Interactions between Benzgalantamine and Retevmo
1 drug interaction and 25 additional warnings found for the following 2 drugs:
- benzgalantamine
- Retevmo (selpercatinib)
Drug interactions
Moderate drug interactions
Moderate:
selpercatinib benzgalantamine
Applies to: Retevmo (selpercatinib) and benzgalantamine
Monitor
Acetylcholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes, which occasionally manifest as bradycardia or heart block (<2%). Because bradycardia is a risk factor for torsade de pointes, a theoretical risk exists when combined with agents that prolong the QT interval. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors including, but not limited to congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation may vary depending on the dosage(s) and specific drug(s) involved.
Management
Caution is advised when acetylcholinesterase inhibitors are used with drugs that can prolong the QT interval. Patients should be monitored for bradycardia, atrioventricular block and syncope, and advised to seek medical attention if they experience dizziness, lightheadedness, fainting, shortness of breath, or slow or irregular heartbeat.
References (12)
- (2001) "Product Information. Aricept (donepezil)." Pfizer U.S. Pharmaceuticals
- (2001) "Product Information. Exelon (rivastigmine)." Novartis Pharmaceuticals
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- Cerner Multum, Inc. "Australian Product Information."
- (2024) "Product Information. Galantamine Hydrobromide ER (galantamine)." Aurobindo Pharma USA Inc
- (2024) "Product Information. Galantamine Hydrobromide (galantamine)." Aurobindo Pharma USA Inc
- (2022) "Product Information. Gaalin (galantamine)." Auro Pharma Inc
- (2023) "Product Information. Galzemic (galantamine)." Zentiva Pharma UK Ltd
- (2023) "Product Information. Galantyl (galantamine)." Viatris UK Healthcare Ltd
- (2020) "Product Information. Auro-Galantamine ER (galantamine)." Auro Pharma Inc
- (2024) "Product Information. Zunveyl (benzgalantamine)." Alpha Cognition, Inc., SUPPL-1
Food/lifestyle interactions
Major food/lifestyle interactions
Major:
selpercatinib Food/Lifestyle
Applies to: Retevmo (selpercatinib)
Generally avoid
Grapefruit juice may increase the plasma concentrations of selpercatinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Inhibition of hepatic CYP450 3A4 may also contribute. The interaction has not been studied with grapefruit juice, but has been reported for other CYP450 3A4 inhibitors. When a single dose of selpercatinib (160 mg) was coadministered with multiple doses of itraconazole (200 mg once daily), a potent CYP450 3A4 inhibitor, selpercatinib peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 30% and 133%, respectively. Based on pharmacokinetic modeling, administration of multiple doses of selpercatinib (160 mg twice daily) with multiple doses of the moderate CYP450 3A4 inhibitors diltiazem (60 mg three times daily), fluconazole (200 mg once daily), or verapamil (80 mg three times daily) is predicted to increase selpercatinib Cmax by 46% to 76% and AUC by 60% to 99%. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Increased exposure to selpercatinib may increase the risk of serious adverse effects such as QT interval prolongation, liver transaminase and bilirubin elevations, hypertension, hemorrhage, edema, and hypersensitivity reactions (e.g., fever, rash, arthralgias/myalgias with concurrent decreased platelets or transaminitis).
Management
Until further information is available, it may be advisable for patients to limit or avoid consumption of grapefruit and grapefruit juice during treatment with selpercatinib.
References (4)
- (2024) "Product Information. Retevmo (selpercatinib)." Lilly, Eli and Company
- (2023) "Product Information. Retevmo (selpercatinib)." Eli Lilly Australia Pty Ltd, vA1.0
- (2024) "Product Information. Retsevmo (selpercatinib)." Eli Lilly and Company Ltd
- (2024) "Product Information. Retevmo (selpercatinib)." Loxo Oncology Inc
Disease interactions
24 potential interactions Applies to: 20 conditions, including High Blood Pressure, Heart Failure, Asthma, COPD, and Seizures.
Arrhythmia
Major:
benzgalantamine
Benzgalantamine has a major potential interaction with Arrhythmia.
Due to their pharmacological action, cholinesterase inhibitors can have a vagotonic effect on the sinoatrial and atrioventricular nodes producing bradycardia or heart block. Therapy with cholinesterase inhibitors should be administered cautiously in patients with preexisting bradycardia or underlying cardiac conduction abnormalities. Syncopal episodes have been reported. Atropine may be used to reverse bradycardia produced by cholinesterase inhibitors.
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Arrhythmia.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Asthma
Major:
benzgalantamine
Benzgalantamine has a major potential interaction with Asthma.
Cholinesterase inhibitors inhibit the hydrolysis of acetylcholine. The enhanced effect of acetylcholine produces constriction of the bronchi, increased bronchial secretions, and bronchospasm. Therapy with cholinesterase inhibitors should be administered cautiously in patients with respiratory dysfunction, history of asthma, or obstructive pulmonary disease. Respiratory function should be closely monitored for the occurrence of respiratory adverse reactions. Use of atropine along with discontinuation of the cholinesterase inhibitor may be required for serious respiratory distress.
Bleeding Disorder
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Bleeding Disorder.
Serious including fatal hemorrhagic events can occur with the use of selpercatinib. Care should be exercised when using this agent in patients with bleeding disorders. It is recommended to permanently discontinue treatment in patients with severe or life-threatening hemorrhage.
Cardiovascular Conditions and Disorders
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Cardiovascular Conditions and Disorders.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
COPD
Major:
benzgalantamine
Benzgalantamine has a major potential interaction with COPD.
Cholinesterase inhibitors inhibit the hydrolysis of acetylcholine. The enhanced effect of acetylcholine produces constriction of the bronchi, increased bronchial secretions, and bronchospasm. Therapy with cholinesterase inhibitors should be administered cautiously in patients with respiratory dysfunction, history of asthma, or obstructive pulmonary disease. Respiratory function should be closely monitored for the occurrence of respiratory adverse reactions. Use of atropine along with discontinuation of the cholinesterase inhibitor may be required for serious respiratory distress.
Electrolyte Abnormalities
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Electrolyte Abnormalities.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Heart Failure
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Heart Failure.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
High Blood Pressure
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with High Blood Pressure.
Selpercatinib may cause hypertension and therapy should not be initiated in patients with uncontrolled hypertension. Care should be exercised when using this agent in hypertensive patients. Optimize blood pressure before starting treatment. It is recommended to monitor blood pressure after 1 week, and regularly as clinically indicated. Initiate or adjust anti-hypertensive therapy as appropriate. Withhold, reduce dose, or permanently discontinue treatment based on the severity.
History - Myocardial Infarction
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with History - Myocardial Infarction.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Hypocalcemia
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Hypocalcemia.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Hypokalemia
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Hypokalemia.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Interstitial Lung Disease
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Interstitial Lung Disease.
Selpercatinib may cause severe, life-threatening, or fatal interstitial lung disease (ILD)/pneumonitis. Monitor for new or worsening pulmonary symptoms. Withhold therapy and promptly investigate acute or worsening respiratory symptoms suggestive of ILD/pneumonitis (e.g., dyspnea, cough, and fever).
Liver Disease
Moderate:
benzgalantamine
Benzgalantamine has a moderate potential interaction with Liver Disease.
In patients with moderate hepatic impairment (Child-Pugh score of 7 to 9), the dosage of galantamine or benzgalantamine should generally not exceed 16 mg/day or 20 mg/day, respectively. The use of galantamine or benzgalantamine in patients with severe hepatic impairment (Child-Pugh score of 10 to 15) is not recommended.
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Liver Disease.
Selpercatinib is metabolized predominantly by CYP450 3A4. The dose of selpercatinib should be reduced in patients with severe hepatic impairment. No dosage modification is recommended for patients with mild or moderate hepatic impairment. Serious hepatic adverse reactions have been reported in patients treated with selpercatinib. Monitor ALT and AST before starting therapy with selpercatinib, every two weeks during the first three months, then monthly thereafter and as clinically indicated. It is recommended to withhold, reduce dose or permanently discontinue treatment based on the severity of selpercatinib-related adverse reactions in patients with hepatic impairment.
Long QT Syndrome
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Long QT Syndrome.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Magnesium Imbalance
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Magnesium Imbalance.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Peptic Ulcer
Moderate:
benzgalantamine
Benzgalantamine has a moderate potential interaction with Peptic Ulcer.
The use of cholinesterase inhibitors is associated with an increase in gastric acid secretion and gastric contractions. Monitor for symptoms of active or occult gastrointestinal bleeding, especially in patients at increased risk for developing ulcers (e.g., history of ulcer disease or concurrent use of nonsteroidal anti-inflammatory drugs).
Renal Dysfunction
Moderate:
benzgalantamine
Benzgalantamine has a moderate potential interaction with Renal Dysfunction.
In patients with creatinine clearance of 9 to 59 mL/min, the dosage of galantamine or benzgalantamine should generally not exceed 16 mg/day or 20 mg/day, respectively. In patients with creatinine clearance less than 9 mL/min, the use of galantamine or benzgalantamine is not recommended.
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Renal Dysfunction.
Tumor lysis syndrome has been reported with use of selpercatinib in patients with medullary thyroid carcinoma. Patients with rapidly growing tumors, a high tumor burden, renal dysfunction, or dehydration who take selpercatinib may be at increased risk. Closely monitor at-risk patients and consider appropriate prophylaxis, including hydration.
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Renal Dysfunction.
A recommended dose of selpercatinib has not been established for patients with end-stage renal disease. No dosage modification is recommended for patients with mild to severe renal impairment. The use of selpercatinib may increase serum creatinine. It is recommended to consider alternative markers of renal function if persistent elevations in serum creatinine are observed.
Seizures
Moderate:
benzgalantamine
Benzgalantamine has a moderate potential interaction with Seizures.
Cholinesterase inhibitors have been associated with convulsions and tremor. Therapy with cholinesterase inhibitors should be administered cautiously in patients with seizure disorders. Patients with Alzheimer's disease should be closely monitored for seizures.
Thyroid Disease
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Thyroid Disease.
Selpercatinib can cause concentration-dependent QT interval prolongation. Monitor patients who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, and severe or uncontrolled heart failure. This drug has not been studied in patients with clinically significant active cardiovascular disease or recent myocardial infarction. Assess QT interval, electrolytes, and TSH at baseline and periodically during treatment, adjusting frequency based upon risk factors, including diarrhea or drug interactions. Correct hypokalemia, hypomagnesemia, and hypocalcemia prior to initiating therapy.
Tumor Lysis Syndrome
Moderate:
Retevmo
The selpercatinib in Retevmo has a moderate potential interaction with Tumor Lysis Syndrome.
Tumor lysis syndrome has been reported with use of selpercatinib in patients with medullary thyroid carcinoma. Patients with rapidly growing tumors, a high tumor burden, renal dysfunction, or dehydration who take selpercatinib may be at increased risk. Closely monitor at-risk patients and consider appropriate prophylaxis, including hydration.
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More resources
benzgalantamine
A total of 455 drugs are known to interact with benzgalantamine.
- Benzgalantamine is in the drug class cholinesterase inhibitors.
- Benzgalantamine is used to treat Alzheimer's Disease.
Retevmo
A total of 670 drugs are known to interact with Retevmo.
- Retevmo is in the drug class multikinase inhibitors.
- Retevmo is used to treat the following conditions:
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
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