Neratinib Disease Interactions

Neratinib is mainly metabolized in the liver and its use has been associated with hepatotoxicity characterized by increased liver enzymes. Patients with severe, preexisting hepatic impairment (Child Pugh Class C) experienced a reduction in neratinib clearance and an increase in C max and AUC. It is recommended to reduce the starting dose of neratinib to 80 mg in patients with severe hepatic impairment (Child Pugh C). Measure total bilirubin, AST, ALT, and alkaline phosphatase prior to starting treatment and monthly for the first 3 months of treatment, then every 3 months while on treatment and as clinically indicated. No dose modifications are recommended for patients with mild to moderate hepatic impairment (Child Pugh A or B).