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Drug Interactions between Dexamethasone Intensol and ibrutinib

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

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Interactions between your drugs

Moderate

dexAMETHasone ibrutinib

Applies to: Dexamethasone Intensol (dexamethasone) and ibrutinib

MONITOR: Coadministration with inducers of CYP450 3A4 may decrease the plasma concentrations of ibrutinib, which is primarily metabolized by the isoenzyme. Preliminary pharmacokinetic data from an ongoing dedicated drug interaction trial and simulations using physiologically based pharmacokinetic models indicate that rifampin, a potent CYP450 3A4 inducer, can decrease ibrutinib peak plasma concentration (Cmax) and systemic exposure (AUC) by more than 10-fold. Pharmacokinetic modeling also suggests that a moderate CYP450 3A4 inducer such as efavirenz may decrease the AUC of ibrutinib up to 3-fold.

MANAGEMENT: The potential for diminished therapeutic effects of ibrutinib should be considered when prescribed in combination with CYP450 3A4 inducers. Patients should be closely monitored, and the dosage of ibrutinib adjusted as necessary in accordance with product labeling.

References (1)
  1. (2013) "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc

Drug and food interactions

Major

ibrutinib food

Applies to: ibrutinib

GENERALLY AVOID: Coadministration with grapefruit, grapefruit juice, or Seville oranges may significantly increase the plasma concentrations of ibrutinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Pharmacokinetic modeling suggests that other moderate CYP450 3A4 inhibitors such as diltiazem and erythromycin may increase ibrutinib systemic exposure (AUC) by 6- to 9-fold under fasting condition. The safety and efficacy of these exposures are unknown. The highest ibrutinib dose evaluated in clinical trials was 12.5 mg/kg (actual doses of 840 to 1400 mg) given for 28 days, which yielded single dose AUC values that were approximately 50% greater than steady-state exposures seen at the highest indicated dose of 560 mg.

ADJUST DOSING INTERVAL: Food increases the oral bioavailability of ibrutinib. The mechanism of interaction is unknown. According to the product labeling, administration with food increases ibrutinib exposure approximately 2-fold compared to administration after overnight fasting.

MANAGEMENT: Patients treated with ibrutinib should avoid consumption of Seville oranges, grapefruit, grapefruit juice, and any supplement containing grapefruit extract. Ibrutinib should be taken once daily at approximately the same time each day.

References (2)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. (2013) "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc

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.

See also

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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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