Drug Interactions between dexamethasone and nilotinib

GENERALLY AVOID: Coadministration with potent inducers of CYP450 3A4 may significantly decrease the plasma concentrations of nilotinib, which is primarily metabolised by the isoenzyme. In healthy subjects receiving the potent inducer rifampin (600 mg once daily for 12 days), nilotinib systemic exposure (AUC) was decreased approximately 80%. Data are not available for nilotinib in combination with other, less potent CYP450 3A4 inducers. In addition, when two or more medications with similar adverse effect profiles are given concurrently, the likelihood of experiencing these adverse reactions may be increased. For example, coadministration with other agents that can prolong the QT interval (e.g., apalutamide, encorafenib, enzalutamide) may result in additive effects and an increased risk of ventricular arrhythmias like torsade de pointes.

MANAGEMENT: Concomitant use of nilotinib with potent CYP450 3A4 inducers should generally be avoided due to the potential for reduced efficacy. If coadministration is required, a dosage increase for nilotinib may be necessary depending on patient tolerability. The dosage should be reduced to the indicated dosage following discontinuation of the potent CYP450 3A4 inducer. If the CYP450 3A4 inducer also carries a risk of prolonging the QT interval, then obtaining more frequent electrocardiograms (ECGs) to monitor the QT interval may be advisable. Patients should be counseled to seek immediate medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, syncope, palpitations, irregular heartbeat, and/or shortness of breath.