Trikafta Disease Interactions

Elexacaftor (available only in combination with ivacaftor and tezacaftor) should not be used in patients with severe hepatic impairment and its use in patients with moderate hepatic impairment should be limited to those patients for which there is a clear medical need and the benefit exceeds the risks. If elexacaftor is used in patients with moderate hepatic impairment, the dose should be reduced and liver function tests should be closely monitored.

Elexacaftor (available only in combination with ivacaftor and tezacaftor), has not been studied in patients with severe renal impairment or end-stage renal disease. No dosage adjustment is recommended in patients with mild (eGFR 60 to <90 mL/min/1.73 m2) or moderate (eGFR 30 to <60 mL/min/1.73 m2) renal impairment. Use with caution in patients with severe (eGFR <30 mL/min/1.73 m2) renal impairment or end-stage renal disease.

Cases of non- congenital lens opacities or cataracts have been reported in pediatric patients treated with ivacaftor, and although other risk factors could be present in some cases, a possible risk attributable to this medication cannot be excluded. Baseline and ophthalmological examinations are recommended in pediatric patients initiating treatment.

Elevated transaminases have been reported in patients with cystic fibrosis receiving ivacaftor. It is recommended that liver function tests are assessed prior to treatment, every 3 months during the first year, and annually thereafter. Patients with increased levels should be closely monitored until the abnormalities resolve, and dosing should be interrupted in patients with ALT or AST of greater than 5 times the upper limit of normal (ULN). In patients with hepatic impairment, no dose adjustment is necessary in patients with mild impairment, but a reduced dose of ivacaftor is recommended in patients with moderate impairment (see prescribing information for dosing recommendations). Studies have not been conducted in patients with severe hepatic impairment, but exposure is expected to be higher than in patients with moderate impairment. Therefore, caution should be used on these patients, and a reduced dose is recommended after weighing the risks and benefits of treatment.

Ivacaftor has not been studied in patients with renal impairment. No dose adjustment is necessary for patients with mild or moderate renal impairment, however, caution is recommended in patients with severe renal impairment or end-stage renal disease.