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Drug Interactions between isotretinoin and palovarotene

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

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Interactions between your drugs

Major

ISOtretinoin palovarotene

Applies to: isotretinoin and palovarotene

GENERALLY AVOID: Concomitant use of a retinoid with vitamin A or other retinoids may result in hypervitaminosis A and additive toxicities. Patients may be at increased risk for potentially serious adverse effects such as vision impairment, pseudotumor cerebri (benign intracranial hypertension), mucositis, esophagitis, hepatitis, hypertriglyceridemia, pancreatitis, ileitis, and colitis.

MANAGEMENT: Patients receiving retinoid therapy should avoid concurrent use of other retinoids or vitamin A supplements in excess of the recommended daily allowance. Patients should be made aware of vitamin A sources in vitamin supplements, fortified foods and over-the-counter medications, and be advised to contact their physician if they experience signs of hypervitaminosis A such as inflammation or bleeding of the gums or lips; dry, scaly skin; alopecia; pruritus; erythema; headache; vertigo; and nausea. Patients should discontinue the medication and seek immediate medical attention if they develop signs and symptoms of pseudotumour cerebri (e.g., headache, nausea, vomiting, visual disturbances, papilledema) or hepatotoxicity (e.g., fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, jaundice).

References

  1. (2001) "Product Information. Accutane (isotretinoin)." Roche Laboratories
  2. (2001) "Product Information. Soriatane (acitretin)." Roche Laboratories
  3. (2001) "Product Information. Vesanoid (tretinoin)." Roche Laboratories
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  5. Cerner Multum, Inc. "Australian Product Information."
View all 5 references

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Drug and food interactions

Major

palovarotene food

Applies to: palovarotene

GENERALLY AVOID: Grapefruit, pomelo, grapefruit hybrids, and juices or supplements containing these fruits may increase the plasma concentrations of palovarotene. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in these fruits. Inhibition of hepatic CYP450 3A4 may also contribute. The interaction has not been studied with these fruits. Concomitant use of erythromycin, a moderate CYP450 3A4 inhibitor, with palovarotene at steady-state plasma levels increased its peak plasma concentration (Cmax) and systemic exposure (AUC) by 1.6 and 2.5-fold, respectively. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Increased concentrations of palovarotene may increase the risk of adverse effects such as dry skin, dry lips, alopecia, pruritus, erythema, paronychia, cellulitis, decubitus ulcer, xerophthalmia, night blindness, depression, mood alterations, and pseudotumour cerebri (benign intracranial hypertension).

ADJUST DOSE: Food increases oral absorption of palovarotene.

MANAGEMENT: The manufacturer advises that concomitant use of palovarotene with grapefruit, pomelo, grapefruit hybrids and juices or supplements containing these fruits should be avoided. To ensure maximal absorption, palovarotene should be administered with food.

References

  1. (2022) "Product Information. Sohonos (palovarotene)." Ipsen Biopharmaceuticals Canada inc, 1
  2. (2023) "Product Information. Sohonos (palovarotene)." Ipsen Biopharmaceuticals, Inc

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Moderate

ISOtretinoin food

Applies to: isotretinoin

GENERALLY AVOID: The combined use of ethanol and isotretinoin may result in a disulfiram-like reaction. The mechanism has not been established.

MANAGEMENT: Alcohol consumption should be avoided during isotretinoin therapy.

References

  1. (2001) "Product Information. Accutane (isotretinoin)." Roche Laboratories

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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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