Pregnancy
Contraindicated
Database
Severe teratogen (Hh pathway)
Contraindicated; strict contraception both sexes
Source: Kimi deep-research + Cla · p1389
Drug reference
vismodegib
Hedgehog pathway inhibitor (SMO antagonist) · Antineoplastic agent
START
150 mg PO once daily (after pregnancy test in females of childbearing potential)
TYPICAL MAX
150 mg/day
STOP IF
Pregnancy, severe muscle / hepatic toxicity, or premature epiphyseal fusion (paediatric)
WATCH
Pregnancy testing prior + monthly; do not donate blood / semen during and 24 mo after
CDSCO approvedATC L01XJ01
KDIGO 2024 + manufacturer label
- ONSET
- 1h · absorption
- PEAK
- 2.5h · Tmax
- t½
- 1.7w · t½ ~12 d (SS)
- DURATION
- 1d · once-daily
EXCRETION
Mainly faecal (~82%); ~4% renal
route + CYP
INTERACTIONS
1 major
incl. contraindicated
PREGNANCY
Contraindicated — severe teratogen; pregnancy testing required; effective contraception during and 24 months after.
FDA category + note
Top interactionssee all 5 →
- PregnancyContraindicatedDatabaseKimi deep-research + Cla · p1389
Mechanism
Selective small-molecule inhibitor of Smoothened (SMO), a transmembrane component of the Hedgehog signalling pathway — blocks aberrant pathway activation driving basal-cell carcinoma growth.
Indications
Metastatic basal-cell carcinomaLocally advanced basal-cell carcinoma not amenable to surgery / radiation
Dosing
- Adult
- 150 mg PO once daily (with or without food).
- Pediatric
- Not approved (paediatric use restricted — premature epiphyseal fusion).
- Renal adjustment
- No specific adjustment.
- Hepatic adjustment
- Mild–moderate: no adjustment; severe: not studied.
- Geriatric
- No specific adjustment.
- Max dose
- 150 mg/day
Pharmacokinetics
Onset
Tumour response over weeks–months
Peak effect
~2.4 h (Tmax)
Duration
~24 h (once-daily)
Half-life
~4 days (single dose); 12 days (steady state)
Bioavailability
~32%
Protein binding
>99%
Metabolism
Hepatic CYP2C9 / 3A4 minor (limited metabolism)
Excretion
Mainly faecal (~82%); ~4% renal
Contraindications
- Pregnancy (severe teratogen — embryo-fetal death, malformations)
- Hypersensitivity
Side effects
Common
Muscle spasmsAlopeciaDysgeusia (taste loss)Weight lossFatigueNausea/diarrhoea
Serious
- Severe embryo-fetal toxicity (boxed)
- Premature epiphyseal fusion (paediatric)
- Severe rhabdomyolysis (rare)
- Hepatotoxicity (rare)
Pregnancy & lactation
Pregnancy
Contraindicated — severe teratogen; pregnancy testing required; effective contraception during and 24 months after.
Lactation
Avoid breastfeeding during and 24 months after therapy; do NOT donate blood/semen during and 24 months after.
Drug interactions
Acid Suppressants
Moderate
Database
Reduced solubility
Avoid chronic acid suppression if possible
Source: Kimi deep-research + Cla
Drugs Causing Muscle Toxicity
Moderate
Database
Additive muscle effects
Monitor CK / muscle symptoms
Source: Kimi deep-research + Cla
Hepatotoxic Drugs
Moderate
Database
Additive hepatic injury
Monitor LFTs
Source: Kimi deep-research + Cla
P Gp Inhibitors
Moderate
Database
Possible increased vismodegib levels
Monitor for AEs
Source: Kimi deep-research + Cla
7 additional low-confidence interactions hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Ask House about vismodegib
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Sources: Goodman & Gilman 14e, Harrison 22e·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20