Metvix (Methyl aminolevulinate) is a prodrug that is available as a cream. It is used in photodynamic therapy to treat skin growth over the neck and facial areas (actinic keratosis)

Methyl aminolevulinate Uses:

• Metvixia [DSC]:

  • Actinic keratosis: For the treatment of thin and moderately thick actinic keratoses on the scalp and face in patients with a healthy immune system, conventional photodynamic therapy (c-PDT) should be used in combination with red light illumination.
• Limitations of use:
  • Methyl aminolevulinate cream's safety and effectiveness have not been shown in patients with immunosuppression, porphyria, or pigmented actinic keratosis. Not to be used without red light illumination; therapy has not been tested on individuals with hereditary or acquired coagulation abnormalities.
  • PDT with methyl aminolevulinate cream has not been proven to be safe or effective for treating cutaneous malignancies or skin lesions other than non-hyperkeratotic actinic keratoses on the face and scalp. 

• Metvix [Canadian product]:

  • Actinic keratosis: When conventional treatments are insufficient, c-PDT should be used in combination with red light illumination or as daylight photodynamic therapy (DL-PDT) to treat thin or nonhyperkeratotic, non-pigmented actinic keratoses on the face and scalp.
  • Basal cell carcinoma: When existing treatments are insufficiently effective, biopsy-confirmed primary superficial basal cell carcinoma beyond the H-zone of the face (such as on the ears and nose) should be treated with c-PDT in combination with red light therapy.

Metvix (Methyl aminolevulinate) Dose in Adults:

Metvix (Methyl aminolevulinate) Dose in the therapy of Actinic keratoses:

• Topical: Actinic keratoses should have a 1 g application combined with occlusion for three hours, followed by red light illumination; this procedure may be repeated every seven days.
• Note: When treating multiple lesions, do not exceed 1g for all lesions combined per treatment session.

Metvix c-PDT [Canadian product]:

Therapy of thin or nonhyperkeratotic and non-pigmented actinic keratoses with metvix (methyl aminolevulinate) dosage

• Topical: A maximum of 2 g should be applied for all lesions combined per treatment session, treated lesions should be occluded for 3 hours, followed by red light illumination.
• The patient should be assessed after 90 days and may give an additional treatment session if needed. Do not use without subsequent red light illumination.

Metvix (Methyl aminolevulinate) Dose in the therapy of superficial Basal cell carcinoma:

• Topical: A maximum of 2 g should be applied for all lesions combined per treatment session, treated lesions should be occluded for 3 hours, followed by red light illumination. Repeat in 7 days.
• After 2nd treatment session, the patient should be assessed after 90 days and may give up to 2 additional treatment sessions if needed (separated by 1 week). Do not use without subsequent red-light illumination.

Metvix DL-PDT [Canadian product]:

Metvix (Methyl aminolevulinate) Dose in the therapy of Actinic keratosis (thin or nonhyperkeratotic and nonpigmented):

• Topical: A maximum of 2 g should be applied for all lesions combined per treatment session, followed by daylight exposure (no occlusion is recommended).
• The patient should be assessed after 90 days and may give an additional treatment session if needed.

Use in children:

Not indicated.

Pregnancy Risk Factor C

• There have not been any animal reproduction studies with methyl aminolevulinate.

Use during breastfeeding:

• It's not known if breast milk secretes it.
• Metvixia Cream should never be given to nursing mothers, as there are many drugs found in human milk.
• The mother can decide if she wishes to continue breastfeeding while using methylaminelevulinate cream.

Dose in kidney disease:

No dosage adjustments have been recommended.

Dose in Liver disease:

No dosage adjustments have been recommended.

Pain and burning may start during illumination; they usually go away entirely in a few minutes or hours, although they might continue for a few days. Erythema and other symptoms take a few days to three weeks to go away.

Common Side Effects of Metvix (Methyl aminolevulinate):

• Central nervous system:

  • Local discomfort

• Dermatologic:

  • Burning sensation of skin
  • Skin pain
  • Erythema
  • Crusted skin
  • Skin blister
  • Skin erosion
  • Pruritus
  • Exfoliation of skin

• Local:

  • Skin edema

• Ophthalmic:

  • Eyelid edema

Less Common Side Effects of Metvix (Methyl aminolevulinate):

• Central nervous system:

  • Localized warm feeling

• Dermatologic:

  • Dermal hemorrhage
  • Hyperpigmentation
  • Skin tightness

• Local:

  • Application site discharge

Contraindications to Metvix (Methyl aminolevulinate):

• Peanut allergy patients may be hypersensitive to methylaminelevulinate or any component of the formula. This has not been confirmed.
• Cutaneous photosensitivity
• Allergy to Porphyrins

Additional contraindications not included on Canadian labels

• Basal cell carcinoma in the Morpheaform.

Warnings & Precautions

• Photosensitivity

  • Photosensitivity can occur at treatment sites. 
  • You should protect them from direct sunlight and bright indoor lighting (eg, operating room lamps, examination lamps or tanning beds) as well as from extreme cold by wearing appropriate clothing and staying indoors for at least 2 days after treatment.
  • Sunscreens cannot protect against photosensitivity reactions to visible light.
  • Cover the areas to be treated with a light source and keep them from direct sunlight for two days.

• Coagulation defects:

  • Patients with acquired or inherited coagulation defects have not been tested.

• Immune deficiency:

  • Patients with immunosuppression have not been tested.

• Pigmented actinic Keratosis

  • Patients with pigmented Keratosis have not been tested.

• Porphyria

  • Patients with porphyria have not been tested.

Monitoring Parameters:

None mentioned.

How to administer Metvix (Methyl aminolevulinate)?

• Lesions should be cleaned using a tiny dermal curette to remove scales and crusts and to roughen the lesion's surface.
• Apply methyl aminolevulinate cream topically to the prepared lesion and the adjacent 5 mm of healthy skin while wearing nitrile gloves (latex and vinyl gloves are insufficiently protective).
• May treat multiple lesions during the same treatment session; a treatment field area of 80 x 180 mm should not be exceeded.
• A total of 1 g of Metvixia cream or 2 g Metvix cream [Canadian product] per treatment session should not be exceeded.

When used in conjunction with c-PDTL:

• Use a nonabsorbent dressing for 3 hours (minimum 2.5 hours, maximum 4 hours) to occlude the site(s) and then remove.
• The excess cream should be removed with saline and illuminated with red light following the lamp manufacturer's instructions.
• Following illumination of site, keep the treated area covered and away from bright indoor light and sunlight for 2 days.
• May restart red light treatment if it is interrupted or stopped.
• However, if red light illumination is not performed for whatever reason, wash off the cream within 3 hours of application and avoid direct sunlight or other intense or continuous light for 2 days.
• Use in conjunction with Atkilite CL 128 lamp.

When used in conjunction with DL-PDT:

• Metvix [Canadian product]:
  • Before preparing the lesions, Apply sunscreen (≥ SPF 30), which does not include filters that may inhibit the absorption of visible light (eg, titanium dioxide, zinc oxide, iron oxide), to all sun-exposed areas including the treatment areas.
  • It is not necessary to occlude the treatment site(s).
  • Patients should go into sunlight immediately after therapy or within half-hour & remain there for 2 continuous hours, then the cream should be removed using soap and water.

Mechanism of action of Metvix (Methyl aminolevulinate):

• Metabolically, the prodrug methyl amylulinate can be converted to photoactive porphyrins. 
• These substances accumulate in the skin, leading to photosensitization. This causes local cytotoxicity.

Fluorescence peak intensity:

• Within 3 hours of application

International Brand Names of Methyl aminolevulinate:

• Metvix
• Metvixia

Methyl aminolevulinate Brand Names in Pakistan:

No Brands Available in Pakistan.