Tafamidis

How it works

It binds to the thyroxine-binding sites of transthyretin, stabilising the tetramer and slowing its dissociation into amyloidogenic monomers that deposit in tissues.

Prescribing in practice

• It is contraindicated in pregnancy and during breastfeeding, and effective contraception is advised in women of childbearing potential.
• It modifies disease progression rather than reversing established amyloid, so it should complement supportive cardiac and heart failure management.
• Formulations and salt forms (tafamidis and tafamidis meglumine) differ, so prescribe and dispense the intended product as specified in the SPC.

Monitoring

Monitor cardiac status and functional capacity as part of ongoing amyloidosis care.

Counselling the patient

• This medicine slows progression of the condition rather than curing it.
• Continue your other heart medicines unless advised otherwise.
• Avoid use in pregnancy and discuss contraception with your clinician.

Evidence & guidelines

The ATTR-ACT trial showed tafamidis reduced mortality and cardiovascular hospitalisations in transthyretin amyloid cardiomyopathy.