Interactions between Darolutamide and Promacta Kit
1 drug interaction and 10 additional warnings found for the following 2 drugs:
- darolutamide
- Promacta Kit (eltrombopag)
Drug interactions
Moderate drug interactions
Moderate:
eltrombopag darolutamide
Applies to: Promacta Kit (eltrombopag) and darolutamide
Generally avoid
Coadministration with darolutamide may increase the plasma concentrations of drugs that are substrates of the breast cancer resistance protein (BCRP) transporter. The proposed mechanism is decreased clearance due to inhibition of BCRP-mediated intestinal and hepatobiliary efflux by darolutamide. When rosuvastatin, a known BCRP substrate, was administered concomitantly with darolutamide, mean rosuvastatin peak plasma concentration (Cmax) and systemic exposure (AUC) increased by approximately 5-fold.
Management
Concomitant use of darolutamide with drugs that are BCRP substrates should be avoided when possible. If coadministration is required, patients should be monitored carefully for increased adverse reactions of these drugs and dosing adjusted as necessary.
References (1)
- (2019) "Product Information. Nubeqa (darolutamide)." Bayer HealthCare Pharmaceuticals Inc.
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
eltrombopag Food/Lifestyle
Applies to: Promacta Kit (eltrombopag)
Adjust dosing interval
High-calcium foods may reduce the oral bioavailability of eltrombopag. In healthy volunteers, a standard high-fat breakfast that included dairy products significantly decreased eltrombopag peak plasma concentration (Cmax) by 65% and systemic exposure (AUC) by 59% and delayed Tmax by one hour. In another study, adult subjects administered a single 25 mg dose of eltrombopag for oral suspension with a high-calcium, moderate-fat, moderate-calorie meal exhibited a 79% decrease in Cmax and 75% decrease in AUC of eltrombopag. Administration of eltrombopag 2 hours after the high-calcium meal decreased eltrombopag Cmax by 48% and AUC by 47%, while administration 2 hours before the high-calcium meal decreased eltrombopag Cmax by 14% and AUC by 20%. Food low in calcium (< 50 mg calcium), regardless of calorie content, did not significantly impact plasma eltrombopag exposure.
Management
Eltrombopag should be taken 2 hours before or 4 hours after a meal containing high-calcium foods. Eltrombopag can be taken with a meal low in calcium (< 50 mg).
References (4)
- (2025) "Product Information. Promacta (eltrombopag)." Novartis Pharmaceuticals, FDA 41 (tablet); FDA
- (2022) "Product Information. Apo-Eltrombopag (eltrombopag)." Apotex Inc
- (2023) "Product Information. Revolade (eltrombopag)." Novartis Pharmaceuticals UK Ltd
- (2024) "Product Information. Revolade (eltrombopag)." Novartis Pharmaceuticals Australia Pty Ltd
Moderate:
darolutamide Food/Lifestyle
Applies to: darolutamide
Adjust dosing interval
Food enhances the oral absorption of darolutamide. According to the prescribing information, bioavailability of darolutamide increased by 2.0 to 2.5-fold when administered with food. A similar increase in exposure was observed for the active metabolite keto-darolutamide.
Management
Darolutamide should be administered with food.
References (1)
- (2019) "Product Information. Nubeqa (darolutamide)." Bayer HealthCare Pharmaceuticals Inc.
Disease interactions
8 potential interactions Applies to: 7 conditions, including Cataract, Thrombotic/Thromboembolic Disorder, Liver Disease, Renal Dysfunction, and History, Thrombotic/Thromboembolic Disorder.
Cataract
Moderate:
Promacta Kit
The eltrombopag in Promacta Kit has a moderate potential interaction with Cataract.
In clinical trials, eltrombopag developed or worsened cataracts in 7% of the patients receiving treatment. A baseline ocular examination prior to administration of eltrombopag is recommended, and regular monitoring for signs and symptoms of cataracts should be performed regularly during treatment.
History, Thrombotic/Thromboembolic Disorder
Moderate:
Promacta Kit
The eltrombopag in Promacta Kit has a moderate potential interaction with History, Thrombotic/Thromboembolic Disorder.
Thromboembolic complications may result from increases in platelet counts with TPO receptor agonists such as avatrombopag, lusutrombopag, and eltrombopag. Consider the potential for increased risk of thromboembolism when administering these medications to patients with known risk factors for thromboembolism, including genetic prothrombotic conditions (Factor V Leiden, Prothrombin 20210 A, Antithrombin deficiency or Protein C or S deficiency).
Infectious Hepatitis
Major:
Promacta Kit
The eltrombopag in Promacta Kit has a major potential interaction with Infectious Hepatitis.
Eltrombopag has shown to increase the risk of hepatic decompensation in patients with chronic hepatitis C in treatment with interferon and ribavirin. Clinical trials reported that ascites and encephalopathy occurred more frequently on these patients than in the placebo arm. Patients with chronic hepatitis and receiving antiviral treatment should be closely monitored. The manufacturers also recommend to discontinue eltrombopag if the antiviral therapy is discontinued.
Liver Disease
Major:
Promacta Kit
The eltrombopag in Promacta Kit has a major potential interaction with Liver Disease.
Eltrombopag can cause liver enzyme elevations. Monitor ALT, AST and bilirubin prior to treatment initiation, and every 2 weeks during dose adjustment phase and then monthly. If abnormalities are confirmed, monitor serum liver tests weekly until resolved or stabilized. Treatment should be discontinued if ALT levels increase to greater than or equal to 3 x ULN in patients with normal liver function, or greater or equal to 3 x baseline in patients with pretreatment transaminase elevations that are progressively increasing, persist for 4 weeks or more, also have an increase in bilirubin, or also have clinical symptoms of liver injury or hepatic decompensation.
Hepatic impairment influences the exposure to eltrombopag. The initial dose should be reduced in patients with chronic ITP or severe aplastic anemia who have hepatic impairment. No dose adjustment is required on patients with chronic hepatitis C and hepatic impairment.
Moderate:
darolutamide
Darolutamide has a moderate potential interaction with Liver Disease.
Patients with moderate hepatic impairment (Child-Pugh Class B) have a higher exposure to darolutamide and reduction of the dose is recommended (see manufacturer package insert for recommended dose). No dose reduction is needed for patients with mild hepatic impairment. The effect of severe hepatic impairment (Child-Pugh C) on darolutamide pharmacokinetics is unknown.
Protein C Deficiency
Moderate:
Promacta Kit
The eltrombopag in Promacta Kit has a moderate potential interaction with Protein C Deficiency.
Thromboembolic complications may result from increases in platelet counts with TPO receptor agonists such as avatrombopag, lusutrombopag, and eltrombopag. Consider the potential for increased risk of thromboembolism when administering these medications to patients with known risk factors for thromboembolism, including genetic prothrombotic conditions (Factor V Leiden, Prothrombin 20210 A, Antithrombin deficiency or Protein C or S deficiency).
Renal Dysfunction
Moderate:
darolutamide
Darolutamide has a moderate potential interaction with Renal Dysfunction.
Patients with severe renal impairment (eGFR 15-29 mL/min/1.73 m2) who are not receiving hemodialysis have a higher exposure to darolutamide and reduction of the dose is recommended (see manufacturer package insert for recommended dose). No dose reduction is needed for patients with mild or moderate renal impairment. The effect of end stage renal disease (eGFR <15 mL/min/1.73 m2) on darolutamide pharmacokinetics is unknown.
Thrombotic/Thromboembolic Disorder
Moderate:
Promacta Kit
The eltrombopag in Promacta Kit has a moderate potential interaction with Thrombotic/Thromboembolic Disorder.
Thromboembolic complications may result from increases in platelet counts with TPO receptor agonists such as avatrombopag, lusutrombopag, and eltrombopag. Consider the potential for increased risk of thromboembolism when administering these medications to patients with known risk factors for thromboembolism, including genetic prothrombotic conditions (Factor V Leiden, Prothrombin 20210 A, Antithrombin deficiency or Protein C or S deficiency).
More resources
darolutamide
A total of 340 drugs are known to interact with darolutamide.
- Darolutamide is in the following drug classes: antiandrogens, hormones/antineoplastics.
- Darolutamide is used to treat Prostate Cancer.
Promacta Kit
A total of 218 drugs are known to interact with Promacta Kit.
- Promacta kit is in the drug class platelet-stimulating agents.
- Promacta kit is used to treat the following conditions:
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.