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Drug interactions between B-Nexa and crizotinib

Results for the following 2 drugs:
B-Nexa (calcium/folic acid/ginger/pyridoxine)
crizotinib

Interactions between your drugs

Moderate

ginger crizotinib

Applies to: B-Nexa (calcium / folic acid / ginger / pyridoxine) and crizotinib

Consumer information for this interaction is not currently available.

MONITOR: Limited data suggests that coadministration with ginger may increase the plasma concentrations and the risk of toxicity of crizotinib. The proposed mechanism, based on in vitro data, may be attributed to decreased clearance due to ginger-mediated inhibition of CYP450 3A4 and/or P-glycoprotein (P-gp). Ginger has previously been shown to inhibit CYP450 3A4, 2C9, and P-gp activities in vitro. In one case report, increased plasma levels and hepatotoxicity developed in a 48-year old woman receiving crizotinib (250 mg twice daily) following consumption of a drink containing grated ginger. Previously, the patient had tolerated crizotinib well. The concentration of crizotinib, two days after its discontinuation, was 1.8-fold higher than the previous level measured prior to the initiation of ginger.

MANAGEMENT: Until more information is available, caution is advised when ginger is used concomitantly with crizotinib. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for crizotinib whenever ginger is added to or withdrawn from therapy.

References

  1. Kimura Y, Ito H, Hatano T "Effects of mace and nutmeg on human cytochrome P450 3A4 and 2C9 activity." Biol Pharm Bull 33 (2010): 1977-82
  2. Revol B, Guitier-Veyret E, Arrive C, et.al "Pharmacokinetic herb-drug interaction between ginger and crizotinib. Available from: URL: https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.13862" Br J Clin Pharmacol 0 (2019): [epub ahead of print]

Drug and food interactions

Major

crizotinib food

Applies to: crizotinib

Do not consume grapefruit or grapefruit juice during treatment with crizotinib unless directed otherwise by your doctor. Grapefruit juice can increase the blood levels of crizotinib to dangerous levels and cause an irregular heart rhythm that may be serious. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or fast or pounding heartbeats during treatment with crizotinib. You may take crizotinib with or without food, but take it the same time each day. 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.

Switch to professional interaction data

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.

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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