Drug Interactions between Dalalone DP and Istodax

GENERALLY AVOID: Coadministration with potent inducers of CYP450 3A4 may increase the plasma concentrations of romidepsin. The exact mechanism of interaction has not been established, particularly since romidepsin is a substrate of CYP450 3A4, and induction of the isoenzyme would be expected to reduce its plasma concentration. In patients with advanced cancer, administration of romidepsin 14 mg/m2 (4-hour infusion) with the potent CYP450 3A4 inducer, rifampin, unexpectedly increased romidepsin peak plasma concentration (Cmax) and systemic exposure (AUC) by 60% and 80%, respectively, compared to romidepsin administered alone. In addition, rifampin decreased romidepsin clearance by 44% and volume of distribution by 52%. It is not known if other potent CYP450 3A4 inducers would alter the pharmacokinetics of romidepsin in the same manner.

MANAGEMENT: The use of romidepsin in combination with potent CYP450 3A4 inducers such as carbamazepine, dexamethasone, enzalutamide, phenobarbital, phenytoin, rifamycins, and St. John's wort should generally be avoided if possible. Alternative treatment lacking CYP450 3A4-inducing activity should be considered in patients receiving romidepsin. If concomitant use is required, patients should be closely monitored for development of hematologic toxicities such as anemia, leukopenia, and thrombocytopenia as well as electrocardiographic changes such as QT interval prolongation and T-wave and ST-segment changes.

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