Drug Interactions between ivacaftor / lumacaftor and Ofev
This report displays the potential drug interactions for the following 2 drugs:
- ivacaftor/lumacaftor
- Ofev (nintedanib)
Interactions between your drugs
nintedanib lumacaftor
Applies to: Ofev (nintedanib) and ivacaftor / lumacaftor
GENERALLY AVOID: Coadministration with inducers of P-glycoprotein (P-gp) and CYP450 3A4 may decrease the plasma concentrations of nintedanib, which is a substrate of the efflux transporter and a minor substrate of the isoenzyme. In a dedicated drug interaction study, administration of nintedanib with the potent P-gp and CYP450 3A4 inducer, rifampin, decreased nintedanib peak plasma concentration (Cmax) and systemic exposure (AUC) by 40% and 50%, respectively, compared to administration of nintedanib alone. No data are available for use with other, less potent inducers.
MANAGEMENT: Concomitant use of nintedanib with P-gp and CYP450 3A4 inducers should generally be avoided due to the potential for reduced efficacy.
References
- (2014) "Product Information. Ofev (nintedanib)." Boehringer Ingelheim
ivacaftor nintedanib
Applies to: ivacaftor / lumacaftor and Ofev (nintedanib)
MONITOR: Coadministration with inhibitors of P-glycoprotein (P-gp) and CYP450 3A4 may increase the plasma concentrations of nintedanib, which is a substrate of the efflux transporter and a minor substrate of the isoenzyme. In a dedicated drug interaction study, administration of nintedanib with the potent P-gp and CYP450 3A4 inhibitor, ketoconazole, increased nintedanib peak plasma concentration (Cmax) by 83% and systemic exposure (AUC) by 61%. No data are available for use with other, less potent inhibitors.
MANAGEMENT: Caution is advised if nintedanib is prescribed in combination with P-gp and CYP450 3A4 inhibitors. Pharmacologic response to nintedanib should be monitored more closely whenever a CYP450 3A4/P-gp inhibitor is added to or withdrawn from therapy, and the nintedanib dosing adjusted or interrupted as necessary in accordance with the product labeling. Patients should be closely monitored for increased adverse effects such as liver enzyme and bilirubin elevations, diarrhea, nausea, vomiting, gastrointestinal perforation, bleeding, and arterial thromboembolic events (e.g., myocardial infarction).
References
- (2014) "Product Information. Ofev (nintedanib)." Boehringer Ingelheim
Drug and food interactions
ivacaftor food
Applies to: ivacaftor / lumacaftor
GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of ivacaftor. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Elexacaftor and tezacaftor are also CYP450 3A4 substrates in vitro and may interact similarly with grapefruit juice, whereas lumacaftor is not expected to interact.
ADJUST DOSING INTERVAL: According to prescribing information, systemic exposure to ivacaftor increased approximately 2.5- to 4-fold, systemic exposure to elexacaftor increased approximately 1.9- to 2.5-fold, and systemic exposure to lumacaftor increased approximately 2-fold following administration with fat-containing foods relative to administration in a fasting state. Tezacaftor exposure is not significantly affected by administration of fat-containing foods.
MANAGEMENT: Patients treated with ivacaftor-containing medications should avoid consumption of grapefruit juice and any food that contains grapefruit or Seville oranges. All ivacaftor-containing medications should be administered with fat-containing foods such as eggs, avocados, nuts, meat, butter, peanut butter, cheese pizza, and whole-milk dairy products. A typical cystic fibrosis diet will satisfy this requirement.
References
- (2012) "Product Information. Kalydeco (ivacaftor)." Vertex Pharmaceuticals
- (2015) "Product Information. Orkambi (ivacaftor-lumacaftor)." Vertex Pharmaceuticals
- (2022) "Product Information. Symdeko (ivacaftor-tezacaftor)." Vertex Pharmaceuticals
- (2019) "Product Information. Trikafta (elexacaftor/ivacaftor/tezacaftor)." Vertex Pharmaceuticals
nintedanib food
Applies to: Ofev (nintedanib)
ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of nintedanib. After food intake, nintedanib exposure increased by approximately 20% compared to administration under fasted conditions. Absorption was also delayed, as indicated by an increase in the median time to reach maximum plasma concentration (Tmax) from 2 hours in the fasted state to approximately 4 hours under fed conditions, irrespective of the type of food ingested.
MANAGEMENT: Nintedanib should be administered with food.
References
- (2014) "Product Information. Ofev (nintedanib)." Boehringer Ingelheim
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
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
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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