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Drug Interactions between ceritinib and Chirocaine

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

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Interactions between your drugs

Moderate

levobupivacaine ceritinib

Applies to: Chirocaine (levobupivacaine) and ceritinib

MONITOR: Coadministration with inhibitors of CYP450 1A2 and/or 3A4 may increase the plasma concentrations of levobupivacaine, which is primarily metabolized by these isoenzymes. Although no clinical studies have been conducted, the possibility of prolonged and/or increased pharmacologic effects of levobupivacaine should be considered.

MANAGEMENT: Caution may be advisable if levobupivacaine is administered to patients receiving inhibitors of CYP450 1A2 (e.g., quinolones, deferasirox, mexiletine, propafenone, ticlopidine, zileuton) or CYP450 3A4 (e.g., azole antifungals, macrolide antibiotics, protease inhibitors, kinase inhibitors, aprepitant, conivaptan, cyclosporine, delavirdine, diltiazem, nefazodone, verapamil). Particular caution and dosage adjustment of levobupivacaine may be warranted during concomitant use of both a CYP450 1A2 inhibitor and a CYP450 3A4 inhibitor, or a drug that inhibits both isoenzymes (e.g., fluvoxamine). Patients should be monitored for early signs and symptoms of central nervous system toxicity such as dizziness, drowsiness, lightheadedness, anxiety, restlessness, incoherent speech, tremors, twitching, numbness and tingling of the mouth and lips, metallic taste, tinnitus, and blurred vision, as well as more serious reactions including convulsions, hypotension, arrhythmias, and cardiorespiratory depression.

References (2)
  1. (2001) "Product Information. Chirocaine (levobupivacaine)." Organon
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."

Drug and food interactions

Major

ceritinib food

Applies to: ceritinib

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of ceritinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because ceritinib is associated with concentration-dependent prolongation of the QT interval, increased levels may potentiate the risk of ventricular arrhythmias such as torsade de pointes and sudden death. Other, more common side effects such as diarrhea, nausea, vomiting, abdominal pain, hyperglycemia, and bradycardia may also increase.

ADJUST DOSING INTERVAL: Food increases the oral bioavailability of ceritinib. The mechanism of interaction is unknown. Compared to the fast state, administration of a single 500 mg dose of ceritinib with a high-fat meal (approximately 1000 calories; 58 grams of fat) increased ceritinib peak plasma concentration (Cmax) and systemic exposure (AUC) by 41% and 73%, respectively, and administration with a low-fat meal (approximately 330 calories; 9 grams of fat) increased ceritinib Cmax and AUC by 43% and 58%, respectively. A dose of 600 mg or higher taken with a meal is expected to produce systemic exposure exceeding that from a 750 mg dose taken in the fasted state, which may lead to increased adverse effects.

MANAGEMENT: Patients treated with ceritinib should avoid consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract. Ceritinib should be administered on an empty stomach (i.e., avoid administration within 2 hours of a meal).

References (1)
  1. (2014) "Product Information. Zykadia (ceritinib)." Novartis Pharmaceuticals

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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