Drug Interactions between apalutamide and pemigatinib

Pemigatinib may be taken with or without food. Do not consume grapefruit, grapefruit juice, or any supplements that contain grapefruit extract during treatment with pemigatinib unless directed otherwise by your doctor. Grapefruit juice can increase the blood levels of pemigatinib. This may increase the frequency and severity of serious side effects such as elevated phosphate levels in the blood (which can eventually lead to low blood calcium levels; calcium deposits in the skin, muscles, and other tissues; anemia; muscle cramps; seizures; and irregular heart rhythm), eye and vision problems, joint pain, mouth sores and inflammation, hair loss, diarrhea, nausea, vomiting, and constipation. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Ischemic cardiovascular events, including events leading to death, occurred in patients receiving apalutamide. It is recommended to monitor for signs and symptoms of ischemic heart disease and to consider discontinuation of treatment for Grade 3 and 4 events. Care should be exercised when prescribing this agent in patients at risk of an ischemic cardiovascular event, such as in those patients with hypertension, diabetes, or dyslipidemia.

Ischemic cardiovascular events, including events leading to death, occurred in patients receiving apalutamide. It is recommended to monitor for signs and symptoms of ischemic heart disease and to consider discontinuation of treatment for Grade 3 and 4 events. Care should be exercised when prescribing this agent in patients at risk of an ischemic cardiovascular event, such as in those patients with hypertension, diabetes, or dyslipidemia.

Ischemic cardiovascular events, including events leading to death, occurred in patients receiving apalutamide. It is recommended to monitor for signs and symptoms of ischemic heart disease and to consider discontinuation of treatment for Grade 3 and 4 events. Care should be exercised when prescribing this agent in patients at risk of an ischemic cardiovascular event, such as in those patients with hypertension, diabetes, or dyslipidemia.

Ischemic cardiovascular events, including events leading to death, occurred in patients receiving apalutamide. It is recommended to monitor for signs and symptoms of ischemic heart disease and to consider discontinuation of treatment for Grade 3 and 4 events. Care should be exercised when prescribing this agent in patients at risk of an ischemic cardiovascular event, such as in those patients with hypertension, diabetes, or dyslipidemia.

No clinically significant differences in the pharmacokinetics of apalutamide or its major metabolite were observed in patients with mild (Child-Pugh A) to moderate (Child-Pugh B) hepatic impairment. The effect on patients with severe hepatic impairment (Child-Pugh C) on apalutamide pharmacokinetics is unknown. Close monitoring of liver function is recommended in these patients.

The recommended dosage of pemigatinib should be reduced in patients with severe hepatic dysfunction. No dose adjustment is recommended for patients with mild or moderate hepatic impairment.

Falls and fractures have occurred in patients receiving apalutamide. Care should be exercised when apalutamide is used in patients at risk for fractures or falls and in those patients with osteoporosis. It is recommended to evaluate patients for fracture and fall risk and to consider the use of bone-targeted agents as medically necessary.

Falls and fractures have occurred in patients receiving apalutamide. Care should be exercised when apalutamide is used in patients at risk for fractures or falls and in those patients with osteoporosis. It is recommended to evaluate patients for fracture and fall risk and to consider the use of bone-targeted agents as medically necessary.

No clinically significant differences in the pharmacokinetics of apalutamide or its major metabolite were observed in patients with mild to moderate renal impairment. The effect on patients with severe renal impairment or end-stage renal disease on apalutamide pharmacokinetics is unknown. Close monitoring of renal function is recommended in these patients.

The recommended dosage of pemigatinib should be reduced in patients with severe renal disease. No dose adjustment is recommended for patients with mild or moderate renal impairment, or those patients with end-stage renal disease receiving intermittent hemodialysis.

The use of apalutamide may cause seizures. It is recommended to discontinue this agent in patients who develop a seizure while on treatment. Care should be exercised when using apalutamide in patients at risk or with a history of seizure disorder.

Pemigatinib can cause retinal pigment epithelial detachment (RPED), which may cause symptoms such as blurred vision, visual floaters, or photopsia. A comprehensive ophthalmological examination including an optical coherence tomography should be performed prior to treatment initiation. Patients with visual disturbances should be closely monitored.