Drug Interactions between Caprelsa and Zema Pak

GENERALLY AVOID: Coadministration with potent inducers of CYP450 3A4 may decrease the plasma concentrations of vandetanib, which is a substrate of the isoenzyme. In 16 healthy male subjects, coadministration of rifampin (600 mg/day on days 1 to 31) and vandetanib (single 300 mg oral dose on day 10) resulted in an approximately 40% decrease in vandetanib exposure (AUC) and almost 50% decrease in half-life (from 217.6 hours to 116.3 hours) compared to vandetanib administered alone. There was no significant change in the peak plasma concentration (Cmax) of vandetanib. In the presence of rifampin, the Cmax and AUC of a metabolite, N-desmethylvandetanib, increased by 414% and 266%, respectively. Rifampin also increased the Cmax and AUC of another metabolite, vandetanib N-oxide, by approximately 179% and 126%, respectively. However, the plasma concentrations of vandetanib N-oxide were very low throughout, thus the change in absolute plasma levels induced by rifampin was actually quite small. The clinical implications of these changes are unknown. The two metabolites have shown in vitro pharmacologic activity in cellular assays against vascular endothelial growth factor and epidermal growth factor, with N-desmethylvandetanib exhibiting similar potency to parent drug and vandetanib N-oxide exhibiting less than 1/50 the activity of the parent drug.

MANAGEMENT: Concomitant use of vandetanib with potent CYP450 3A4 inducers should generally be avoided.

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