Facial nerve paralysis, peripheral neuropathy

Neuromuscular & skeletal: Arthritis, back pain (8%), Dupuytren contracture, musculoskeletal pain (8%), panniculitis

Ophthalmic: Retinal vein occlusion, uveitis (2%; including iritis)

Respiratory: Cough (8%)

<1%: Hepatic: Increased serum aspartate aminotransferase

Frequency not defined: Cardiovascular: Prolonged QT interval on ECG

Postmarketing:

Dermatologic: Dermatitis (granulomatous) (Hui Ong 2019), Sweet syndrome (Yorio 2014)

Gastrointestinal: Pancreatitis (Muluneh 2013)

Hematologic & oncologic: Chronic myelomonocytic leukemia with NRAS mutation (progression of preexisting condition), disseminated intravascular coagulation (van den Brom 2015), leukopenia (Orouji 2014), neutropenia, nonautoimmune hemolytic anemia (Fusi 2014)

Hepatic: Granulomatous hepatitis (Spengler 2017)

Hypersensitivity: Drug reaction with eosinophilia and systemic symptoms (Munch 2016), severe hypersensitivity reaction (including anaphylaxis, peripheral demyelinating polyneuropathy [acute inflammatory demyelinating polyneuropathy]) (Johnson 2013; Rana 2021)

Local: Local acneiform eruptions (Ansai 2016)

Neuromuscular & skeletal: Plantar fasciitis (plantar fascial fibromatosis) (Perez 2017)

Respiratory: Pulmonary infiltrates (Schmitt 2013)

Miscellaneous: Radiation recall phenomenon (including recall skin sensitization) (Boussemart 2013; Conen 2015)

Contraindications

There are no contraindications listed in the manufacturer's US labeling.

Canadian labeling: Hypersensitivity to vemurafenib or any component of the formulation.

Warnings/Precautions

Concerns related to adverse effects:

• Dermatologic toxicity: Dermatologic reactions have been observed, including case reports of Stevens-Johnson syndrome and toxic epidermal necrolysis.

• Fibroproliferative disease: Cases of Dupuytren contracture and plantar fascial fibromatosis have been reported with vemurafenib use (Chan 2015; Perez 2017; Vandersleyen 2016). In June of 2017, the vemurafenib manufacturer issued a “Dear Healthcare Provider” letter stating that the majority of cases reported were mild to moderate, although disabling Dupuytren contracture cases have been observed. The median time to onset was 224 days from therapy initiation; the majority of patients experienced symptom resolution or improvement with interruption or discontinuation of vemurafenib (Perez 2017).

• Hepatotoxicity: Liver injury has been reported and may cause functional impairment such as coagulopathy or other organ dysfunction.

• Hypersensitivity: Anaphylaxis and severe hypersensitivity may occur during treatment or upon reinitiation. Serious reactions have included generalized rash, erythema, hypotension, and drug rash with eosinophilia and systemic symptoms (DRESS syndrome).

• Malignancies: Cutaneous squamous cell carcinomas (cuSCC), keratoacanthomas, and melanoma have been reported (at a higher rate in patients receiving vemurafenib compared to control). Cutaneous SCC generally occurs early in the treatment course (median onset: 7 to 8 weeks in melanoma patients and ~12 weeks in Erdheim Chester disease [ECD] patients) and is managed with excision (while continuing vemurafenib treatment). Approximately one-third of melanoma patients experienced >1 cuSCC occurrence and the median time between occurrences was 6 weeks. Potential risk factors for cuSCC include age ≥65 years, history of skin cancer, or chronic sun exposure. In patients receiving vemurafenib for the treatment of melanoma, new primary malignant melanomas have been reported (rare). Noncutaneous squamous cell carcinomas (non-cuSCC) of the head and neck have also been observed; monitor closely for signs/symptoms. Vemurafenib may promote malignancies correlated with RAS activation; monitor for signs/symptoms of other malignancies. Myeloid malignancies in patients with ECD have been reported, including patients receiving vemurafenib.

• Nephrotoxicity: Acute kidney injury, including interstitial nephritis, acute tubular necrosis, and serum creatinine elevations (grades 1 to 4) have been reported.

• Ocular toxicity: Uveitis (including iritis), blurred vision, and photophobia may occur. Retinal vein occlusion has been reported in clinical trials.

• Pancreatitis: Pancreatitis has been reported (rare). Onset occurs within 2 weeks after initiation, with exacerbation occurring upon rechallenge at a reduced dose (Muluneh 2013).

• Photosensitivity: Photosensitivity ranging from mild to severe has been reported. Advise patients to avoid sun exposure and wear protective clothing and use effective UVA/UVB sunscreen and lip balm (SPF ≥30) when outdoors.

• QT prolongation: QT prolongation (dose-dependent) has been observed; may lead to increased risk for ventricular arrhythmia, including torsades de pointes.

• Radiation sensitization/recall: Radiation sensitization and recall (some cases may be severe or involve cutaneous and visceral organs) have been reported in patients treated with radiation prior to, during, or after treatment with vemurafenib; fatal cases have been reported in patients with visceral organ involvement.

Special populations:

• Older adult: Patients ≥65 years of age may be at increased risk for development of cuSCC.

Other warnings/precautions:

• BRAF genomics: Only patients with a BRAF V600 mutation-positive melanoma (including BRAF V600E) will benefit from treatment; mutation must be detected in tumor specimen(s) and confirmed by an approved test prior to treatment. The cobas 4800 BRAF V600 Mutation Test was used in clinical trials and is approved to detect BRAF V600E mutation.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Zelboraf: 240 mg

Generic Equivalent Available: US

Pricing: US

Tablets (Zelboraf Oral)

240 mg (per each): $63.16

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Zelboraf: 240 mg

Prescribing and Access Restrictions

Available through specialty pharmacies. Further information may be obtained from the manufacturer, Genentech, at 1-888-249-4918, or at http://www.zelboraf.com.

Administration: Adult

Oral: Doses should be administered orally in the morning and evening, ~12 hours apart. May administer with or without a meal. If vomiting occurs after a dose is taken, do not take an additional dose; continue with the next scheduled dose.

Swallow whole with a glass of water; do not crush or chew. There are case reports of vemurafenib administration after crushing (Ref), however vemurafenib is nearly insoluble in water and is manufactured as a microprecipitated bulk powder core (to improve solubility/bioavailability) within a film coated tablet (Ref). Pharmacokinetics and efficacy of administration other than swallowing tablets whole have not been determined.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2024 [table 2]).

Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2023; NIOSH 2024; USP-NF 2020).

Note: Facilities may perform risk assessment of some hazardous drugs to determine if appropriate for alternative handling and containment strategies (USP-NF 2020). Refer to institution-specific handling policies/procedures.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/202429s016lbl.pdf#page=21, must be dispensed with this medication.

Use: Labeled Indications

Melanoma, unresectable or metastatic, with BRAF V600E mutation: Treatment of unresectable or metastatic melanoma in patients with a BRAF V600E mutation (as detected by an approved test).

Limitations of use: Not indicated for treatment of wild-type BRAF melanoma.

Erdheim-Chester disease, with BRAF V600 mutation: Treatment of Erdheim-Chester disease (ECD) in patients with a BRAF V600 mutation.

Use: Off-Label: Adult

Hairy cell leukemia, relapsed or refractory; Langerhans cell histiocytosis, with BRAF V600 mutation; Melanoma, metastatic, with BRAF V600K mutation; Non-small cell lung cancer, relapsed/refractory, with BRAF V600 mutation; Thyroid cancer, papillary, recurrent or metastatic, BRAF V600E-mutated

Medication Safety Issues

Sound-alike/look-alike issues:

Vemurafenib may be confused with axitinib, cabozantinib, cobimetinib, dabrafenib, encorafenib, ponatinib, regorafenib, SORAfenib, tovorafenib, trametinib, vandetanib, venetoclax, vimseltinib, vismodegib, vorasidenib

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (chemotherapeutic agent, parenteral and oral) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care, Community/Ambulatory Care, and Long-Term Care Settings).

Metabolism/Transport Effects

Substrate of BCRP, CYP3A4 (Major), P-glycoprotein (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits CYP1A2 (Moderate), CYP2D6 (Weak), P-glycoprotein; Induces CYP3A4 (Weak);

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Afatinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Afatinib. Management: If combined, administer the P-gp inhibitor simultaneously with, or after, the dose of afatinib. Monitor closely for signs and symptoms of afatinib toxicity and if the combination is not tolerated, reduce the afatinib dose by 10 mg. Risk D: Consider Therapy Modification

Agomelatine: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Agomelatine. Risk C: Monitor

Aliskiren: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Aliskiren. Risk C: Monitor

Alosetron: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Alosetron. Management: Avoid concomitant use of alosetron and moderate CYP1A2 inhibitors whenever possible. If combined use is necessary, monitor for increased alosetron effects/toxicities. Risk D: Consider Therapy Modification

Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

Amisulpride (Oral): May increase QTc-prolonging effects of QT-prolonging Agents (Moderate Risk). Risk C: Monitor

Anagrelide: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Anagrelide. CYP1A2 Inhibitors (Moderate) may increase active metabolite exposure of Anagrelide. Risk C: Monitor

Androgens: Hypertension-Associated Agents may increase hypertensive effects of Androgens. Risk C: Monitor

Atogepant: CYP3A4 Inducers (Weak) may decrease serum concentration of Atogepant. Management: For treatment of episodic migraine, the recommended dose of atogepant is 30 mg once daily or 60 mg once daily when combined with CYP3A4 inducers. When used for treatment of chronic migraine, use of atogepant with CYP3A4 inducers should be avoided. Risk D: Consider Therapy Modification

Azithromycin (Systemic): QT-prolonging Kinase Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Azithromycin (Systemic). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Bendamustine: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Bendamustine. Management: Consider alternatives to moderate CYP1A2 inhibitors during therapy with bendamustine due to the potential for increased bendamustine plasma concentrations and increased bendamustine toxicity. Risk D: Consider Therapy Modification

Beta-Acetyldigoxin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Beta-Acetyldigoxin. Risk C: Monitor

Bilastine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Bilastine. Risk X: Avoid

Caffeine and Caffeine Containing Products: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Caffeine and Caffeine Containing Products. Risk C: Monitor

Celiprolol: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Celiprolol. Risk C: Monitor

Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor

CloZAPine: CYP1A2 Inhibitors (Moderate) may increase serum concentration of CloZAPine. Risk C: Monitor

Colchicine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Colchicine. Colchicine distribution into certain tissues (e.g., brain) may also be increased. Management: This combination is often contraindicated, but combined use may be permitted with dose adjustment and monitoring. Recommendations vary based on brand, indication, use of CYP3A4 inhibitors, and hepatic/renal function. See interaction monograph for details. Risk D: Consider Therapy Modification

CycloSPORINE (Systemic): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of CycloSPORINE (Systemic). Risk C: Monitor

CYP3A4 Inducers (Moderate): May decrease serum concentration of Vemurafenib. Risk C: Monitor

CYP3A4 Inducers (Strong): May decrease serum concentration of Vemurafenib. Management: Avoid coadministration of vemurafenib and strong CYP3A4 inducers if possible. If coadministration is unavoidable, increase the vemurafenib dose by 240 mg as tolerated. Resume prior vemurafenib dose 2 weeks after discontinuation of strong CYP3A4 inducer. Risk D: Consider Therapy Modification

CYP3A4 Inhibitors (Moderate): May increase serum concentration of Vemurafenib. Risk C: Monitor

CYP3A4 Inhibitors (Strong): May increase serum concentration of Vemurafenib. Management: Avoid concurrent use of vemurafenib with strong CYP3A4 inhibitors when possible. If concomitant use is unavoidable, consider a vemurafenib dose reduction if clinically indicated. Risk D: Consider Therapy Modification

Dabigatran Etexilate: P-glycoprotein/ABCB1 Inhibitors may increase active metabolite exposure of Dabigatran Etexilate. Risk C: Monitor

Dabrafenib: May increase QTc-prolonging effects of Vemurafenib. Dabrafenib may decrease serum concentration of Vemurafenib. Management: Monitor for decreased vemurafenib efficacy, QTc interval prolongation and ventricular arrhythmias, including torsades de pointes when these agents are combined. Risk C: Monitor

Diazoxide Choline: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Diazoxide Choline. Risk C: Monitor

Digitoxin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Digitoxin. Risk C: Monitor

Digoxin: Vemurafenib may increase serum concentration of Digoxin. Management: Avoid coadministration of vemurafenib and digoxin when possible. If combined, measure digoxin levels and reduce digoxin concentrations by either reducing the digoxin dose by 30% to 50% or by modifying the dosing frequency. Risk D: Consider Therapy Modification

Domperidone: QT-prolonging Agents (Moderate Risk) may increase QTc-prolonging effects of Domperidone. Risk X: Avoid

DOXOrubicin (Conventional): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of DOXOrubicin (Conventional). Risk X: Avoid

DOXOrubicin (Liposomal): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of DOXOrubicin (Liposomal). Risk C: Monitor

DULoxetine: CYP1A2 Inhibitors (Moderate) may increase serum concentration of DULoxetine. Risk C: Monitor

Edoxaban: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Edoxaban. Risk C: Monitor

Encorafenib: May increase QTc-prolonging effects of Vemurafenib. Encorafenib may decrease serum concentration of Vemurafenib. Management: Avoid use of vemurafenib and encorafenib if possible. If combined increase the vemurafenib dose by 240 mg as tolerated. Resume prior vemurafenib dose 2 weeks after encorafenib discontinuation. Monitor for QTc interval prolongation and arrhythmias. Risk D: Consider Therapy Modification

Ensartinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Ensartinib. Risk X: Avoid

Etoposide Phosphate: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Etoposide Phosphate. Risk C: Monitor

Etoposide: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Etoposide. Risk C: Monitor

Everolimus: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Everolimus. Risk C: Monitor

Fexinidazole: QT-prolonging Kinase Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Fexinidazole. Fexinidazole may decrease serum concentration of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Additionally, monitor for reduced efficacy of these kinase inhibitors. Risk C: Monitor

Fezolinetant: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Fezolinetant. Risk X: Avoid

Fluorouracil Products: May increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification

Glecaprevir and Pibrentasvir: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Glecaprevir and Pibrentasvir. Risk C: Monitor

Grapefruit Juice: May increase serum concentration of Vemurafenib. Risk C: Monitor

Haloperidol: QT-prolonging Kinase Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Hormonal Contraceptives: CYP3A4 Inducers (Weak) may decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a weak CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider Therapy Modification

Ipilimumab: May increase hepatotoxic effects of Vemurafenib. Management: Consider alternatives to this combination when possible. Use of this combination should only be undertaken with extra close monitoring of liver function (hepatic transaminases and bilirubin) and signs/symptoms of hepatotoxicity. Risk D: Consider Therapy Modification

Lapatinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Lapatinib. Risk C: Monitor

Larotrectinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Larotrectinib. Risk C: Monitor

Lefamulin: May increase QTc-prolonging effects of QT-prolonging CYP3A4 Substrates. Management: Do not use lefamulin tablets with QT-prolonging CYP3A4 substrates. Lefamulin prescribing information lists this combination as contraindicated. Risk X: Avoid

Levoketoconazole: QT-prolonging CYP3A4 Substrates may increase QTc-prolonging effects of Levoketoconazole. Levoketoconazole may increase serum concentration of QT-prolonging CYP3A4 Substrates. Risk X: Avoid

Mavorixafor: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Mavorixafor. Risk C: Monitor

Melatonin: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Melatonin. Risk C: Monitor

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Midostaurin: May increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Morphine (Systemic): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Morphine (Systemic). Risk C: Monitor

Nadolol: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Nadolol. Risk C: Monitor

Naldemedine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Naldemedine. Risk C: Monitor

Naloxegol: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Naloxegol. Risk C: Monitor

NiMODipine: CYP3A4 Inducers (Weak) may decrease serum concentration of NiMODipine. Risk C: Monitor

OLANZapine: CYP1A2 Inhibitors (Moderate) may increase serum concentration of OLANZapine. Risk C: Monitor

Ondansetron: May increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

PAZOPanib: Vemurafenib may increase QTc-prolonging effects of PAZOPanib. Vemurafenib may increase serum concentration of PAZOPanib. Risk X: Avoid

Pentamidine (Systemic): May increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Pentoxifylline: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Pentoxifylline. Risk C: Monitor

Pimozide: May increase QTc-prolonging effects of QT-prolonging Agents (Moderate Risk). Risk X: Avoid

Piperaquine: QT-prolonging Agents (Moderate Risk) may increase QTc-prolonging effects of Piperaquine. Risk X: Avoid

Pirfenidone: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Pirfenidone. Management: Avoid concomitant use of pirfenidone and moderate CYP1A2 inhibitors whenever possible. If combined, decrease the pirfenidone dose to 1,602 mg per day (534 mg three times daily) and monitor for increased pirfenidone toxicities. Risk D: Consider Therapy Modification

Pomalidomide: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Pomalidomide. Risk C: Monitor

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Posaconazole: May increase serum concentration of QT-prolonging CYP3A4 Substrates. Such increases may lead to a greater risk for proarrhythmic effects and other similar toxicities. Risk X: Avoid

Pralsetinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Pralsetinib. Management: If this combo cannot be avoided, decrease pralsetinib dose from 400 mg daily to 300 mg daily; from 300 mg daily to 200 mg daily; and from 200 mg daily to 100 mg daily. Risk D: Consider Therapy Modification

Propranolol: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Propranolol. Risk C: Monitor

QT-prolonging Agents (Highest Risk): May increase QTc-prolonging effects of Vemurafenib. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider Therapy Modification

QT-prolonging Antidepressants (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Antipsychotics (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Class IC Antiarrhythmics (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-Prolonging Inhalational Anesthetics (Moderate Risk): QT-prolonging Kinase Inhibitors (Moderate Risk) may increase QTc-prolonging effects of QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Kinase Inhibitors (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Miscellaneous Agents (Moderate Risk): QT-prolonging Kinase Inhibitors (Moderate Risk) may increase QTc-prolonging effects of QT-prolonging Miscellaneous Agents (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of QT-prolonging Kinase Inhibitors (Moderate Risk). Risk C: Monitor

QT-prolonging Quinolone Antibiotics (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Strong CYP3A4 Inhibitors (Highest Risk): May increase QTc-prolonging effects of Vemurafenib. QT-prolonging Strong CYP3A4 Inhibitors (Highest Risk) may increase serum concentration of Vemurafenib. Management: Avoid concomitant use of vemurafenib and strong CYP3A4 inhibitors that prolong the QTc interval whenever possible. If combined monitor patients for vemurafenib toxicities including QTc prolongation and TdP, and consider a vemurafenib dose reduction. Risk D: Consider Therapy Modification

QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk): Vemurafenib may increase QTc-prolonging effects of QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Vemurafenib. Management: Avoid concomitant use of vemurafenib and strong CYP3A4 inhibitors that prolong the QTc interval whenever possible. If combined monitor patients for vemurafenib toxicities including QTc prolongation and TdP, and consider a vemurafenib dose reduction. Risk D: Consider Therapy Modification

Ramelteon: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Ramelteon. Risk C: Monitor

Ramosetron: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Ramosetron. Risk C: Monitor

Ranolazine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Ranolazine. Risk C: Monitor

Rasagiline: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Rasagiline. Management: Limit rasagiline dose to 0.5 mg once daily in patients taking moderate CYP1A2 inhibitors. Risk D: Consider Therapy Modification

Relugolix, Estradiol, and Norethindrone: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Relugolix, Estradiol, and Norethindrone. Management: Avoid use of relugolix/estradiol/norethindrone with P-glycoprotein (P-gp) inhibitors. If concomitant use is unavoidable, relugolix/estradiol/norethindrone should be administered at least 6 hours before the P-gp inhibitor. Risk D: Consider Therapy Modification

Relugolix: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Relugolix. Management: Avoid coadministration of relugolix with oral P-gp inhibitors whenever possible. If combined, take relugolix at least 6 hours prior to the P-gp inhibitor and monitor patients more frequently for adverse reactions. Risk D: Consider Therapy Modification

Repotrectinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Repotrectinib. Risk X: Avoid

RifAXIMin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of RifAXIMin. Risk C: Monitor

Rimegepant: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Rimegepant. Management: Avoid administration of another dose of rimegepant within 48 hours if given concomitantly with a P-glycoprotein (P-gp) inhibitor. Risk D: Consider Therapy Modification

RisperiDONE: May increase QTc-prolonging effects of Vemurafenib. Vemurafenib may increase serum concentration of RisperiDONE. Management: Monitor for increased risperidone toxicities, including QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

RomiDEPsin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of RomiDEPsin. Risk C: Monitor

ROPINIRole: CYP1A2 Inhibitors (Moderate) may increase serum concentration of ROPINIRole. Risk C: Monitor

ROPivacaine: CYP1A2 Inhibitors (Moderate) may increase serum concentration of ROPivacaine. Risk C: Monitor

Sertindole: May increase QTc-prolonging effects of QT-prolonging Agents (Moderate Risk). Risk X: Avoid

Silodosin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Silodosin. Risk C: Monitor

Sirolimus (Conventional): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Sirolimus (Conventional). Management: Avoid concurrent use of sirolimus with P-glycoprotein (P-gp) inhibitors when possible and alternative agents with lesser interaction potential with sirolimus should be considered. Monitor for increased sirolimus concentrations/toxicity if combined. Risk D: Consider Therapy Modification

Sirolimus (Protein Bound): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Sirolimus (Protein Bound). Risk X: Avoid

Solriamfetol: May increase hypertensive effects of Hypertension-Associated Agents. Risk C: Monitor

Tacrolimus (Systemic): CYP3A4 Inducers (Weak) may decrease serum concentration of Tacrolimus (Systemic). Risk C: Monitor

Tacrolimus (Systemic): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor

Talazoparib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Talazoparib. Risk C: Monitor

Tasimelteon: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Tasimelteon. Risk C: Monitor

Teniposide: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Teniposide. Risk C: Monitor

Tenofovir Disoproxil Fumarate: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Tenofovir Disoproxil Fumarate. Risk C: Monitor

Theophylline Derivatives: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Theophylline Derivatives. Management: Consider avoidance of this combination. If coadministration is necessary, monitor for increased theophylline serum concentrations and toxicities when combined. Theophylline dose reductions will likely be required. Risk D: Consider Therapy Modification

Thioridazine: QT-prolonging Agents (Moderate Risk) may increase QTc-prolonging effects of Thioridazine. Risk X: Avoid

TiZANidine: CYP1A2 Inhibitors (Moderate) may increase serum concentration of TiZANidine. Management: Avoid the use of tizanidine with moderate CYP1A2 inhibitors when possible. If combined, monitor closely for increased tizanidine toxicities (eg, hypotension, bradycardia, drowsiness). Tizanidine dose reduction or discontinuation may be necessary. Risk D: Consider Therapy Modification

Topotecan: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Topotecan. Risk X: Avoid

Ubrogepant: CYP3A4 Inducers (Weak) may decrease serum concentration of Ubrogepant. Management: Use an initial ubrogepant dose of 100 mg and second dose (if needed) of 100 mg when used with a weak CYP3A4 inducer. Risk D: Consider Therapy Modification

Ubrogepant: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Ubrogepant. Management: Use an initial ubrogepant dose of 50 mg and second dose (at least 2 hours later if needed) of 50 mg when used with a P-gp inhibitor. Risk D: Consider Therapy Modification

Venetoclax: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Venetoclax. Management: Reduce the venetoclax dose by at least 50% in patients requiring concomitant treatment with P-glycoprotein (P-gp) inhibitors. Resume the previous venetoclax dose 2 to 3 days after discontinuation of a P-gp inhibitor. Risk D: Consider Therapy Modification

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

VinCRIStine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of VinCRIStine. Risk X: Avoid

Vorasidenib: CYP1A2 Inhibitors (Moderate) may increase serum concentration of Vorasidenib. Management: Avoid concurrent use with moderate CYP1A2 inhibitors when possible. If combined use cannot be avoided, monitor for evidence of adverse effects and adjust vorasidenib dose accordingly if necessary. Risk D: Consider Therapy Modification

Food Interactions

Grapefruit and grapefruit juice may inhibit CYP3A4-mediated metabolism of vemurafenib. Management: Monitor for increased effects/toxicity with concomitant use.

Reproductive Considerations

Patients who could become pregnant should use effective contraception during treatment and for at least 2 weeks after the last vemurafenib dose.

Pregnancy Considerations

Vemurafenib crosses the placenta and can be detected in the newborn at delivery (Maleka 2013).

Based on the mechanism of action, vemurafenib may cause fetal harm if administered during pregnancy. Outcome data following maternal use of vemurafenib during pregnancy are available from case reports following treatment for melanoma (de Haan 2018; Maleka 2013; Marcé 2019; Pagan 2019).

The European Society for Medical Oncology has published guidelines for diagnosis, treatment, and follow-up of cancer during pregnancy. The guidelines recommend referral to a facility with expertise in cancer during pregnancy and encourage a multidisciplinary team (obstetrician, neonatologist, oncology team) approach (ESMO [Peccatori 2013]). Treatment of melanoma in pregnant patients should consider the trimester of pregnancy and the stage of disease at diagnosis (Swetter 2019).

A long-term observational research study is collecting information about the diagnosis and treatment of cancer during pregnancy. For additional information about the pregnancy and cancer registry or to become a participant, contact Cooper Health (877-635-4499).

Breastfeeding Considerations

It is not known if vemurafenib is present in breast milk.

Due to the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended by the manufacturer during treatment and for 2 weeks after the last vemurafenib dose.

Monitoring Parameters

Confirm BRAF V600 mutation status in tumor specimen(s) (in patients with melanoma). Monitor liver transaminases, alkaline phosphatase, and bilirubin at baseline and monthly during treatment (or as clinically appropriate). In patients with severe hepatic impairment, monitor LFTs twice a week as clinically indicated (Krens 2019). Monitor serum creatinine at baseline and periodically during treatment. Monitor CBC in patients with Erdheim-Chester disease and coexisting myeloid malignancies. Electrolytes (calcium, magnesium, and potassium) at baseline and after dosage modification. ECG at baseline, 15 days after initiation, then monthly for 3 months, then every 3 months thereafter (more frequently if clinically appropriate) and with dosage adjustments. Consider evaluating unexplained abdominal pain for pancreatitis (eg, serum lipase and amylase; abdominal CT) as clinically indicated. Dermatology evaluation (for new skin lesions) at baseline and every 2 months during treatment; also consider continued monitoring for 6 months after completion of treatment. Monitor for signs/symptoms of hypersensitivity reactions, uveitis, and malignancies; monitor for signs of radiation sensitization and recall. Monitor adherence.

The American Society of Clinical Oncology hepatitis B virus (HBV) screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends HBV screening with hepatitis B surface antigen, hepatitis B core antibody, total Ig or IgG, and antibody to hepatitis B surface antigen prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.

Cardiovascular monitoring specifics: Comprehensive assessment prior to treatment including a history and physical examination, screening for cardiovascular disease risk factors such as hypertension, diabetes, dyslipidemia, obesity, and smoking (ASCO [Armenian 2017]). Assess BP at baseline and each clinical visit (as well as outpatient monitoring weekly for initial 3 months, then monthly thereafter). In patients receiving cobimetinib plus vemurafenib assess ECG at baseline, at 2 and 4 weeks, then every 3 months thereafter; obtain a baseline echocardiography in high- and very-high risk patients scheduled to receive BRAF-MEK inhibitor combination therapy (consider repeating every 4 months during the first year); consider echocardiography in low- and moderate-risk patients scheduled to receive BRAF-MEK inhibitor combination therapy (ESC [Lyon 2022]).

Mechanism of Action

Vemurafenib is a low molecular weight oral BRAF kinase inhibitor (potent) which inhibits tumor growth in melanomas by inhibiting kinase activity of certain mutated forms of BRAF, including BRAF with V600E mutation, thereby blocking cellular proliferation in melanoma cells with the mutation. It does not have activity against cells with wild-type BRAF. BRAF V600E activating mutations are present in ~50% of melanomas; V600E mutation involves the substitution of glutamic acid for valine at amino acid 600.

Pharmacokinetics (Adult Data Unless Noted)

Distribution: V_d: ~106 L.

Protein binding: >99%, to albumin and α₁-acid glycoprotein.

Bioavailability: Mean: 64% at steady state.

Half-life, elimination: 57 hours (range: 30 to 120 hours).

Time to peak: 3 hours.

Excretion: Feces (~94%); urine (~1%).

Clearance: 31 L/day.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Zelboraf;
(AR) Argentina: Zelboraf;
(AT) Austria: Zelboraf;
(AU) Australia: Zelboraf;
(BE) Belgium: Zelboraf;
(BG) Bulgaria: Zelboraf;
(BR) Brazil: Zelboraf;
(CH) Switzerland: Zelboraf;
(CL) Chile: Zelboraf;
(CN) China: Zelboraf;
(CO) Colombia: Zelboraf;
(CZ) Czech Republic: Zelboraf;
(DE) Germany: Zelboraf;
(EC) Ecuador: Zelboraf;
(EG) Egypt: Zelboraf;
(ES) Spain: Zelboraf;
(FI) Finland: Zelboraf;
(FR) France: Zelboraf;
(GB) United Kingdom: Zelboraf;
(GR) Greece: Zelboraf;
(HK) Hong Kong: Zelboraf;
(HR) Croatia: Zelboraf;
(HU) Hungary: Zelboraf;
(ID) Indonesia: Zelboraf;
(IE) Ireland: Zelboraf;
(IT) Italy: Zelboraf;
(JP) Japan: Zelboraf;
(KR) Korea, Republic of: Zelboraf;
(KW) Kuwait: Zelboraf;
(LB) Lebanon: Zelboraf;
(LT) Lithuania: Zelboraf;
(LU) Luxembourg: Zelboraf;
(LV) Latvia: Zelboraf;
(MY) Malaysia: Zelboraf;
(NL) Netherlands: Zelboraf;
(NO) Norway: Zelboraf;
(NZ) New Zealand: Zelboraf;
(PE) Peru: Zelboraf;
(PH) Philippines: Zelboraf;
(PL) Poland: Zelboraf;
(PR) Puerto Rico: Zelboraf;
(PT) Portugal: Zelboraf;
(PY) Paraguay: Zelboraf;
(QA) Qatar: Zelboraf;
(RO) Romania: Zelboraf;
(RU) Russian Federation: Zelboraf;
(SA) Saudi Arabia: Zelboraf;
(SE) Sweden: Zelboraf;
(SG) Singapore: Zelboraf;
(SI) Slovenia: Zelboraf;
(SK) Slovakia: Zelboraf;
(TH) Thailand: Zelboraf;
(TN) Tunisia: Zelboraf;
(TR) Turkey: Zelboraf;
(TW) Taiwan: Zelboraf;
(UY) Uruguay: Zelboraf;
(ZA) South Africa: Zelboraf

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Vemurafenib: Drug information