Drug Interactions between brimonidine / dorzolamide / latanoprost / timolol ophthalmic and ceritinib

GENERALLY AVOID: Coadministration of ceritinib with other drugs that can slow the heart rate such as beta-blockers, calcium channel blockers, digitalis, and clonidine may increase the risk of bradycardia, which can lead to heart block and QT prolongation. Bradycardia has occurred in patients receiving ceritinib alone. In one study, sinus bradycardia, defined as a heart rate of less than 50 beats per minute, was noted as a new finding in 1% of 255 patients. Bradycardia was reported as an adverse drug reaction in 3% of patients.

MANAGEMENT: Concomitant use of ceritinib with other agents known to cause bradycardia should be avoided if possible. All patients treated with ceritinib should have their heart rate and blood pressure monitored regularly. Consult the product labeling for dosage adjustment and management recommendations if symptomatic or life-threatening bradycardia occurs. Patients should be advised to notify their doctor if they experience irregular heartbeat, slow pulse, dizziness, or syncope.

MONITOR: Topically administered alpha-2 adrenergic receptor agonists such as apraclonidine and brimonidine are systemically absorbed, with the potential for producing rare but clinically significant systemic effects such as hypotension and bradycardia. The possibility for an additive or potentiating effect on blood pressure and heart rate should be considered when used with other medications that affect these parameters, such as ophthalmic and systemic beta blockers, vasodilators, cardiac glycosides, and antihypertensive agents.

MANAGEMENT: Blood pressure and pulse rate should be monitored regularly when topical alpha-2 adrenergic receptor agonists are prescribed in combination with cardiovascular drugs. Patients should be advised to notify their physician if they experience slow pulse, irregular heartbeat, dizziness, lightheadedness, or syncope.