Enasidib should be taken with meals to improve tolerance, and dosage adjustments are mainly based on differentiation syndrome, bilirubin levels, and other toxicity grades. Discontinuation decisions should be based on disease progression or repeated toxicity. All adjustments must be made under the guidance of a physician and cannot be changed by oneself.

1、 Fasting or with meals?

Recommended to be taken with meals to reduce gastrointestinal reactions such as nausea and stomach discomfort.

If there is no obvious discomfort after taking on an empty stomach, it can also be taken on an empty stomach, but it is recommended to take the medication at a fixed time every day to maintain consistency.

Swallow the whole piece, do not crush, chew or pry open.

2、 Principle of dose adjustment

2.1 Standard starting dose

100mg， Once a day until disease progression or intolerable toxicity occurs.

2.2 Differentiation syndrome (DS) related adjustments

When suspecting DS, suspend medication and administer corticosteroids.

After the symptoms are relieved, the original dose (100mg) can be restarted.

2.3 Elevated bilirubin (>3 × ULN)

Suspend medication until bilirubin returns to ≤ 2 × ULN.

Continue at 100mg during restart; If it rises again, reduce it to 50mg.

2.4 Other toxicity levels ≥ 3

Pause until recovery level ≤ 1, restart at 100mg; Reduce to 50mg for recurrence.

3、 Suggestion for discontinuation of medication

3.1 Disease progression

If there is clear progress in imaging or clinical studies and no sustained benefit, the medication will be permanently discontinued.

3.2 Intolerable toxicity

After two dose reductions (100mg → 50mg), grade ≥ 3 adverse reactions still occurred and the medication was permanently discontinued.

3.3 Differentiation syndrome crisis

After sufficient treatment with dexamethasone, if the condition continues to worsen or respiratory failure occurs, the medication will be permanently discontinued.

3.4 Planned Surgery/Invasive Operations

Discontinue use for at least 3 days before surgery, and wait for the wound to heal well (usually ≥ 1 week) before resuming after surgery.