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Drug Interactions between alpelisib and nilotinib

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

nilotinib alpelisib

Applies to: nilotinib and alpelisib

MONITOR: Coadministration with inhibitors of CYP450 3A4 and/or P-glycoprotein may increase the plasma concentrations of nilotinib, which is a substrate of both the isoenzyme and the efflux transporter. In healthy subjects receiving the potent inhibitor ketoconazole (400 mg once daily for 6 days), nilotinib systemic exposure (AUC) was increased approximately 3-fold. Because nilotinib is associated with concentration-dependent prolongation of the QT interval, increased levels may potentiate the risk of ventricular arrhythmias such as torsade de pointes and sudden death. Data are not available for nilotinib in combination with other CYP450 3A4 or P-glycoprotein inhibitors. Theoretically, a reverse interaction may also occur, since many CYP450 3A4 and P-glycoprotein inhibitors are also substrates, and nilotinib is an inhibitor of both.

MANAGEMENT: Caution is advised if nilotinib is prescribed in combination with CYP450 3A4 and/or P-glycoprotein inhibitors. Pharmacologic response to nilotinib should be monitored more closely whenever a CYP450 3A4 or P-glycoprotein inhibitor is added to or withdrawn from therapy, and the nilotinib dosage adjusted as necessary. Patients should have frequent ECGs and be monitored for arrhythmias when QT interval is prolonged. A QTc interval exceeding 480 msec will require suspension of nilotinib therapy and immediate action to correct any concomitant risk factors before resuming treatment. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope. Patients should also be monitored for altered efficacy and safety of the concomitant administered drug.

References (1)
  1. (2007) "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals

Drug and food interactions

Major

nilotinib food

Applies to: nilotinib

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of nilotinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Because nilotinib is associated with concentration-dependent prolongation of the QT interval, increased levels may potentiate the risk of ventricular arrhythmias such as torsade de pointes and sudden death.

ADJUST DOSING INTERVAL: Food increases the oral bioavailability of nilotinib. The mechanism of interaction is unknown. Compared to the fast state, nilotinib systemic exposure (AUC) increased by 82% when the dose was given 30 minutes after a high-fat meal. Because nilotinib is associated with concentration-dependent prolongation of the QT interval, increased levels may potentiate the risk of ventricular arrhythmias such as torsade de pointes and sudden death.

MANAGEMENT: Patients treated with nilotinib should avoid consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract. In addition, no food should be consumed for at least 2 hours before and 1 hour after a nilotinib dose.

References (1)
  1. (2007) "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals
Moderate

alpelisib food

Applies to: alpelisib

ADJUST DOSING INTERVAL: Food significantly enhances the oral absorption and bioavailability of alpelisib. When administered with a high-fat high-calorie meal (985 calories with 58.1 g of fat) or a low-fat low-calorie meal (334 calories with 8.7 g of fat) the AUC and Cmax of a single dose of alpelisib was increased by 73% and 84% and 77% and 145%, respectively. There were no clinically significant differences in alpelisib AUC between the two types of meals. In addition, food appears to have a more pronounced effect on the solubility of alpelisib than gastric pH. When coadministered with a single 300 mg dose of alpelisib, ranitidine decreased the absorption and overall exposure of alpelisib. Following administration of ranitidine with a low-fat low-calorie meal, the mean AUC and Cmax of alpelisib was decreased by 21% and 36%, respectively. Administration of ranitidine under fasting conditions reduced the mean AUC and Cmax of alpelisib by 30% and 51%, respectively.

MANAGEMENT: To ensure maximal oral absorption, alpelisib should be administered with a meal.

References (1)
  1. (2019) "Product Information. Piqray (alpelisib)." Novartis Pharmaceuticals

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.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown 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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