Interactions between Encorafenib and Espotabs
1 drug interaction and 12 additional warnings found for the following 2 drugs:
- encorafenib
- Espotabs (phenolphthalein)
Drug interactions
Moderate drug interactions
Moderate:
phenolphthalein encorafenib
Applies to: Espotabs (phenolphthalein) and encorafenib
Monitor
Bowel cleansing as well as overuse of certain laxatives may cause electrolyte loss and increase the risk of torsade de pointes ventricular arrhythmia in patients treated with drugs that prolong the QT interval. Electrolyte disturbances including hypokalemia and hypomagnesemia have been reported with laxative abuse and are known risk factors for torsade de pointes associated with QT interval prolongation.
Management
Patients treated with drugs that prolong the QT interval should exercise caution when self-medicating with laxatives. The recommended dosage and duration of use should not be exceeded. Patients treated with lactulose for more than six months should be monitored periodically for electrolyte imbalance. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.
References (4)
- Chin RL (1998) "Laxative-induced hypokalemia." Ann Emerg Med, 32, p. 517-8
- Muller-Lissner SA (1993) "Adverse effects of laxatives: fact and fiction." Pharmacology, 47, p. 138-45
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- Schaefer DC, Cheskin LJ (1998) "Constipation in the elderly." Am Fam Physician, 58, p. 907-14
Food/lifestyle interactions
Major food/lifestyle interactions
Major:
encorafenib Food/Lifestyle
Applies to: encorafenib
Generally avoid
Coadministration with potent or moderate inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of encorafenib, which is primarily metabolized by the isoenzyme. When a single 50 mg dose of encorafenib (equivalent to 0.1 times the recommended dose) was administered with posaconazole, a potent CYP450 3A4 inhibitor, encorafenib peak plasma concentration (Cmax) increased by 68% and systemic exposure (AUC) increased by 3-fold. When the same dose of encorafenib was administered with diltiazem, a moderate CYP450 3A4 inhibitor, encorafenib Cmax increased by 45% and AUC increased by 2-fold. Increased exposure to encorafenib may increase the risk of serious and life-threatening adverse effects such as hemorrhage, uveitis, QT prolongation, hepatotoxicity, dermatologic reactions, and new malignancies.
Management
Concomitant use of encorafenib with grapefruit or grapefruit juice should generally be avoided. If coadministration is required, the manufacturer recommends reducing the encorafenib dose to one-third of the dose used prior to addition of a potent CYP450 3A4 inhibitor or one-half of the dose used prior to addition of a moderate CYP450 3A4 inhibitor. After the inhibitor has been discontinued for 3 to 5 elimination half-lives, the encorafenib dose that was taken prior to initiating the inhibitor may be resumed.
References (1)
- (2018) "Product Information. Braftovi (encorafenib)." Array BioPharma Inc.
Moderate food/lifestyle interactions
Moderate:
phenolphthalein multivitamins with minerals
Applies to: Espotabs (phenolphthalein)
Generally avoid
Chronic use of stimulant laxatives may decrease the absorption of fat-soluble vitamins (A, D, E, and K) and minerals such as calcium, potentially leading to deficiencies. This effect is due to accelerated intestinal transit time, which reduces nutrient absorption.
Management
To minimize this risk, limit the use of stimulant laxatives to short-term or occasional use.
References (2)
- (2023) "Product Information. Domnisol (calcifediol)." Flynn Pharma Ltd
- Wakeman M (2021) "A Literature Review of the Potential Impact of Medication on Vitamin D Status" Risk Man Heal Pol, 14, p. 3357-3381
Disease interactions
10 potential interactions Applies to: 10 conditions, including Heart Failure, Hypokalemia, Inflammatory Bowel Disease, Cardiomyopathy, and Liver Disease.
Cardiomyopathy
Moderate:
encorafenib
Encorafenib has a moderate potential interaction with Cardiomyopathy.
Cardiomyopathy, manifesting as left ventricular dysfunction, has been reported with use of encorafenib in combination with binimetinib. The safety of encorafenib has not been established in patients with baseline ejection fraction below 50% or below the institutional lower limit of normal. Patients with cardiovascular risk factors should be closely monitored during therapy with encorafenib. Assess ejection fraction at baseline, 1 month after initiation, and every 2 to 3 months during therapy. Withhold, reduce dose, or permanently discontinue therapy based on severity of adverse cardiovascular effects.
Gastrointestinal Obstruction
Major:
Espotabs
The phenolphthalein in Espotabs has a major potential interaction with Gastrointestinal Obstruction.
The use of laxatives is contraindicated in patients with intestinal obstruction disorders. Patients with intestinal obstruction disorders may need their underlying condition treated to correct the constipation. Some laxatives require reduction in the colon to their active form to be effective which may be a problem in patients with intestinal obstruction.
Heart Failure
Moderate:
encorafenib
Encorafenib has a moderate potential interaction with Heart Failure.
Encorafenib is associated with dose-dependent QTc interval prolongation in some patients. Monitor patients who already have or who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, severe or uncontrolled heart failure and those taking other medicinal products associated with QT prolongation. Correct hypokalemia and hypomagnesemia prior to and during therapy with encorafenib. Withhold, reduce dose, or permanently discontinue for QTc > 500 ms.
Hypokalemia
Moderate:
encorafenib
Encorafenib has a moderate potential interaction with Hypokalemia.
Encorafenib is associated with dose-dependent QTc interval prolongation in some patients. Monitor patients who already have or who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, severe or uncontrolled heart failure and those taking other medicinal products associated with QT prolongation. Correct hypokalemia and hypomagnesemia prior to and during therapy with encorafenib. Withhold, reduce dose, or permanently discontinue for QTc > 500 ms.
Inflammatory Bowel Disease
Major:
Espotabs
The phenolphthalein in Espotabs has a major potential interaction with Inflammatory Bowel Disease.
The use of laxatives is contraindicated in patients with inflammatory bowel disease. Patients with inflammatory bowel disease may experience colonic perforation with use of stimulant laxatives.
Liver Disease
Moderate:
encorafenib
Encorafenib has a moderate potential interaction with Liver Disease.
A recommended dose of encorafenib has not been established for patients with moderate (Child-Pugh B) or severe (Child-Pugh C) hepatic impairment. Dose adjustment is not recommended in patients with mild hepatic impairment (Child-Pugh A).
Long QT Syndrome
Moderate:
encorafenib
Encorafenib has a moderate potential interaction with Long QT Syndrome.
Encorafenib is associated with dose-dependent QTc interval prolongation in some patients. Monitor patients who already have or who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, severe or uncontrolled heart failure and those taking other medicinal products associated with QT prolongation. Correct hypokalemia and hypomagnesemia prior to and during therapy with encorafenib. Withhold, reduce dose, or permanently discontinue for QTc > 500 ms.
Magnesium Imbalance
Moderate:
encorafenib
Encorafenib has a moderate potential interaction with Magnesium Imbalance.
Encorafenib is associated with dose-dependent QTc interval prolongation in some patients. Monitor patients who already have or who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, severe or uncontrolled heart failure and those taking other medicinal products associated with QT prolongation. Correct hypokalemia and hypomagnesemia prior to and during therapy with encorafenib. Withhold, reduce dose, or permanently discontinue for QTc > 500 ms.
Renal Dysfunction
Moderate:
encorafenib
Encorafenib has a moderate potential interaction with Renal Dysfunction.
A recommended dose of encorafenib has not been established for patients with severe renal impairment (CrCl < 30 mL/min). Caution and monitoring is advised if used on these patients. No dose adjustment is recommended for patients with mild to moderate renal impairment (CrCl 30 to < 90 mL/min).
Visual Defect/Disturbance
Moderate:
encorafenib
Encorafenib has a moderate potential interaction with Visual Defect/Disturbance.
Encorafenib, administered in combination with binimetinib, may cause uveitis, including iritis and iridocyclitis. Assess for visual symptoms at each visit and perform ophthalmologic evaluations at regular intervals, or as indicated, for new or worsening visual disturbances.
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encorafenib
A total of 664 drugs are known to interact with encorafenib.
- Encorafenib is in the drug class multikinase inhibitors.
- Encorafenib is used to treat the following conditions:
Espotabs
A total of 269 drugs are known to interact with Espotabs.
- Espotabs is in the drug class laxatives.
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
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