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Drug Interactions between alpelisib and ranolazine

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

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Interactions between your drugs

Moderate

ranolazine alpelisib

Applies to: ranolazine and alpelisib

MONITOR: Coadministration with inhibitors of the P-glycoprotein (P-gp) efflux transporter may increase the oral bioavailability of ranolazine, which has been shown in vitro to be a substrate of P-gp. Ranolazine can prolong the QT interval in a dose-dependent manner, thus increased plasma levels may potentiate the risk of ventricular arrhythmias including ventricular fibrillation and torsade de pointes. However, the interaction has not been evaluated in pharmacokinetic studies. Plasma levels of ranolazine (750 mg twice a day) were increased about 2-fold by the CYP450 3A4 and P-gp inhibitor, verapamil (120 mg three times a day), although the extent to which P-gp inhibition actually contributes to the overall interaction is unknown.

MANAGEMENT: Caution is advised if ranolazine is prescribed in combination with P-gp inhibitors. Pharmacologic response to ranolazine should be monitored more closely whenever a P-gp inhibitor is added to or withdrawn from therapy, and the ranolazine dosage adjusted as necessary. Patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, palpitations, or syncope.

References (1)
  1. (2006) "Product Information. Ranexa (ranolazine)." Calmoseptine Inc

Drug and food interactions

Major

ranolazine food

Applies to: ranolazine

GENERALLY AVOID: Grapefruit and grapefruit juice may significantly increase the plasma concentrations of orally administered ranolazine. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because ranolazine prolongs QT interval in a dose-dependent manner, high plasma levels of ranolazine may increase the risk of ventricular arrhythmias such as ventricular tachycardia, ventricular fibrillation, and torsade de pointes.

MANAGEMENT: Patients treated with ranolazine should avoid consumption of grapefruit juice and other grapefruit products if possible. Otherwise, the dosage of ranolazine should be limited to 500 mg twice a day.

References (1)
  1. (2006) "Product Information. Ranexa (ranolazine)." Calmoseptine Inc
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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