Drug Interactions between echinacea and Trikafta

Ivacaftor should be taken with fat-containing foods such as eggs, avocados, nuts, meat, butter, peanut butter, cheese pizza, and whole-milk dairy products to help with its absorption. Do not consume grapefruit juice or any food that contains grapefruit or Seville oranges during treatment with ivacaftor unless directed otherwise by your doctor. Grapefruit juice can significantly increase the blood levels of ivacaftor. This may increase the risk and/or severity of serious side effects such as liver damage. Call your doctor immediately if you have fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark urine, pale stools, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Do not consume grapefruit juice or any food that contains grapefruit during treatment with tezacaftor. Grapefruit juice may significantly increase the blood levels of tezacaftor. This may increase the risk and/or severity of serious side effects such as liver damage. Call your doctor immediately if you have fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark urine, pale stools, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. Tezacaftor should be taken whole, at approximately the same time of the day, with fat-containing foods such as eggs, avocados, nuts, meat, butter, peanut butter, cheese pizza, and whole-milk dairy products to help with its absorption. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Elexacaftor (available only in combination with ivacaftor and tezacaftor) should not be used in patients with severe hepatic impairment and its use in patients with moderate hepatic impairment should be limited to those patients for which there is a clear medical need and the benefit exceeds the risks. If elexacaftor is used in patients with moderate hepatic impairment, the dose should be reduced and liver function tests should be closely monitored.

Elexacaftor (available only in combination with ivacaftor and tezacaftor) should not be used in patients with severe hepatic impairment and its use in patients with moderate hepatic impairment should be limited to those patients for which there is a clear medical need and the benefit exceeds the risks. If elexacaftor is used in patients with moderate hepatic impairment, the dose should be reduced and liver function tests should be closely monitored.

Cases of non-congenital lens opacities or cataracts have been reported in pediatric patients treated with products containing ivacaftor. Although other risk factors could be present in some cases (e.g., corticosteroid use or exposure to radiation), a possible risk attributable to this medication cannot be excluded. Baseline and ophthalmological examinations are recommended in pediatric patients initiating treatment

Cases of non-congenital lens opacities or cataracts have been reported in pediatric patients treated with products containing ivacaftor. Although other risk factors could be present in some cases (e.g., corticosteroid use or exposure to radiation), a possible risk attributable to this medication cannot be excluded. Baseline and ophthalmological examinations are recommended in pediatric patients initiating treatment

The use of products containing ivacaftor is associated with an increase in blood pressure. Close monitoring of blood pressure is recommended periodically in all patients, in particular in hypertensive patients.

There are no data on the use of ivacaftor in patients with severe liver dysfunction. Ivacaftor should not be used in patients less than 6 months of age with any level of hepatic impairment. Caution is recommended if using products containing ivacaftor in cystic fibrosis (CF) patients with advanced liver disease. Use of ivacaftor in these patients has been associated with worsening of liver function, including hepatic encephalopathy. In CF patients with pre-existing cirrhosis with portal hypertension, liver function decompensation, including liver failure leading to death, has been reported. Closely monitor patients as recommended by the manufacturer after initiating treatment, especially in those with liver disease or a history of transaminase/bilirubin elevations.

The use of products containing ivacaftor has not been studied in patients with cystic fibrosis who have undergone organ transplantation. Use in transplanted patients is not recommended due to potential drug-drug interactions with immunosuppressants.

The use of products containing ivacaftor is associated with respiratory events (e.g., chest discomfort, dyspnea, and respiration abnormal). Close monitoring is recommended in patients with advanced lung disease (percent predicted FEV1 less than 40).

Ivacaftor has not been studied in patients with renal impairment. No dose adjustment is necessary for patients with mild or moderate renal impairment, however, caution is recommended in patients with severe renal impairment or end-stage renal disease.

Elexacaftor (available only in combination with ivacaftor and tezacaftor), has not been studied in patients with severe renal impairment or end-stage renal disease. No dosage adjustment is recommended in patients with mild (eGFR 60 to <90 mL/min/1.73 m2) or moderate (eGFR 30 to <60 mL/min/1.73 m2) renal impairment. Use with caution in patients with severe (eGFR <30 mL/min/1.73 m2) renal impairment or end-stage renal disease.

Elexacaftor (available only in combination with ivacaftor and tezacaftor), has not been studied in patients with severe renal impairment or end-stage renal disease. No dosage adjustment is recommended in patients with mild (eGFR 60 to <90 mL/min/1.73 m2) or moderate (eGFR 30 to <60 mL/min/1.73 m2) renal impairment. Use with caution in patients with severe (eGFR <30 mL/min/1.73 m2) renal impairment or end-stage renal disease.