Drug Interactions between cinacalcet and Farxiga

Food can enhance the levels of cinacalcet in your body. Cinacalcet should be taken just after eating food. Do not take it on an empty stomach. This will make it easier for your body to absorb the medication. Do not crush, chew, or break the tablets. Swallow them whole.

Alcohol may affect blood glucose levels in patients with diabetes. Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) may occur, depending on how much and how often you drink. You should avoid using alcohol if your diabetes is not well controlled or if you have high triglycerides, neuropathy (nerve damage), or pancreatitis. Moderate alcohol consumption generally does not affect blood glucose levels if your diabetes is under control. However, it may be best to limit alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with your normal meal plan. Avoid drinking alcohol on an empty stomach or following exercise, as it may increase the risk of hypoglycemia. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors ertugliflozin and canagliflozin are not recommended for use in patients with severe hepatic impairment due to lack of clinical data. Sotagliflozin is not recommended for use in patients with moderate to severe hepatic impairment. Dapagliflozin has not been studied in patients with severe hepatic impairment and caution is recommended. The manufacturer's product labeling should be consulted for specific dosing of SGLT2 inhibitors in patients with hepatic impairment.

The glucose lowering effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors are decreased in patients with worsening renal function. Additionally, patients with impaired renal function (estimated GFR less than 60 mL/min/1.73 m2), older adult patients, and patients on loop diuretics may be more likely to experience adverse reactions related to volume depletion such as hypotension and acute kidney injury during therapy. Renal function should be evaluated prior to treatment initiation and monitored regularly in at-risk patients. Volume status should be assessed and volume depletion corrected before initiating therapy. The use of SGLT2 inhibitors in patients undergoing dialysis is either contraindicated or not recommended. The manufacturer product information should be consulted for contraindications and indication specific renal dosing.

Postmarketing safety surveillance studies have reported cases of hypotension, worsening heart failure and/or arrhythmias in patients with impaired cardiac function receiving cinacalcet. A causal relationship could not been excluded and this may be mediated by reductions in serum calcium. Cinacalcet should be used with caution in patients with hypotension or preexisting impaired cardiac function.

Cinacalcet lowers serum calcium, and therefore patients should be carefully monitored for the occurrence of hypocalcemia. Potential manifestations of hypocalcemia include paresthesias, myalgias, cramping, tetany, and convulsions. Cinacalcet treatment should not be initiated if serum calcium is less than the lower limit of the normal range (8.4 mg/dL). Monitor serum calcium 1 week after treatment initiation or dose adjustment, and once every month once the maintenance dose has been established.

Postmarketing safety surveillance studies have reported cases of hypotension, worsening heart failure and/or arrhythmias in patients with impaired cardiac function receiving cinacalcet. A causal relationship could not been excluded and this may be mediated by reductions in serum calcium. Cinacalcet should be used with caution in patients with hypotension or preexisting impaired cardiac function.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors cause intravascular volume contraction which may lead to symptomatic hypotension after treatment initiation, especially in older adult patients, patients with impaired renal function, patients with low systolic blood pressure, or those using diuretics. Volume status should be assessed and corrected before starting treatment and patients should be monitored during therapy.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors increase the risk of genital mycotic infections. Care should be exercised when using an SGLT2 inhibitor in patients who have a history of chronic or recurrent genital mycotic infections or who are uncircumcised as these patients are more likely to develop genital mycotic infections. Patients should be monitored and treated appropriately.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors cause intravascular volume contraction which may lead to symptomatic hypotension after treatment initiation, especially in older adult patients, patients with impaired renal function, patients with low systolic blood pressure, or those using diuretics. Volume status should be assessed and corrected before starting treatment and patients should be monitored during therapy.

Cinacalcet may lower seizure threshold in patients with a history of seizures. Serum calcium levels should be closely monitored in patients receiving cinacalcet, particularly in patients with history of seizure disorders.