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Drug Interactions between ivacaftor / lumacaftor and ulipristal

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

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Interactions between your drugs

Major

ulipristal lumacaftor

Applies to: ulipristal and ivacaftor / lumacaftor

GENERALLY AVOID: Coadministration with potent and moderate inducers of CYP450 3A4 may significantly decrease the plasma concentrations of ulipristal acetate and its pharmacologically active metabolite. Based on in vitro and pharmacokinetic data, ulipristal acetate is thought to be primarily metabolized by CYP450 3A4 to mono-demethylated and di-demethylated metabolites. When a single 30 mg dose of ulipristal acetate was administered following a 9-day treatment with 600 mg once daily of rifampin, a potent CYP450 3A4 inducer, ulipristal acetate peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by 90% and 93% respectively, while half-life decreased by 2.2-fold. The Cmax and AUC of monodemethyl-ulipristal acetate, the active metabolite, decreased by 84% and 90%, respectively. The interaction has not been studied with other, less potent inducers.

MANAGEMENT: Concomitant use of ulipristal acetate with potent and moderate CYP450 3A4 inducers should generally be avoided due to the potential for loss of therapeutic efficacy. For patients who have used enzyme-inducing drugs within the past 4 weeks and are seeking emergency contraception, ulipristal acetate is not recommended and a non-hormonal method (i.e. a copper intrauterine device (Cu-IUD)) should be considered.

References (6)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. (2022) "Product Information. Ella (ulipristal)." Afaxys Inc.
  4. Cerner Multum, Inc. (2015) "Canadian Product Information."
  5. (2021) "Product Information. Esmya (ulipristal)." Gedeon Richter (UK) Ltd
  6. (2021) "Product Information. EllaOne (ulipristal)." HRA Pharma UK & Ireland Ltd

Drug and food interactions

Moderate

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 (4)
  1. (2012) "Product Information. Kalydeco (ivacaftor)." Vertex Pharmaceuticals
  2. (2015) "Product Information. Orkambi (ivacaftor-lumacaftor)." Vertex Pharmaceuticals
  3. (2022) "Product Information. Symdeko (ivacaftor-tezacaftor)." Vertex Pharmaceuticals
  4. (2019) "Product Information. Trikafta (elexacaftor/ivacaftor/tezacaftor)." Vertex Pharmaceuticals

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.

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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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