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Interactions between Aquest and Ritlecitinib

1 drug interaction and 7 additional warnings found for the following 2 drugs:

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Drug interactions

Major drug interactions

Major:

estrone ritlecitinib

Applies to: Aquest (estrone) and ritlecitinib
Monitor closely

Coadministration of Janus kinase (JAK) inhibitors and combined hormonal contraceptives, hormone replacement therapy (HRT), or estrogen receptor modulators may potentiate the risk of venous thromboembolism (VTE). Serious and sometimes fatal VTE events including pulmonary embolism (PE) and deep vein thrombosis (DVT) have been observed in patients taking JAK inhibitors. In a randomized safety study of patients with rheumatoid arthritis with at least one cardiovascular risk factor (e.g., prior VTE, body mass index greater than or equal to 35 kg/m2, older age, history of chronic lung disease), an increased risk for VTE was observed with tofacitinib compared to tumor necrosis factor (TNF) inhibitors. Similarly, in a meta-analysis evaluating 16 randomized controlled trials for the incidence of venous thromboembolism with JAK inhibitor use (including tofacitinib, upadacitinib, filgotinib, and baricitinib), a potential increase in the risk of VTE, although not clinically significant, was observed compared to placebo or TNF inhibitors. Subgroup analyses showed higher VTE events with tofacitinib compared to TNF inhibitors and with higher doses of JAK inhibitors. Data surrounding the use of JAK inhibitors with hormonal contraceptives, HRT and/or estrogen receptor modulators are not available.

Management

Caution and close clinical monitoring are advised when JAK inhibitors are administered in patients with an increased risk for venous thromboembolism (VTE), such as those taking combined hormonal contraceptives, hormone replacement therapy (HRT) and/or estrogen receptor modulators. While not discussed in US product labeling, international labeling for some JAK inhibitors recommends avoiding concomitant use due to their potential to increase the risk of VTE. Other international labeling suggests JAK inhibitors may be administered if necessary, but with additional monitoring. Patients and their caregivers should be advised to seek medical attention if they experience signs and symptoms of VTE. Individual product labeling should be consulted for further guidance.

References (17)
  1. (2011) "Product Information. Jakafi (ruxolitinib)." Incyte Corporation
  2. (2019) "Product Information. Rinvoq (upadacitinib)." AbbVie US LLC
  3. (2022) "Product Information. Cibinqo (abrocitinib)." Pfizer U.S. Pharmaceuticals Group
  4. (2022) "Product Information. Vonjo (pacritinib)." CTI BioPharma Corp.
  5. (2021) "Product Information. Xeljanz (tofacitinib)." Pfizer U.S. Pharmaceuticals Group, SUPPL-28
  6. (2021) "Product Information. Xeljanz (tOFACitinib)." Pfizer Australia Pty Ltd, pfpxeljt11021
  7. (2022) "Product Information. Xeljanz (tofacitinib)." Pfizer Ltd, XJ 5mg 26_0 GB
  8. (2022) "Product Information. Olumiant (baricitinib)." Lilly, Eli and Company, SUPPL-7
  9. (2023) "Product Information. Litfulo (ritlecitinib)." Pfizer U.S. Pharmaceuticals Group
  10. (2023) "Product Information. Ojjaara (momelotinib)." GlaxoSmithKline
  11. (2023) "Product Information. Olumiant (bARICITinib)." Eli Lilly Australia Pty Ltd, vA9.0_May2023
  12. (2024) "Product Information. Olumiant (baricitinib)." Eli Lilly and Company Ltd
  13. (2025) "Product Information. Inrebic (fedratinib)." Bristol-Myers Squibb Australia Pty Ltd
  14. (2026) "Product Information. Inrebic (fedratinib)." Bristol-Myers Squibb Pharmaceuticals Ltd
  15. (2026) "Product Information. INREBIC (fedratinib)." BRISTOL-MYERS SQUIBB PHARMA EEIG
  16. (2025) "Product Information. Inrebic (fedratinib)." Celgene Inc
  17. (2026) "Product Information. Inrebic (fedratinib)." Bristol-Myers Squibb

Food/lifestyle interactions

Minor food/lifestyle interactions

Minor:

estrone Food/Lifestyle

Applies to: Aquest (estrone)

Coadministration with grapefruit juice may increase the bioavailability of oral estrogens. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits. In a small, randomized, crossover study, the administration of ethinyl estradiol with grapefruit juice (compared to herbal tea) increased peak plasma drug concentration (Cmax) by 37% and area under the concentration-time curve (AUC) by 28%. Based on these findings, grapefruit juice is unlikely to affect the overall safety profile of ethinyl estradiol. However, as with other drug interactions involving grapefruit juice, the pharmacokinetic alterations are subject to a high degree of interpatient variability. Also, the effect on other estrogens has not been studied.

References (2)
  1. Weber A, Jager R, Borner A, et al. (1996) "Can grapefruit juice influence ethinyl estradiol bioavailability?" Contraception, 53, p. 41-7
  2. Schubert W, Eriksson U, Edgar B, Cullberg G, Hedner T (1995) "Flavonoids in grapefruit juice inhibit the in vitro hepatic metabolism of 17B-estradiol." Eur J Drug Metab Pharmacokinet, 20, p. 219-24

Disease interactions

6 potential interactions Applies to: 6 conditions, including Liver Disease, Infection, Smoking, Cardiovascular Conditions and Disorders, and Immunodeficiency.

Cardiovascular Conditions and Disorders

Major:

ritlecitinib

Ritlecitinib has a major potential interaction with Cardiovascular Conditions and Disorders.

In a major safety study of a Janus kinase (JAK) inhibitor, tofacitinib, in rheumatoid arthritis patients 50 years and older with at least 1 cardiovascular risk factor, higher rates of all-cause mortality (including sudden cardiovascular death) and major adverse cardiovascular events (MACE) (defined as cardiovascular death, myocardial infarction, and stroke) were observed with the JAK inhibitor when compared with tumor necrosis factor (TNF) blockers. Patients who were current or past smokers had an additional increased risk. Based on a shared mechanism of action, this risk should be considered for other JAK inhibitors, including baricitinib, upadacitinib, ruxolitinib, fedratinib, ritlecitinib, deuruxolitinib, and pacritinib. Consider the benefits and risks for each individual patient prior and during treatment with JAK inhibitors, especially in patients with other cardiovascular risk factors, history of cardiovascular events, and patients who are current or past smokers. Patients should be informed about the symptoms of serious cardiovascular events and what to do if they occur.

History, Tuberculosis

Major:

ritlecitinib

Ritlecitinib has a major potential interaction with History, Tuberculosis.

Avoid the use of ritlecitinib in patients with an active, serious infection. Consider the risks and benefits of treatment in patients with chronic or recurrent infection, exposed to tuberculosis (TB), with a history of serious infection or an opportunistic infection, who have resided or traveled in areas of endemic TB or mycoses, or with underlying conditions that may predispose them to infection. Patients should be screened for TB before treatment initiation. This drug should not be given to patients with active TB or untreated latent TB; anti-TB therapy should be started prior to initiating treatment. Screening for viral hepatitis should be performed in accordance with clinical guidelines before starting therapy. Treatment interruption should be considered in patients with viral reactivation (e.g., herpes zoster).

Immunodeficiency

Major:

ritlecitinib

Ritlecitinib has a major potential interaction with Immunodeficiency.

Avoid the use of ritlecitinib in patients with an active, serious infection. Consider the risks and benefits of treatment in patients with chronic or recurrent infection, exposed to tuberculosis (TB), with a history of serious infection or an opportunistic infection, who have resided or traveled in areas of endemic TB or mycoses, or with underlying conditions that may predispose them to infection. Patients should be screened for TB before treatment initiation. This drug should not be given to patients with active TB or untreated latent TB; anti-TB therapy should be started prior to initiating treatment. Screening for viral hepatitis should be performed in accordance with clinical guidelines before starting therapy. Treatment interruption should be considered in patients with viral reactivation (e.g., herpes zoster).

Infection

Major:

ritlecitinib

Ritlecitinib has a major potential interaction with Infection.

Avoid the use of ritlecitinib in patients with an active, serious infection. Consider the risks and benefits of treatment in patients with chronic or recurrent infection, exposed to tuberculosis (TB), with a history of serious infection or an opportunistic infection, who have resided or traveled in areas of endemic TB or mycoses, or with underlying conditions that may predispose them to infection. Patients should be screened for TB before treatment initiation. This drug should not be given to patients with active TB or untreated latent TB; anti-TB therapy should be started prior to initiating treatment. Screening for viral hepatitis should be performed in accordance with clinical guidelines before starting therapy. Treatment interruption should be considered in patients with viral reactivation (e.g., herpes zoster).

Liver Disease

Moderate:

ritlecitinib

Ritlecitinib has a moderate potential interaction with Liver Disease.

Ritlecitinib is not recommended in patients with severe (Child Pugh C) hepatic impairment.

Smoking

Major:

ritlecitinib

Ritlecitinib has a major potential interaction with Smoking.

In a major safety study of a Janus kinase (JAK) inhibitor, tofacitinib, in rheumatoid arthritis patients 50 years and older with at least 1 cardiovascular risk factor, higher rates of all-cause mortality (including sudden cardiovascular death) and major adverse cardiovascular events (MACE) (defined as cardiovascular death, myocardial infarction, and stroke) were observed with the JAK inhibitor when compared with tumor necrosis factor (TNF) blockers. Patients who were current or past smokers had an additional increased risk. Based on a shared mechanism of action, this risk should be considered for other JAK inhibitors, including baricitinib, upadacitinib, ruxolitinib, fedratinib, ritlecitinib, deuruxolitinib, and pacritinib. Consider the benefits and risks for each individual patient prior and during treatment with JAK inhibitors, especially in patients with other cardiovascular risk factors, history of cardiovascular events, and patients who are current or past smokers. Patients should be informed about the symptoms of serious cardiovascular events and what to do if they occur.

More resources

Aquest

A total of 272 drugs are known to interact with Aquest.

ritlecitinib

A total of 874 drugs are known to interact with ritlecitinib.

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.