Interactions between Cerinta and Mobocertinib
2 drug interactions and 52 additional warnings found for the following 2 drugs:
- Cerinta (ethinyl estradiol/levonorgestrel)
- mobocertinib
Drug interactions
Major drug interactions
Major:
ethinyl estradiol mobocertinib
Applies to: Cerinta (ethinyl estradiol / levonorgestrel) and mobocertinib
Generally avoid
Coadministration with mobocertinib may decrease the plasma concentrations of hormonal contraceptives and possibly render them ineffective. The proposed mechanism is mobocertinib-mediated induction of CYP450 3A4, the isoenzyme primarily responsible for the metabolic clearance of hormonal contraceptives. Based on interaction data with midazolam, a sensitive CYP450 3A4 substrate, mobocertinib appears to be a weak inducer of CYP450 3A4. In addition, mobocertinib can cause fetal harm when administered to a pregnant woman.
Management
Hormonal contraceptives, including oral, injectable, transdermal, and implantable forms, may not be reliable during concomitant therapy with mobocertinib. Women using hormonal contraceptives should be advised of the risk of breakthrough bleeding and unintended pregnancy when receiving mobocertinib. Because use of mobocertinib may cause embryo-fetal harm, it is particularly important that patients not become pregnant during treatment. Therefore, hormonal contraceptives should not be used as method of birth control in women of childbearing potential treated with mobocertinib. Female patients of reproductive potential should use a highly effective, non-hormonal method of contraception during treatment and for 1 month after treatment. Male patients with female partners of reproductive potential should use effective contraception during treatment with mobocertinib and for 1 week after treatment.
References (3)
- (2021) "Product Information. Exkivity (mobocertinib)." Takeda Pharmaceuticals America
- (2022) "Product Information. Exkivity (mobocertinib)." Takeda UK Ltd
- (2022) "Product Information. Exkivity (mobocertinib)." Takeda Pharmaceuticals Australia Pty Ltd, EXKIVITY PI V1.0 (CC
Major:
levonorgestrel mobocertinib
Applies to: Cerinta (ethinyl estradiol / levonorgestrel) and mobocertinib
Generally avoid
Coadministration with mobocertinib may decrease the plasma concentrations of hormonal contraceptives and possibly render them ineffective. The proposed mechanism is mobocertinib-mediated induction of CYP450 3A4, the isoenzyme primarily responsible for the metabolic clearance of hormonal contraceptives. Based on interaction data with midazolam, a sensitive CYP450 3A4 substrate, mobocertinib appears to be a weak inducer of CYP450 3A4. In addition, mobocertinib can cause fetal harm when administered to a pregnant woman.
Management
Hormonal contraceptives, including oral, injectable, transdermal, and implantable forms, may not be reliable during concomitant therapy with mobocertinib. Women using hormonal contraceptives should be advised of the risk of breakthrough bleeding and unintended pregnancy when receiving mobocertinib. Because use of mobocertinib may cause embryo-fetal harm, it is particularly important that patients not become pregnant during treatment. Therefore, hormonal contraceptives should not be used as method of birth control in women of childbearing potential treated with mobocertinib. Female patients of reproductive potential should use a highly effective, non-hormonal method of contraception during treatment and for 1 month after treatment. Male patients with female partners of reproductive potential should use effective contraception during treatment with mobocertinib and for 1 week after treatment.
References (3)
- (2021) "Product Information. Exkivity (mobocertinib)." Takeda Pharmaceuticals America
- (2022) "Product Information. Exkivity (mobocertinib)." Takeda UK Ltd
- (2022) "Product Information. Exkivity (mobocertinib)." Takeda Pharmaceuticals Australia Pty Ltd, EXKIVITY PI V1.0 (CC
Food/lifestyle interactions
Major food/lifestyle interactions
Major:
mobocertinib Food/Lifestyle
Applies to: mobocertinib
Generally avoid
Grapefruit juice may increase the plasma concentrations of mobocertinib. The mechanism may involve 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. Based on drug interaction studies using model-informed approaches, coadministration of mobocertinib with multiple doses of itraconazole or ketoconazole (strong CYP450 3A4 inhibitors) is predicted to increase the steady-state combined molar AUC (systemic exposure) of mobocertinib and its active metabolites by 374% to 419%, while coadministration with multiple doses of a moderate CYP450 3A4 inhibitor is predicted to increase this value by approximately 100% to 200%. 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. Elevated plasma concentrations of mobocertinib may increase the risk for adverse effects such as QT prolongation, heart failure or reduced ejection fraction, cardiomyopathy, heart block, diarrhea, rash, stomatitis, fatigue, and musculoskeletal pain.
Management
Patients should avoid consumption of grapefruit and grapefruit juice during treatment with mobocertinib.
References (2)
- (2021) "Product Information. Exkivity (mobocertinib)." Takeda Pharmaceuticals America
- (2022) "Product Information. Exkivity (mobocertinib)." Takeda UK Ltd
Moderate food/lifestyle interactions
Moderate:
levonorgestrel Food/Lifestyle
Applies to: Cerinta (ethinyl estradiol / levonorgestrel)
Monitor
Grapefruit or grapefruit juice may increase the plasma concentrations of orally administered drugs that are substrates of the CYP450 3A4 isoenzyme. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because grapefruit juice inhibits primarily intestinal rather than hepatic CYP450 3A4, the magnitude of interaction is greatest for those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability). 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. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.
Management
Patients who regularly consume grapefruit or grapefruit juice should be monitored for adverse effects and altered plasma concentrations of drugs that undergo significant presystemic metabolism by CYP450 3A4. Grapefruit and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact with these drugs.
References (32)
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- Sigusch H, Hippius M, Henschel L, Kaufmann K, Hoffmann A (1994) "Influence of grapefruit juice on the pharmacokinetics of a slow release nifedipine formulation." Pharmazie, 49, p. 522-4
- Bailey DG, Arnold JM, Strong HA, Munoz C, Spence JD (1993) "Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics." Clin Pharmacol Ther, 54, p. 589-94
- Yamreudeewong W, Henann NE, Fazio A, Lower DL, Cassidy TG (1995) "Drug-food interactions in clinical practice." J Fam Pract, 40, p. 376-84
- (1995) "Grapefruit juice interactions with drugs." Med Lett Drugs Ther, 37, p. 73-4
- Hukkinen SK, Varhe A, Olkkola KT, Neuvonen PJ (1995) "Plasma concentrations of triazolam are increased by concomitant ingestion of grapefruit juice." Clin Pharmacol Ther, 58, p. 127-31
- Min DI, Ku YM, Geraets DR, Lee HC (1996) "Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers." J Clin Pharmacol, 36, p. 469-76
- Majeed A, Kareem A (1996) "Effect of grapefruit juice on cyclosporine pharmacokinetics." Pediatr Nephrol, 10, p. 395
- Clifford CP, Adams DA, Murray S, Taylor GW, Wilkins MR, Boobis AR, Davies DS (1996) "Pharmacokinetic and cardiac effects of terfenadine after inhibition of its metabolism by grapefruit juice." Br J Clin Pharmacol, 42, p662
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- Ozdemir M, Aktan Y, Boydag BS, Cingi MI, Musmul A (1998) "Interaction between grapefruit juice and diazepam in humans." Eur J Drug Metab Pharmacokinet, 23, p. 55-9
- Bailey DG, Malcolm J, Arnold O, Spence JD (1998) "Grapefruit juice-drug interactions." Br J Clin Pharmacol, 46, p. 101-10
- Bailey DG, Kreeft JH, Munoz C, Freeman DJ, Bend JR (1998) "Grapefruit juice felodipine interaction: Effect of naringin and 6',7'-dihydroxybergamottin in humans." Clin Pharmacol Ther, 64, p. 248-56
- Garg SK, Kumar N, Bhargava VK, Prabhakar SK (1998) "Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy." Clin Pharmacol Ther, 64, p. 286-8
- Lilja JJ, Kivisto KT, Neuvonen PJ (1998) "Grapefruit juice-simvastatin interaction: Effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors." Clin Pharmacol Ther, 64, p. 477-83
- Fuhr U, Maier-Bruggemann A, Blume H, et al. (1998) "Grapefruit juice increases oral nimodipine bioavailability." Int J Clin Pharmacol Ther, 36, p. 126-32
- Lilja JJ, Kivisto KT, Neuvonen PJ (1999) "Grapefruit juice increases serum concentrations of atorvastatin and has no effect on pravastatin." Clin Pharmacol Ther, 66, p. 118-27
- Eagling VA, Profit L, Back DJ (1999) "Inhibition of the CYP3A4-mediated metabolism and P-glycoprotein-mediated transport of the HIV-I protease inhibitor saquinavir by grapefruit juice components." Br J Clin Pharmacol, 48, p. 543-52
- Damkier P, Hansen LL, Brosen K (1999) "Effect of diclofenac, disulfiram, itraconazole, grapefruit juice and erythromycin on the pharmacokinetics of quinidine." Br J Clin Pharmacol, 48, p. 829-38
- Lee AJ, Chan WK, Harralson AF, Buffum J, Bui BCC (1999) "The effects of grapefruit juice on sertraline metabolism: An in vitro and in vivo study." Clin Ther, 21, p. 1890-9
- Dresser GK, Spence JD, Bailey DG (2000) "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet, 38, p. 41-57
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- Takanaga H, Ohnishi A, Maatsuo H, et al. (2000) "Pharmacokinetic analysis of felodipine-grapefruit juice interaction based on an irreversible enzyme inhibition model." Br J Clin Pharmacol, 49, p. 49-58
- Libersa CC, Brique SA, Motte KB, et al. (2000) "Dramatic inhibition of amiodarone metabolism induced by grapefruit juice." Br J Clin Pharmacol, 49, p. 373-8
- Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR (2000) "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther, 68, p. 468-77
- Zaidenstein R, Soback S, Gips M, Avni B, Dishi V, Weissgarten Y, Golik A, Scapa E (2001) "Effect of grapefruit juice on the pharmacokinetics of losartan and its active metabolite E3174 in healthy volunteers." Ther Drug Monit, 23, p. 369-73
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- Flanagan D (2005) "Understanding the grapefruit-drug interaction." Gen Dent, 53, 282-5; quiz 286
Moderate:
ethinyl estradiol Caffeine
Applies to: Cerinta (ethinyl estradiol / levonorgestrel)
Monitor
Coadministration of ethinyl estradiol may increase the plasma concentrations of drugs that are primarily metabolized by CYP450 1A2. In a study of 30 healthy volunteers administered the CYP450 1A2 substrate tizanidine, the systemic exposure (AUC) of tizanidine was 3.9 times greater in women using an oral contraceptive containing ethinyl estradiol.
Management
Patients should be monitored for increased adverse effects of the CYP450 1A2 substrate during concomitant use with ethinyl estradiol. Product labeling for the specific CYP450 1A2 substrate should be consulted for additional recommendations.
References (1)
- Granfors MT, Backman JT, Laitila J, Neuvonen PJ (2005) "Oral contraceptives containing ethinyl estradiol and gestodene markedly increase plasma concentrations and effects of tizanidine by inhibiting cytochrome P450 1A2." Clin Pharmacol Ther, 78, p. 400-11
Minor food/lifestyle interactions
Minor:
ethinyl estradiol Food/Lifestyle
Applies to: Cerinta (ethinyl estradiol / levonorgestrel)
Coadministration with grapefruit juice may increase the bioavailability of oral estrogens. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits. In a small, randomized, crossover study, the administration of ethinyl estradiol with grapefruit juice (compared to herbal tea) increased peak plasma drug concentration (Cmax) by 37% and area under the concentration-time curve (AUC) by 28%. Based on these findings, grapefruit juice is unlikely to affect the overall safety profile of ethinyl estradiol. However, as with other drug interactions involving grapefruit juice, the pharmacokinetic alterations are subject to a high degree of interpatient variability. Also, the effect on other estrogens has not been studied.
References (2)
- Weber A, Jager R, Borner A, et al. (1996) "Can grapefruit juice influence ethinyl estradiol bioavailability?" Contraception, 53, p. 41-7
- Schubert W, Eriksson U, Edgar B, Cullberg G, Hedner T (1995) "Flavonoids in grapefruit juice inhibit the in vitro hepatic metabolism of 17B-estradiol." Eur J Drug Metab Pharmacokinet, 20, p. 219-24
Minor:
ethinyl estradiol Alcohol (Ethanol)
Applies to: Cerinta (ethinyl estradiol / levonorgestrel)
The central nervous system effects and blood levels of ethanol may be increased in patients taking oral contraceptives, although data are lacking and reports are contradictory. The mechanism may be due to enzyme inhibition. Consider counseling women about this interaction which is unpredictable.
References (1)
- Hobbes J, Boutagy J, Shenfield GM (1985) "Interactions between ethanol and oral contraceptive steroids." Clin Pharmacol Ther, 38, p. 371-80
Minor:
levonorgestrel Alcohol (Ethanol)
Applies to: Cerinta (ethinyl estradiol / levonorgestrel)
The central nervous system effects and blood levels of ethanol may be increased in patients taking oral contraceptives, although data are lacking and reports are contradictory. The mechanism may be due to enzyme inhibition. Consider counseling women about this interaction which is unpredictable.
References (1)
- Hobbes J, Boutagy J, Shenfield GM (1985) "Interactions between ethanol and oral contraceptive steroids." Clin Pharmacol Ther, 38, p. 371-80
Disease interactions
46 potential interactions Applies to: 34 conditions, including High Blood Pressure, High Cholesterol, Depression, Migraine, and Weight Loss.
Abnormal Uterine Bleeding
Major:
Cerinta
The ethinyl estradiol in Cerinta has a major potential interaction with Abnormal Uterine Bleeding.
The use of estrogens is contraindicated in patients with undiagnosed, abnormal vaginal bleeding. Prolonged (greater than 1 year), unopposed estrogen use (i.e. estrogen without concomitant progestin therapy) has been associated with a significant, dose-related risk of endometrial carcinoma. The risk may be offset substantially by the addition of a progestin but may not be completely abolished. Prior to initiating estrogen therapy, appropriate diagnostic tests should be performed in patients with abnormal vaginal bleeding to rule out endometrial malignancy. The same applies if recurrent or persistent bleeding develops during estrogen therapy.
Major:
Cerinta
The levonorgestrel in Cerinta has a major potential interaction with Abnormal Uterine Bleeding.
The use of contraceptives is contraindicated when there is an undiagnosed abnormal genital bleeding. Adequate diagnostic measures should be undertaken to rule out the presence of any malignancy.
Angioedema
Moderate:
Cerinta
The ethinyl estradiol in Cerinta has a moderate potential interaction with Angioedema.
The use of exogenous estrogens may induce or exacerbate symptoms of angioedema, particularly in women with hereditary angioedema. Consider the risk versus benefits of estrogen therapy. Close monitoring is recommended when prescribing these agents to patients predisposed to angioedema.
Asthma
Moderate:
Cerinta
The ethinyl estradiol and levonorgestrel in Cerinta both have a moderate potential interaction with Asthma.
Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.
Breast Cancer
Major:
Cerinta
The levonorgestrel in Cerinta has a major potential interaction with Breast Cancer.
The use of progestogens is considered by manufacturers to be contraindicated in patients with existing or suspected malignancy of the breast. Some supportive data are available for medroxyprogesterone. Specifically, medroxyprogesterone treatment may be associated with breast cancer, primarily when the drug is administered intramuscularly. A pooled analysis of two case-control studies, one from the World Health Organization and the other from New Zealand, revealed a small overall relative risk of breast cancer in women who have ever used intramuscular medroxyprogesterone acetate. The relative risk was higher in the subgroup of women who had initiated therapy within the previous 5 years. Thus, an increased risk (approximately 2-fold) is associated with intramuscular medroxyprogesterone use in the first 5 years. A more recent U.S. study also found a statistically significant increase in breast cancer risk among recent users (defined as last use within the past five years) who used depo-medroxyprogesterone acetate for 12 months or longer.
Major:
Cerinta
The ethinyl estradiol in Cerinta has a major potential interaction with Breast Cancer.
When treated with an estrogen, patients with breast cancer and bone metastases may develop severe hypercalcemia, in which case the drug should be stopped and measures be taken to reduce serum calcium levels.
Cardiomyopathy
Moderate:
mobocertinib
Mobocertinib has a moderate potential interaction with Cardiomyopathy.
Mobocertinib can cause cardiac toxicity (including decreased ejection fraction, cardiomyopathy, and congestive heart failure) resulting in heart failure which can be fatal. Cardiac function (including assessment of left ventricular ejection fraction) should be monitored at baseline and during therapy. Therapy should be withheld, the dose should be reduced, or mobocertinib should be discontinued based on the severity of decreased ejection fraction or heart failure.
Cerebral Vascular Disorder
Major:
Cerinta
The ethinyl estradiol in Cerinta has a major potential interaction with Cerebral Vascular Disorder.
The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of metastatic breast or prostatic malignancy.
Moderate:
Cerinta
The levonorgestrel in Cerinta has a moderate potential interaction with Cerebral Vascular Disorder.
The use of levonorgestrel requires careful assessment and caution in conditions of arterial disease, including stroke and myocardial infarction, and also, in patients with increased blood pressure and coagulopathies.
Depression
Moderate:
Cerinta
The ethinyl estradiol and levonorgestrel in Cerinta both have a moderate potential interaction with Depression.
The use of oral contraceptives has been associated with an increased incidence of depression. It is uncertain whether this effect is related to the estrogenic or the progestogenic component of the contraceptive, although excess progesterone activity is associated with depression. Patients with a history of depression receiving estrogen and/or progestogen therapy should be followed closely. The manufacturer of medroxyprogesterone recommends monitoring patients who have a history of depression and to not re- administer medroxyprogesterone if depression recurs.
Diabetes Mellitus
Moderate:
Cerinta
The ethinyl estradiol and levonorgestrel in Cerinta both have a moderate potential interaction with Diabetes Mellitus.
Impaired glucose tolerance has been observed in some patients administered oral contraceptives and appears to be related primarily to the estrogen dose. However, progestogens can increase insulin secretion and produce insulin resistance to varying degrees, depending on the agent. Caution and close monitoring are recommended in patients with diabetes mellitus during therapy with estrogens and/or progestogens, and adjustments made accordingly in their antidiabetic regimen.
Electrolyte Abnormalities
Major:
mobocertinib
Mobocertinib has a major potential interaction with Electrolyte Abnormalities.
Mobocertinib can cause life-threatening QTc prolongation, including torsades de pointes, which can be fatal, and requires monitoring of QTc and electrolytes. QTc and electrolytes should be assessed at baseline and abnormalities in sodium, potassium, calcium, and magnesium should be corrected before starting mobocertinib. QTc and electrolytes should be monitored periodically during therapy. Monitoring frequency should be increased in patients with risk factors for QTc prolongation (such as patients with congenital long QT syndrome, heart disease, or electrolyte abnormalities); caution is recommended in these patients. Therapy should be withheld, the dose should be reduced, or mobocertinib should be discontinued based on the severity of QTc prolongation.
Fluid Retention
Moderate:
Cerinta
The ethinyl estradiol and levonorgestrel in Cerinta both have a moderate potential interaction with Fluid Retention.
Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.
Gallbladder Disease
Moderate:
Cerinta
The ethinyl estradiol in Cerinta has a moderate potential interaction with Gallbladder Disease.
A two- to four-fold increase in risk of gallbladder disease has been noted in women receiving postmenopausal estrogen therapy. The risk for gallbladder disease may be less for premenopausal women using oral contraceptives containing low-dose estrogens and/or progestins. Therapy with estrogens should be administered cautiously in patients with preexisting gallbladder disease or a history of pregnancy-related cholestasis.
Heart Disease
Major:
mobocertinib
Mobocertinib has a major potential interaction with Heart Disease.
Mobocertinib can cause life-threatening QTc prolongation, including torsades de pointes, which can be fatal, and requires monitoring of QTc and electrolytes. QTc and electrolytes should be assessed at baseline and abnormalities in sodium, potassium, calcium, and magnesium should be corrected before starting mobocertinib. QTc and electrolytes should be monitored periodically during therapy. Monitoring frequency should be increased in patients with risk factors for QTc prolongation (such as patients with congenital long QT syndrome, heart disease, or electrolyte abnormalities); caution is recommended in these patients. Therapy should be withheld, the dose should be reduced, or mobocertinib should be discontinued based on the severity of QTc prolongation.
Heart Failure
Moderate:
Cerinta
The ethinyl estradiol and levonorgestrel in Cerinta both have a moderate potential interaction with Heart Failure.
Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.
Moderate:
mobocertinib
Mobocertinib has a moderate potential interaction with Heart Failure.
Mobocertinib can cause cardiac toxicity (including decreased ejection fraction, cardiomyopathy, and congestive heart failure) resulting in heart failure which can be fatal. Cardiac function (including assessment of left ventricular ejection fraction) should be monitored at baseline and during therapy. Therapy should be withheld, the dose should be reduced, or mobocertinib should be discontinued based on the severity of decreased ejection fraction or heart failure.
Hepatic Tumor
Major:
Cerinta
The ethinyl estradiol and levonorgestrel in Cerinta both have a major potential interaction with Hepatic Tumor.
The use of oral contraceptives is contraindicated in patients with liver tumors. An increased risk of benign hepatic adenomas and hepatocellular carcinomas has been associated with long-term, oral estrogen- progestin contraceptive use of at least 4 years and 8 years, respectively. Although these tumors are rare and have not been reported with other types of estrogen or progestogen therapies, any preparation containing estrogens and/or progestogens should probably be avoided in patients with existing tumors of the liver. Hepatic hemangiomas and nodular hyperplasia of the liver have been reported with isolated estrogen therapy.
High Blood Pressure
Major:
Cerinta
The ethinyl estradiol in Cerinta has a major potential interaction with High Blood Pressure.
The risk of myocardial infarction and strokes, including those associated with oral contraceptive use and some estrogen use, is increased in patients with hypertension. Moreover, estrogens (and progestogens) may elevate blood pressure and worsen the hypertension, thus compounding the risk. Clinically significant blood pressure increases have been reported during estrogen therapy, particularly in patients receiving high dosages or treated with oral contraceptive combinations having high progestational activity. These effects also increase with duration of therapy and patient age. Therapy with estrogens should be administered cautiously in patients with preexisting hypertension. Some estrogen-based therapies, such as combined hormonal contraceptives, may be contraindicated in patients with uncontrolled hypertension or hypertension with vascular disease. Patients should be monitored for changes in cardiovascular status, and their antihypertensive regimen adjusted or estrogen therapy withdrawn as necessary. In patients requiring contraception, alternative methods should be considered for those who are hypertensive, over age 35, and smoke.
Moderate:
Cerinta
The levonorgestrel in Cerinta has a moderate potential interaction with High Blood Pressure.
Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.
High Cholesterol
Moderate:
Cerinta
The levonorgestrel in Cerinta has a moderate potential interaction with High Cholesterol.
Some progestogenic agents may elevate plasma LDL levels and/or lower HDL levels, although data have been inconsistent. Patients with preexisting hyperlipidemia may require closer monitoring during progestogen therapy, and adjustments made accordingly in their lipid-lowering regimen.
Moderate:
Cerinta
The ethinyl estradiol in Cerinta has a moderate potential interaction with High Cholesterol.
Estrogens may cause adverse lipid changes. Use of estrogens has been associated with elevations in triglyceride levels, particularly in women with pre-existing hypertriglyceridemia. Discontinue therapy if elevated triglycerides lead to pancreatitis. Manage hypercholesterolemia appropriately as indicated.
History, Thrombotic/Thromboembolic Disorder
Major:
Cerinta
The ethinyl estradiol in Cerinta has a major potential interaction with History, Thrombotic/Thromboembolic Disorder.
The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of metastatic breast or prostatic malignancy.
Moderate:
Cerinta
The levonorgestrel in Cerinta has a moderate potential interaction with History, Thrombotic/Thromboembolic Disorder.
The use of levonorgestrel requires careful assessment and caution in conditions of arterial disease, including stroke and myocardial infarction, and also, in patients with increased blood pressure and coagulopathies.
Hypocalcemia
Major:
mobocertinib
Mobocertinib has a major potential interaction with Hypocalcemia.
Mobocertinib can cause life-threatening QTc prolongation, including torsades de pointes, which can be fatal, and requires monitoring of QTc and electrolytes. QTc and electrolytes should be assessed at baseline and abnormalities in sodium, potassium, calcium, and magnesium should be corrected before starting mobocertinib. QTc and electrolytes should be monitored periodically during therapy. Monitoring frequency should be increased in patients with risk factors for QTc prolongation (such as patients with congenital long QT syndrome, heart disease, or electrolyte abnormalities); caution is recommended in these patients. Therapy should be withheld, the dose should be reduced, or mobocertinib should be discontinued based on the severity of QTc prolongation.
Hypokalemia
Major:
mobocertinib
Mobocertinib has a major potential interaction with Hypokalemia.
Mobocertinib can cause life-threatening QTc prolongation, including torsades de pointes, which can be fatal, and requires monitoring of QTc and electrolytes. QTc and electrolytes should be assessed at baseline and abnormalities in sodium, potassium, calcium, and magnesium should be corrected before starting mobocertinib. QTc and electrolytes should be monitored periodically during therapy. Monitoring frequency should be increased in patients with risk factors for QTc prolongation (such as patients with congenital long QT syndrome, heart disease, or electrolyte abnormalities); caution is recommended in these patients. Therapy should be withheld, the dose should be reduced, or mobocertinib should be discontinued based on the severity of QTc prolongation.
Hyponatremia
Major:
mobocertinib
Mobocertinib has a major potential interaction with Hyponatremia.
Mobocertinib can cause life-threatening QTc prolongation, including torsades de pointes, which can be fatal, and requires monitoring of QTc and electrolytes. QTc and electrolytes should be assessed at baseline and abnormalities in sodium, potassium, calcium, and magnesium should be corrected before starting mobocertinib. QTc and electrolytes should be monitored periodically during therapy. Monitoring frequency should be increased in patients with risk factors for QTc prolongation (such as patients with congenital long QT syndrome, heart disease, or electrolyte abnormalities); caution is recommended in these patients. Therapy should be withheld, the dose should be reduced, or mobocertinib should be discontinued based on the severity of QTc prolongation.
Ischemic Heart Disease
Major:
Cerinta
The ethinyl estradiol in Cerinta has a major potential interaction with Ischemic Heart Disease.
The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of metastatic breast or prostatic malignancy.
Liver Disease
Major:
Cerinta
The levonorgestrel in Cerinta has a major potential interaction with Liver Disease.
The use of progestogens, in general, is contraindicated in patients with impaired hepatic function or liver disease. There are little or no data concerning the pharmacokinetic disposition of the different progestogens in patients with hepatic disease. However, most hormones, including progestational hormones, are known to be extensively metabolized by the liver. Medroxyprogesterone should not be used by women with significant liver disease and should be discontinued if jaundice or disturbances of liver function occur.
Moderate:
Cerinta
The ethinyl estradiol in Cerinta has a moderate potential interaction with Liver Disease.
Estrogens are primarily metabolized by the liver. Use of estrogen therapy is contraindicated in patients with liver dysfunction or disease. Patients with impaired hepatic function may be at increased risk for adverse effects associated with estrogen administration due to decreased drug clearance. Patients with hepatic hemangiomas are at increased risk of exacerbation with use of estrogens. Therapy with estrogens should be administered cautiously in patients with cholestatic jaundice associated with past estrogen use or with pregnancy. In addition, clinicians should be aware that estrogen therapy may affect liver function tests.
Moderate:
mobocertinib
Mobocertinib has a moderate potential interaction with Liver Disease.
No dosage adjustment of mobocertinib is recommended for patients with mild (total bilirubin up to the upper limit of normal [ULN] and AST greater than ULN or total bilirubin greater than 1 to 1.5 times ULN [1 to 1.5 x ULN] and any AST) or moderate (total bilirubin 1.5 to 3 x ULN and any AST) liver dysfunction. The recommended dosage of mobocertinib has not been established for patients with severe liver dysfunction (total bilirubin greater than 3 times ULN and any AST); caution is recommended in these patients.
Magnesium Imbalance
Major:
mobocertinib
Mobocertinib has a major potential interaction with Magnesium Imbalance.
Mobocertinib can cause life-threatening QTc prolongation, including torsades de pointes, which can be fatal, and requires monitoring of QTc and electrolytes. QTc and electrolytes should be assessed at baseline and abnormalities in sodium, potassium, calcium, and magnesium should be corrected before starting mobocertinib. QTc and electrolytes should be monitored periodically during therapy. Monitoring frequency should be increased in patients with risk factors for QTc prolongation (such as patients with congenital long QT syndrome, heart disease, or electrolyte abnormalities); caution is recommended in these patients. Therapy should be withheld, the dose should be reduced, or mobocertinib should be discontinued based on the severity of QTc prolongation.
Melasma
Moderate:
Cerinta
The ethinyl estradiol in Cerinta has a moderate potential interaction with Melasma.
The use of exogenous estrogens may occasionally cause chloasma, especially in women with a history of chloasma gravidarum. Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet radiation while taking combination oral contraceptives.
Migraine
Major:
Cerinta
The ethinyl estradiol in Cerinta has a major potential interaction with Migraine.
The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of metastatic breast or prostatic malignancy.
Moderate:
Cerinta
The ethinyl estradiol and levonorgestrel in Cerinta both have a moderate potential interaction with Migraine.
Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.
Neoplasia, Estrogen Dependent
Major:
Cerinta
The ethinyl estradiol in Cerinta has a major potential interaction with Neoplasia, Estrogen Dependent.
The use of estrogens is generally contraindicated in patients with known or suspected estrogen-dependent neoplasia such as breast and endometrial cancer, since it may stimulate tumor proliferation. High dosages of estrogens may be used for the palliative treatment of inoperable, metastatic breast cancer, but only in appropriately selected men and postmenopausal women.
Pancreatitis
Moderate:
Cerinta
The ethinyl estradiol in Cerinta has a moderate potential interaction with Pancreatitis.
Estrogens may cause adverse lipid changes. Use of estrogens has been associated with elevations in triglyceride levels, particularly in women with pre-existing hypertriglyceridemia. Discontinue therapy if elevated triglycerides lead to pancreatitis. Manage hypercholesterolemia appropriately as indicated.
Pulmonary Impairment
Moderate:
mobocertinib
Mobocertinib has a moderate potential interaction with Pulmonary Impairment.
Mobocertinib can cause interstitial lung disease (ILD)/pneumonitis, which can be fatal. Care should be exercised when using this drug in patients with preexisting pulmonary impairment. Mobocertinib should be immediately withheld in patients with suspected ILD/pneumonitis and permanently discontinued if ILD/pneumonitis is confirmed. Patients should be monitored for new/worsening pulmonary symptoms indicative of ILD/pneumonitis.
Renal Dysfunction
Moderate:
Cerinta
The ethinyl estradiol and levonorgestrel in Cerinta both have a moderate potential interaction with Renal Dysfunction.
Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.
Moderate:
mobocertinib
Mobocertinib has a moderate potential interaction with Renal Dysfunction.
No dosage adjustment of mobocertinib is recommended for patients with mild to moderate renal dysfunction (estimated glomerular filtration rate [eGFR] 30 to 89 mL/min/1.73 m2 by Modification of Diet in Renal Disease equation). The recommended dosage of mobocertinib has not been established for patients with severe renal dysfunction (eGFR less than 30 mL/min/1.73 m2); caution is recommended in these patients.
Seizures
Moderate:
Cerinta
The ethinyl estradiol and levonorgestrel in Cerinta both have a moderate potential interaction with Seizures.
Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.
Smoking
Major:
Cerinta
The ethinyl estradiol in Cerinta has a major potential interaction with Smoking.
Cigarette smoking increases the risk of serious cardiovascular events from estrogen-containing combination oral contraceptives (COC). This risk increases with age, particularly in females over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs are contraindicated in females who are over 35 years of age and smoke.
Thrombotic/Thromboembolic Disorder
Major:
Cerinta
The ethinyl estradiol in Cerinta has a major potential interaction with Thrombotic/Thromboembolic Disorder.
The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of metastatic breast or prostatic malignancy.
Moderate:
Cerinta
The levonorgestrel in Cerinta has a moderate potential interaction with Thrombotic/Thromboembolic Disorder.
The use of levonorgestrel requires careful assessment and caution in conditions of arterial disease, including stroke and myocardial infarction, and also, in patients with increased blood pressure and coagulopathies.
Thyroid Disease
Moderate:
Cerinta
The ethinyl estradiol and levonorgestrel in Cerinta both have a moderate potential interaction with Thyroid Disease.
When administering estrogen and/or progestogen therapy in patients with thyroid disorders, clinicians should be aware that these hormones may affect thyroid function tests. Patients on thyroid replacement therapy may require higher doses of thyroid hormone and appropriate monitoring. Changes have mostly been reported with the use of combination oral contraceptives. Specifically, thyroid-binding globulin (TBG) may be increased, resulting in elevated circulating total thyroid hormone, as measured by PBI (protein-bound iodine), T4 by column or radioimmunoassay, or T3 by radioimmunoassay. Free T3 resin uptake may be decreased. On the contrary, a decrease in TBG and, consequently, thyroxine concentration, has been reported by the manufacturers of the progestin-only (norethindrone) oral contraceptives.
Weight Loss
Minor:
Cerinta
The levonorgestrel in Cerinta has a minor potential interaction with Weight Loss.
Progestogens can cause weight gain, which may be significant (as is the case with parenteral medroxyprogesterone) and undesirable in obese patients attempting to lose weight.
More resources
Cerinta
A total of 533 drugs are known to interact with Cerinta.
- Cerinta is in the drug class contraceptives.
- Cerinta is used to treat Birth Control.
mobocertinib
A total of 580 drugs are known to interact with mobocertinib.
- Mobocertinib is in the drug class EGFR inhibitors.
- Mobocertinib is used to treat Non Small Cell Lung Cancer.
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.