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Drug Interactions between amprenavir and pomalidomide

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

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Interactions between your drugs

Moderate

amprenavir pomalidomide

Applies to: amprenavir and pomalidomide

GENERALLY AVOID: Coadministration with potent inhibitors of CYP450 1A2, CYP450 3A4, and P-glycoprotein may increase the plasma concentrations of pomalidomide, which has been shown to be primarily metabolized by these isoenzymes and also a substrate of the efflux transporter. Pomalidomide exposure is increased when given with a strong CYP450 1A2 inhibitor (e.g., fluvoxamine) in the presence of a strong CYP450 3A4 and P-gp inhibitor (e.g., ketoconazole). Coadministration with ketoconazole alone did not have a clinically significant effect on exposure to pomalidomide. However, the combination of pomalidomide and fluvoxamine in the presence of ketoconazole increased exposure to pomalidomide by 104% compared to pomalidomide plus ketoconazole.

MANAGEMENT: The use of pomalidomide with potent inhibitors of CYP450 1A2 (e.g., ciprofloxacin, fluvoxamine, tiabendazole) in the presence of strong CYP450 3A4 and P-gp inhibitors should generally be avoided. If coadministration is considered clinically necessary, the pomalidomide dose should be reduced by 50%. Dose reduction may also be required if pomalidomide is given with a strong inhibitor of CYP450 1A2 in the absence of a coadministered CYP450 3A4 and P-gp inhibitor. Patients should be monitored for occurrence of pomalidomide-related side effects, including nausea, diarrhea, and neutropenia.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. (2013) "Product Information. Pomalyst (pomalidomide)." QLT Phototherapeutics Inc

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Drug and food interactions

Moderate

amprenavir food

Applies to: amprenavir

GENERALLY AVOID: Administration with a high-fat meal may decrease the oral bioavailability of amprenavir. The mechanism is unknown. In healthy volunteers, consumption of a standardized high-fat meal decreased the peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of amprenavir (1200 mg single oral dose) by 36% and 21%, respectively, compared to administration in the fasted state. The time to reach Cmax (Tmax) was increased 44% following a high-fat meal.

Grapefruit juice does not appear to significantly affect the pharmacokinetics of amprenavir. In 12 healthy volunteers, administration with grapefruit juice (200 mL) decreased the mean peak plasma concentration (Cmax) of amprenavir (1200 mg single oral dose) by 22% compared to water. The median time to reach Cmax (Tmax) was prolonged from 0.75 to 1.13 hours. These pharmacokinetic changes are not thought to be clinically significant, since antiretroviral response is more closely associated with systemic exposure (AUC) and trough plasma concentration (Cmin), which were not affected in the study.

MANAGEMENT: Amprenavir may be taken with or without food, but should not be taken with a high-fat meal.

References

  1. (2001) "Product Information. Agenerase (amprenavir)." Glaxo Wellcome
  2. Demarles D, Gillotin C, Bonaventure-Paci S, Vincent I, Fosse S, Taburet AM (2002) "Single-dose pharmacokinetics of amprenavir coadministered with grapefruit juice." Antimicrob Agents Chemother, 46, p. 1589-1590

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Moderate

pomalidomide food

Applies to: pomalidomide

MONITOR: Cigarette smoking may reduce pomalidomide exposure due to induction of CYP450 1A2, the isoenzyme that is responsible for the metabolic clearance of pomalidomide along with CYP450 3A4.

MANAGEMENT: Patients should be advised that smoking may reduce the efficacy of pomalidomide therapy. Pomalidomide should be taken on an empty stomach, at least 2 hours before or 2 hours after a meal.

References

  1. (2013) "Product Information. Pomalyst (pomalidomide)." QLT Phototherapeutics Inc

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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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