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Drug Interactions between cabozantinib and nevirapine

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

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Interactions between your drugs

Moderate

nevirapine cabozantinib

Applies to: nevirapine and cabozantinib

MONITOR: Coadministration of nevirapine with cabozantinib may increase or decrease cabozantinib plasma concentrations. The proposed mechanism is multidrug resistance-associated protein (MRP2) inhibition and CYP450 3A4 induction of cabozantinib (an MRP2 and CYP450 3A4 substrate) by nevirapine. In vitro studies have shown MRP2 inhibitors, such as nevirapine may increase the plasma concentrations of cabozantinib; additionally, a study in healthy subjects has shown administration of the potent CYP450 3A4 inducer rifampin (600 mg daily for 31 days) decreases single dose cabozantinib plasma exposure (AUC) by 77%. The potency of CYP450 3A4 induction by nevirapine has not been quantified.

MANAGEMENT: Use caution with coadministration of nevirapine and cabozantinib as there is a potential for both diminished and increased pharmacologic effects of cabozantinib. Monitor for reduced cabozantinib efficacy and increased cabozantinib toxicity, including diarrhea, hypertension, palmar-plantar erythrodysesthesia, hemorrhage, thrombotic events, or gastrointestinal perforation. Alternative treatments may be required if an interaction is suspected.

References (4)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. (2012) "Product Information. Cometriq (cabozantinib)." Exelixis Inc
  4. (2016) "Product Information. Cabometyx (cabozantinib)." Exelixis Inc

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.

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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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