Drug Interactions between Epitol and nintedanib
This report displays the potential drug interactions for the following 2 drugs:
- Epitol (carbamazepine)
- nintedanib
Interactions between your drugs
carBAMazepine nintedanib
Applies to: Epitol (carbamazepine) and nintedanib
GENERALLY AVOID: Coadministration with inducers of P-glycoprotein (P-gp) and CYP450 3A4 may decrease the plasma concentrations of nintedanib, which is a substrate of the efflux transporter and a minor substrate of the isoenzyme. In a dedicated drug interaction study, administration of nintedanib with the potent P-gp and CYP450 3A4 inducer, rifampin, decreased nintedanib peak plasma concentration (Cmax) and systemic exposure (AUC) by 40% and 50%, respectively, compared to administration of nintedanib alone. No data are available for use with other, less potent inducers.
MANAGEMENT: Concomitant use of nintedanib with P-gp and CYP450 3A4 inducers should generally be avoided due to the potential for reduced efficacy.
References
- (2014) "Product Information. Ofev (nintedanib)." Boehringer Ingelheim
Drug and food interactions
carBAMazepine food
Applies to: Epitol (carbamazepine)
GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of carbamazepine. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
In a small, randomized, crossover study, the administration of carbamazepine with grapefruit juice (compared to water) increased plasma drug concentrations by approximately 40%. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.
MANAGEMENT: Patients receiving carbamazepine should be advised to avoid or limit consumption of alcohol. Given the drug's narrow therapeutic index, patients receiving carbamazepine therapy should preferably avoid the regular consumption of grapefruits and grapefruit juice to prevent any undue fluctuations in plasma drug levels. Patients should be advised to report signs of carbamazepine toxicity (nausea, visual disturbances, dizziness, or ataxia) to their physicians.
References
- (2002) "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals
- Garg SK, Kumar N, Bhargava VK, Prabhakar SK (1998) "Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy." Clin Pharmacol Ther, 64, p. 286-8
- Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR (2000) "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther, 68, p. 468-77
nintedanib food
Applies to: nintedanib
ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of nintedanib. After food intake, nintedanib exposure increased by approximately 20% compared to administration under fasted conditions. Absorption was also delayed, as indicated by an increase in the median time to reach maximum plasma concentration (Tmax) from 2 hours in the fasted state to approximately 4 hours under fed conditions, irrespective of the type of food ingested.
MANAGEMENT: Nintedanib should be administered with food.
References
- (2014) "Product Information. Ofev (nintedanib)." Boehringer Ingelheim
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
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
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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