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Interactions between Fostemsavir and Jadenu Sprinkle

1 drug interaction and 12 additional warnings found for the following 2 drugs:

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Drug interactions

Minor drug interactions

Minor:

deferasirox fostemsavir

Applies to: Jadenu Sprinkle (deferasirox) and fostemsavir

Coadministration of fostemsavir with moderate or weak CYP450 3A4 inducers may decrease the plasma concentrations of temsavir, the active moiety of fostemsavir. According to the prescribing information, temsavir is a substrate of CYP450 3A4, esterases, P-glycoprotein (P-gp), and breast cancer resistance protein (BCRP). When fostemsavir (600 mg twice daily) was coadministered with the moderate CYP450 3A4 inducer etravirine (200 mg twice daily) in 14 study subjects, mean temsavir peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Ctau) decreased by 48%, 50% and 52%, respectively, compared to fostemsavir administered alone. When the same dosage of fostemsavir was given to 22 study subjects with another moderate CYP450 3A4 inducer, rifabutin (300 mg once daily), mean temsavir Cmax, AUC and Ctau decreased by 27%, 30% and 41%, respectively. These changes are not considered clinically relevant, and no dosage adjustment of fostemsavir is recommended when coadministered with moderate or weak CYP450 3A4 inducers.

References (3)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. (2020) "Product Information. Rukobia (fostemsavir)." ViiV Healthcare

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

deferasirox Food/Lifestyle

Applies to: Jadenu Sprinkle (deferasirox)
Adjust dosing interval

According to product labeling, the bioavailability of deferasirox was variably increased when taken with a meal.

Management

To ensure consistent plasma drug levels, deferasirox should be taken on an empty stomach 30 minutes before eating preferably at the same time everyday.

References (1)
  1. (2005) "Product Information. Exjade (deferasirox)." Novartis Pharmaceuticals

Disease interactions

11 potential interactions Applies to: 10 conditions, including Heart Disease, Hearing Loss, Liver Disease, Thrombocytopenia, and Immunodeficiency.

Dermatitis, Drug-Induced

Major:

Jadenu Sprinkle

The deferasirox in Jadenu Sprinkle has a major potential interaction with Dermatitis, Drug-Induced.

Fatal cases of severe cutaneous reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and erythema multiforme have occurred in patients treated with deferasirox. The risk of other skin reactions cannot be excluded. It is recommended that if SJS or TEN is suspected to interrupt therapy until the etiology of the reaction has been determined, and if SJS or TEN is confirmed to permanently discontinue treatment with deferasirox. Monitor patients for the development of these severe cutaneous reactions, discontinue deferasirox if clinically appropriate and do not reintroduce therapy. For severe cases of rash, interrupt treatment and consider reintroducing therapy after resolution of the rash at a lower dose with dose escalation as appropriate.

Esophageal Ulceration with Bleeding

Moderate:

Jadenu Sprinkle

The deferasirox in Jadenu Sprinkle has a moderate potential interaction with Esophageal Ulceration with Bleeding.

Gastrointestinal hemorrhage, ulcerations, perforations, including deaths have been documented in patients using deferasirox, especially in elderly patients who had advanced hematologic malignancies and/or low platelet counts. The risk of gastrointestinal hemorrhage may be increased when administering deferasirox in combination with drugs that have ulcerogenic or hemorrhagic potential, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, oral bisphosphonates, or anticoagulants. It is recommended to monitor patients and discontinue therapy for suspected GI ulceration or hemorrhage. Care is recommended when using this agent in patients at risk of GI complications.

Hearing Loss

Moderate:

Jadenu Sprinkle

The deferasirox in Jadenu Sprinkle has a moderate potential interaction with Hearing Loss.

Auditory disturbances (high-frequency hearing loss, decreased hearing), and ocular disturbances (lens opacities, cataracts, elevations in intraocular pressure, and retinal disorders) have been reported in patients using deferasirox. It is recommended to perform auditory and ophthalmic testing (including slit lamp examinations and dilated fundoscopy) before starting therapy with deferasirox and thereafter as clinically indicated. If disturbances are noted, consider dose reduction or interruption if appropriate.

Heart Disease

Moderate:

fostemsavir

Fostemsavir has a moderate potential interaction with Heart Disease.

Fostemsavir has been shown to significantly prolong the QTc interval of the electrocardiogram with higher than recommended dosages. Fostemsavir should be used with caution in patients with a history of QTc interval prolongation, when co-administered with a drug with a known risk of Torsade de Pointes, or in patients with relevant preexisting cardiac disease.

Immunodeficiency

Major:

Jadenu Sprinkle

The deferasirox in Jadenu Sprinkle has a major potential interaction with Immunodeficiency.

The use of deferasirox is contraindicated in patients with platelet counts below 50 x 109/L. Cytopenias, worsening anemia, and thrombocytopenia, including fatal events, have been reported in patients treated with deferasirox. Preexisting hematologic disorders may increase this risk. It is recommended to monitor blood counts in all patients and to interrupt treatment in patients who develop cytopenias until the cause of the cytopenia has been determined.

Infectious Hepatitis

Moderate:

fostemsavir

Fostemsavir has a moderate potential interaction with Infectious Hepatitis.

Fostemsavir may cause elevations in hepatic transaminases in patients co-infected with hepatitis B or C. It is recommended to monitor liver function in patients with hepatitis B or C co-infection. Particular attention should be practiced in initiating or maintaining effective hepatitis B therapy when starting fostemsavir treatment in patients co-infected with hepatitis B.

Liver Disease

Major:

Jadenu Sprinkle

The deferasirox in Jadenu Sprinkle has a major potential interaction with Liver Disease.

The use of deferasirox should be avoided in patients with severe hepatic impairment. The starting dose of deferasirox should be reduced by 50% in patients with moderate hepatic impairment. It is recommended to measure serum transaminases and bilirubin in all patients prior to initiating treatment, every 2 weeks during the first month, and at least monthly or more frequently as clinically appropriate. Closely monitor patients with mild or moderate hepatic impairment for efficacy and adverse reactions that may require dose titration.

Renal Dysfunction

Major:

Jadenu Sprinkle

The deferasirox in Jadenu Sprinkle has a major potential interaction with Renal Dysfunction.

The use of deferasirox is contraindicated in patients with serum creatinine greater than two times the age-appropriate upper limit of normal or creatinine clearance less than 40 mL/min. The starting dose of deferasirox should be reduced by 50% in patients with creatine clearance 40 to 60 mL/min. It is recommended to measure serum creatine and calculate clearance in duplicate prior to initiating treatment in all patients and monitor renal function at least monthly or more frequently as clinically appropriate. Consider dose reduction, interruption, or discontinuation of deferasirox based on increases in serum creatinine.

Thrombocytopenia

Major:

Jadenu Sprinkle

The deferasirox in Jadenu Sprinkle has a major potential interaction with Thrombocytopenia.

The use of deferasirox is contraindicated in patients with platelet counts below 50 x 109/L. Cytopenias, worsening anemia, and thrombocytopenia, including fatal events, have been reported in patients treated with deferasirox. Preexisting hematologic disorders may increase this risk. It is recommended to monitor blood counts in all patients and to interrupt treatment in patients who develop cytopenias until the cause of the cytopenia has been determined.

Moderate:

Jadenu Sprinkle

The deferasirox in Jadenu Sprinkle has a moderate potential interaction with Thrombocytopenia.

Gastrointestinal hemorrhage, ulcerations, perforations, including deaths have been documented in patients using deferasirox, especially in elderly patients who had advanced hematologic malignancies and/or low platelet counts. The risk of gastrointestinal hemorrhage may be increased when administering deferasirox in combination with drugs that have ulcerogenic or hemorrhagic potential, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, oral bisphosphonates, or anticoagulants. It is recommended to monitor patients and discontinue therapy for suspected GI ulceration or hemorrhage. Care is recommended when using this agent in patients at risk of GI complications.

Visual Defect/Disturbance

Moderate:

Jadenu Sprinkle

The deferasirox in Jadenu Sprinkle has a moderate potential interaction with Visual Defect/Disturbance.

Auditory disturbances (high-frequency hearing loss, decreased hearing), and ocular disturbances (lens opacities, cataracts, elevations in intraocular pressure, and retinal disorders) have been reported in patients using deferasirox. It is recommended to perform auditory and ophthalmic testing (including slit lamp examinations and dilated fundoscopy) before starting therapy with deferasirox and thereafter as clinically indicated. If disturbances are noted, consider dose reduction or interruption if appropriate.

More resources

fostemsavir

A total of 392 drugs are known to interact with fostemsavir.

Jadenu Sprinkle

A total of 621 drugs are known to interact with Jadenu Sprinkle.

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.