Drug Interactions between belumosudil and black cohosh
This report displays the potential drug interactions for the following 2 drugs:
- belumosudil
- black cohosh
Interactions between your drugs
black cohosh belumosudil
Applies to: black cohosh and belumosudil
Consumer information for this interaction is not currently available.
GENERALLY AVOID: Concomitant use of black cohosh (Cimicifuga racemosa rhizome) with other agents that are known to induce hepatotoxicity may theoretically increase the risk of liver injury. Black cohosh has been suspected in rare cases of liver toxicity ranging from abnormal liver function tests and jaundice to various forms of hepatitis and hepatic failure requiring transplantation. The onset has typically been within the first 3 months after initiation of black cohosh. Although approximately half of the cases resulted in hospitalization, most improved or resolved following discontinuation of the product. Many of the cases were not well documented with respect to the specific herbal formulation and dose used or timeframe of treatment in relation to onset of reaction, or they were complicated by multiple confounding factors. Some of the cases also involved products containing multiple herbal or other medicinal substances. Nevertheless, the European Medicines Agency (EMEA) and the Committee on Herbal Medicinal Products (HMPC) reviewed 42 such cases and released an assessment statement in 2006 indicating a potential connection between products containing Cimicifuga racemosa rhizome and human hepatotoxicity. The Medicines and Healthcare products Regulatory Agency (MHRA) in the U.K. also issued an assessment report supporting a causal association after reviewing data from over 40 cases received through their reporting system and similar systems in other countries, as well as in the published literature. Hepatotoxicity warnings are currently required on products containing black cohosh marketed in many European countries and Australia.
MANAGEMENT: Until more information is available, patients should consider avoiding the use of black cohosh if they are receiving other potentially hepatotoxic agents (e.g., acetaminophen; alcohol; androgens and anabolic steroids; antituberculous agents; azole antifungal agents; ACE inhibitors; cyclosporine (high dosages); disulfiram; endothelin receptor antagonists; interferons; ketolide and macrolide antibiotics; kinase inhibitors; minocycline; nonsteroidal anti-inflammatory agents; nucleoside reverse transcriptase inhibitors; proteasome inhibitors; retinoids; sulfonamides; tamoxifen; thiazolidinediones; tolvaptan; vincristine; zileuton; anticonvulsants such as carbamazepine, hydantoins, felbamate, and valproic acid; lipid-lowering medications such as fenofibrate, lomitapide, mipomersen, niacin, and statins; other herbals and nutritional supplements such as chaparral, comfrey, DHEA, kava, pennyroyal oil, and red yeast rice). Patients should be advised to seek medical attention if they experience potential signs and symptoms of hepatotoxicity such as fever, rash, itching, anorexia, nausea, vomiting, fatigue, malaise, right upper quadrant pain, dark urine, pale stools, and jaundice.
References
- Westphal JF, Vetter D, Brogard JM (1994) "Hepatic side-effects of antibiotics." J Antimicrob Chemother, 33, p. 387-401
- Whiting PW, Clouston A, Kerlin P (2002) "Black cohosh and other herbal remedies associated with acute hepatitis." Med J Aust, 177, p. 440-3
- Lee WM (2003) "Drug-induced hepatotoxicity." N Engl J Med, 349, p. 474-85
- Low Dog T (2005) "Menopause: a review of botanical dietary supplements." Am J Med, 118(12 Suppl 2), p. 98-108
- Therapeutic Research Faculty (2008) Natural Medicines Comprehensive Database. http://www.naturaldatabase.com
- MHRA UKPAR (2008) Black Cohosh: UK Public Assessment Report. http://www.mhra.gov.uk/home/groups/es-herbal/documents/websiteresources/con2024279.pdf
Drug and food interactions
belumosudil food
Applies to: belumosudil
Consumer information for this interaction is not currently available.
ADJUST DOSING INTERVAL: Administration with food increases the oral bioavailability of belumosudil. The mechanism has not been described. Administration of belumosudil (200 mg single oral dose) in healthy subjects, with a fatty and calorie-rich meal (approximately half of the calories were contained in the fat) increased the mean belumosudil peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) by 120% and 100%, respectively, compared to administration under fasting conditions. The time to reach peak concentration (Tmax) was delayed by 30 minutes. Administration of oral belumosudil 200 mg once daily with food in patients with chronic graft-versus-host disease (chronic GVHD) lead to steady-state concentrations of the drug with an accumulation ration of 1.4.
MANAGEMENT: To ensure maximal oral absorption, belumosudil should be administered with a meal, every day at the same time.
References
- (2024) "Product Information. Rezurock (belumosudil)." Sanofi
- (2024) "Product Information. Rezurock (belumosudil)." Kadmon Pharmaceuticals, 11/2023
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.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
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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