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Sunitinib Disease Interactions

There are 12 disease interactions with sunitinib:

Major

Sunitinib (Includes Sunitinib) ↔ Liver Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Liver Disease

The use of sunitinib has been associated with hepatotoxicity, including hepatic failure and in some cases with fatal outcomes. Patients with hepatic impairment (total bilirubin > upper limit of normal (ULN) or Child-Pugh A, B and C) should be closely monitored during therapy with sunitinib. Safety in patients with ALT or AST >2.5 × ULN or, if due to liver metastases, >5.0 × ULN has not been established. Clinical monitoring of hepatic function (transaminases, bilirubin, and alkaline phosphatase) is recommended during treatment and increase frequency of monitoring is required for patients with preexisting or existing hepatic impairment. Obtain periodic liver function testing and withhold for Grade 3 or 4 drug-related hepatic adverse events. Discontinued if symptoms of pancreatitis or hepatic failure are present. Do not restart sunitinib if patients subsequently experience severe changes in liver function tests or have other signs and symptoms of liver failure.

Moderate

Sunitinib (Includes Sunitinib) ↔ Adrenal Toxicity

Moderate Potential Hazard, Moderate plausibility

Applies to: Infection - Bacterial/Fungal/Protozoal/Viral, Adrenal Insufficiency

Caution should be exercised when prescribing sunitinib in patients that elicit a stress response due to the hormonal and metabolic changes resulting from an injury, trauma, or a severe infection.

Moderate

Sunitinib (Includes Sunitinib) ↔ Cardiovascular Events

Moderate Potential Hazard, Moderate plausibility

Applies to: Cardiomyopathy, Myocardial Infarction, Congestive Heart Failure, Ischemic Heart Disease

The use of sunitinib has been associated with adverse cardiovascular events, including heart failure, cardiomyopathy, myocardial ischemia, and myocardial infarction, some of which were fatal. Because of these risks, physicians are advised to weigh this risk against the potential benefits of the drug when prescribing this drug to patients with cardiovascular dysfunction. These patients should be carefully monitored and baseline and periodic evaluations of cardiovascular function should be considered while these patients are receiving sunitinib, especial caution is recommended in patients who are at risk for, or who have a history of cardiovascular events. In patients without cardiac risk factors, a baseline evaluation of ejection fraction should be considered.

Moderate

Sunitinib (Includes Sunitinib) ↔ Dermatologic Toxicities

Moderate Potential Hazard, Moderate plausibility

Applies to: Dermatitis - Drug-Induced

Cutaneous reactions, in some cases severe, have been reported with the use of sunitinib. Monitor patients who develop dermatologic or soft tissue toxicities while receiving this agent. It is recommended to withhold treatment, and appropriate measures should be instituted as appropriate or discontinue the use of this agent for dermatologic or soft tissue toxicity associated with severe or life-threatening complications. If a diagnosis of Stevens-Johnson syndrome or toxic epidermal necrolysis is suspected treatment with sunitinib must not be re-started.

Moderate

Sunitinib (Includes Sunitinib) ↔ Hemorrhagic Events

Moderate Potential Hazard, Moderate plausibility

Applies to: Bleeding

The use of sunitinib has been associated with hemorrhagic events, some of which have been fatal. Caution should be exercised in patients with or predisposed to bleeding complications. Clinical assessment of these patients should include serial complete blood counts and physical examinations.

Moderate

Sunitinib (Includes Sunitinib) ↔ Hypertension

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypertension

The use of sunitinib has been associated with hypertension and it should be used with caution in patients with elevated blood pressure. Therapy with sunitinib should be withheld in case of severe hypertension and appropriate measures should be taken to correct the blood pressure to acceptable readings. Close monitoring of blood pressure is recommended.

Moderate

Sunitinib (Includes Sunitinib) ↔ Hypoglycemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

The use of sunitinib has been associated with symptomatic hypoglycemia, resulting in loss of consciousness or hospitalization. Patients with diabetes mellitus should be monitored more closely during and after discontinuation of treatment with sunitinib, and their antidiabetic regimen should be adjusted accordingly.

Moderate

Sunitinib (Includes Sunitinib) ↔ Onj

Moderate Potential Hazard, High plausibility

Applies to: Infection - Bacterial/Fungal/Protozoal/Viral

Osteonecrosis of the jaw (ONJ), which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, and has been reported in patients taking sunitinib. Patients with risk factors, such as those taking bisphosphonate medications or that have a dental disease could be at an increased risk of developing ONJ. Close monitoring should be exercise when prescribing sunitinib to these patients.

Moderate

Sunitinib (Includes Sunitinib) ↔ Proteinuria

Moderate Potential Hazard, Moderate plausibility

Applies to: Proteinuria

Therapy with sunitinib should be administered cautiously in patients with renal dysfunction. Monitoring for proteinuria and hematuria is recommended and perform baseline and periodic urinalyses during treatment, with follow up measurement as clinically indicated. Patients with nephrotic syndrome or repeat episodes of urine protein >=3 grams despite dose reductions should be instructed to withhold the dose of sunitinib and take appropriate actions according to clinical standards.

Moderate

Sunitinib (Includes Sunitinib) ↔ Qt Prolongation

Moderate Potential Hazard, Moderate plausibility

Applies to: Arrhythmias, Ventricular Arrhythmia

Sunitinib can cause QT prolongation in a dose-dependent manner, which may lead to an increased risk for ventricular arrhythmias, including Torsade de Pointes. This agent should be administered with caution in patients with congenital long QTc syndrome, congestive heart failure, electrolyte abnormalities, or those who are taking medications known to prolong the QTc interval. Serum electrolytes should be corrected before initiating therapy with this agent. Periodic monitoring of ECGs and electrolytes is recommended in these patients.

Moderate

Sunitinib (Includes Sunitinib) ↔ Thyroid Abnormality

Moderate Potential Hazard, Moderate plausibility

Applies to: Thyroid Disease

Thyroid abnormalities, hypothyroidism or hyperthyroidism, have been reported in patients taking sunitinib. Therapy with sunitinib should be administered cautiously to patients with thyroid dysfunction. Baseline laboratory measurement of thyroid function is recommended and if appropriate, treatment per standard medical practice should be given prior to initiation of therapy. Clinical monitoring of thyroid function is recommended during therapy.

Moderate

Sunitinib – Renal Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

No dosage adjustment of sunitinib is necessary in patients with renal impairment. However, when sunitinib therapy was given to patients with end-stage renal disease (ESRD) or on hemodialysis, the systemic exposure was 47% lower in subjects with ESRD on hemodialysis compared to subjects with normal renal function. Therefore, the subsequent doses may be increased gradually up to 2 fold based on safety and tolerability.

sunitinib drug Interactions

There are 447 drug interactions with sunitinib

sunitinib alcohol/food Interactions

There are 2 alcohol/food interactions with sunitinib

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

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.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2017 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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