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Drug Interactions between betiatide and ivacaftor / lumacaftor

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

lumacaftor betiatide

Applies to: ivacaftor / lumacaftor and betiatide

MONITOR: The administration of an organic anion transporter 1 (OAT1) inhibitor just prior to or concurrently with the radiopharmaceutical, technetium (Tc99m) mertiatide, may reduce its renal uptake and excretion as it is a substrate of this transporter. Delayed clearance could result in a misinterpretation of diagnostic study results. Clinical data is limited. One crossover study conducted in 12 healthy male volunteers (22-25 years old), compared the results of Tc99m mertiatide injection alone to those obtained after the subjects received a potent OAT1 inhibitor (probenecid 750 mg) 1 hour prior to the radiopharmaceutical injection. Probenecid administration prolonged the plasma clearance half-life of Tc99m mertiatide in the late phase (30-60 minutes post injection), from 24.4 +/- 9.9 minutes to 33.1 +/- 12.9 minutes. Similarly, the volunteer's Tc99m mertiatide blood concentrations were higher after treatment with probenecid, suggesting that renal excretion of the radiopharmaceutical was inhibited by the OAT1 inhibitor.

MANAGEMENT: Administration of an organic anion transporter 1 (OAT1) inhibitor just prior to or concurrently with technetium (Tc99m) mertiatide should be done with caution as it may delay excretion of the radiopharmaceutical and affect the efficacy of the diagnostic procedure. Dehydration and acidosis can also lead to prolonged elimination of Tc99m mertiatide, further impacting the efficacy of the diagnostic test. Refer to the product labeling or local protocols for guidelines on patient hydration.

References

  1. (2019) "Product Information. IELMAG3 (mertiatide)." Xiel Ltd
  2. Takahara N, Saga T, Inubushi M, et al. (2013) "Drugs interacting with OAT-1 affect uptake of Tc-99m-mercaptoacetyl-triglycine (MAG3) in the human kidney: Therapeutic drug interaction in Tc-99m-MAG3 diagnosis of renal function and possible application of Tc-99m-MAG3 for drug development" Nucl Med Biol, 40, p. 643-50

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Drug and food interactions

Moderate

ivacaftor food

Applies to: ivacaftor / lumacaftor

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of ivacaftor. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Elexacaftor and tezacaftor are also CYP450 3A4 substrates in vitro and may interact similarly with grapefruit juice, whereas lumacaftor is not expected to interact.

ADJUST DOSING INTERVAL: According to prescribing information, systemic exposure to ivacaftor increased approximately 2.5- to 4-fold, systemic exposure to elexacaftor increased approximately 1.9- to 2.5-fold, and systemic exposure to lumacaftor increased approximately 2-fold following administration with fat-containing foods relative to administration in a fasting state. Tezacaftor exposure is not significantly affected by administration of fat-containing foods.

MANAGEMENT: Patients treated with ivacaftor-containing medications should avoid consumption of grapefruit juice and any food that contains grapefruit or Seville oranges. All ivacaftor-containing medications should be administered with fat-containing foods such as eggs, avocados, nuts, meat, butter, peanut butter, cheese pizza, and whole-milk dairy products. A typical cystic fibrosis diet will satisfy this requirement.

References

  1. (2012) "Product Information. Kalydeco (ivacaftor)." Vertex Pharmaceuticals
  2. (2015) "Product Information. Orkambi (ivacaftor-lumacaftor)." Vertex Pharmaceuticals
  3. (2022) "Product Information. Symdeko (ivacaftor-tezacaftor)." Vertex Pharmaceuticals
  4. (2019) "Product Information. Trikafta (elexacaftor/ivacaftor/tezacaftor)." Vertex Pharmaceuticals
View all 4 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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