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Drug Interactions between cabozantinib and horse chestnut

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

horse chestnut cabozantinib

Applies to: horse chestnut and cabozantinib

GENERALLY AVOID: When administered systemically, horse chestnut may theoretically potentiate the effects of anticoagulants, platelet inhibitors and other agents that affect hemostasis, possibly increasing the risk of bleeding and bruising. Horse chestnut contains the coumarin glycosides aesculetin, fraxin, and scopolin.

MANAGEMENT: Patients should consult a healthcare provider before taking any herbal or alternative medicine. Until more information is available, consumption of horse chestnut should preferably be avoided during use of anticoagulants, platelet inhibitors, or other agents that can cause bleeding. In patients who have used horse chestnut extensively prior to receiving these agents, the potential for an interaction should be considered. Close clinical and laboratory monitoring for bleeding complications is recommended. Patients should be advised to promptly report any signs of unusual bleeding or bruising to their physician, including pain, swelling, headache, dizziness, weakness, nosebleeds, prolonged bleeding from cuts, bleeding of gums from brushing, red or brown urine, and red or black stools.

References (3)
  1. (2001) "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals
  2. Heck AM, DeWitt BA, Lukes AL (2000) "Potential interactions between alternative therapies and warfarin." Am J Health Syst Pharm, 57, 1221-7; quiz 1228-30
  3. Therapeutic Research Faculty (2008) Natural Medicines Comprehensive Database. http://www.naturaldatabase.com

Drug and food interactions

Moderate

cabozantinib food

Applies to: cabozantinib

ADJUST DOSING INTERVAL: Food may alter the oral bioavailability of cabozantinib. When healthy subjects were given a single 140 mg oral dose with a high-fat meal, cabozantinib peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 41% and 57%, respectively, relative to administration under fasting conditions. In clinical studies, patients were administered cabozantinib without food.

GENERALLY AVOID: Coadministration with grapefruit juice is likely to increase the plasma concentrations of cabozantinib, which is primarily metabolized by CYP450 3A4. However, the interaction has not been studied. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit.

MANAGEMENT: Cabozantinib should be administered at least one hour before or two hours after a meal. The consumption of grapefruit, grapefruit juice, and supplements that contain grapefruit extract should be avoided.

References (1)
  1. (2012) "Product Information. Cometriq (cabozantinib)." Exelixis Inc

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

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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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