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Drug Interactions between Cladribine Novaplus and ritonavir

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

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Interactions between your drugs

Moderate

cladribine ritonavir

Applies to: Cladribine Novaplus (cladribine) and ritonavir

GENERALLY AVOID: Oral bioavailability and systemic exposure of cladribine may be increased by potent inhibitors of breast cancer resistance protein (BCRP) while intracellular distribution and renal elimination of cladribine may be altered by potent inhibitors of equilibrative nucleoside transporter 1 (ENT1) and concentrative nucleoside transporter 3 (CNT3). The mechanism involves inhibition of ENT1, CNT3, and/or BCRP as cladribine is a substrate of each of these transporter systems. The clinical relevance remains unknown.

MANAGEMENT: Coadministration of potent ENT1, CNT3, or BCRP transporter inhibitors should be avoided during the 4 to 5-day oral cladribine treatment cycles. If coadministration is required, consider concomitant alternatives that exhibit no or minimal inhibition of ENT1, CNT3, or BCRP. If this is not possible, dose reduction to the minimum mandatory dose, separation in the timing of administration, and careful patient monitoring is recommended.

References

  1. (2001) "Product Information. Leustatin (cladribine)." Ortho Biotech Inc
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."

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Drug and food interactions

Moderate

cladribine food

Applies to: Cladribine Novaplus (cladribine)

ADJUST DOSING INTERVAL: Oral cladribine may increase the bioavailability of other drugs, which may increase the risk or severity of adverse reactions. Cladribine tablets may contain hydroxypropyl betadex, which could form a complex with the active ingredients of other drugs, especially agents with low solubility. The clinical relevance of this interaction remains unknown.

MANAGEMENT: Administration of oral cladribine should be separated from any other oral drug by at least 3 hours.

References

  1. (2001) "Product Information. Leustatin (cladribine)." Ortho Biotech Inc
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."

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Moderate

ritonavir food

Applies to: ritonavir

ADJUST DOSING INTERVAL: Administration with food may modestly affect the bioavailability of ritonavir from the various available formulations. When the oral solution was given under nonfasting conditions, peak ritonavir concentrations decreased 23% and the extent of absorption decreased 7% relative to fasting conditions. Dilution of the oral solution (within one hour of dosing) with 240 mL of chocolate milk or a nutritional supplement (Advera or Ensure) did not significantly affect the extent and rate of ritonavir absorption. When a single 100 mg dose of the tablet was administered with a high-fat meal (907 kcal; 52% fat, 15% protein, 33% carbohydrates), approximately 20% decreases in mean peak concentration (Cmax) and systemic exposure (AUC) were observed relative to administration after fasting. Similar decreases in Cmax and AUC were reported when the tablet was administered with a moderate-fat meal. In contrast, the extent of absorption of ritonavir from the soft gelatin capsule formulation was 13% higher when administered with a meal (615 KCal; 14.5% fat, 9% protein, and 76% carbohydrate) relative to fasting.

MANAGEMENT: Ritonavir should be taken with meals to enhance gastrointestinal tolerability.

References

  1. (2001) "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical

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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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