Drug Interactions between Orkambi and Revatio
This report displays the potential drug interactions for the following 2 drugs:
- Orkambi (ivacaftor/lumacaftor)
- Revatio (sildenafil)
Interactions between your drugs
sildenafil lumacaftor
Applies to: Revatio (sildenafil) and Orkambi (ivacaftor / lumacaftor)
Consumer information for this interaction is not currently available.
ADJUST DOSE: Coadministration with moderate to potent CYP450 3A4 inducers may significantly decrease the plasma concentrations and effects of sildenafil, which is primarily metabolized by CYP450 3A4 and, to a lesser extent, by CYP450 2C9. This interaction has been demonstrated in studies using bosentan, a moderate CYP450 3A4 inducer and weak CYP450 2C9 inducer in vivo as well as an in vitro inducer of CYP450 2C19. Coadministration of oral sildenafil (80 mg three times daily) at steady state with bosentan (125 mg twice daily) at steady state over 6 days in healthy adult volunteers decreased the systemic exposure (AUC) and peak plasma concentration (Cmax) of sildenafil by 62.6% and 55.4%, respectively. The same effect was also observed with lower doses of oral sildenafil (20 mg three times daily) added to bosentan therapy (62.5 mg - 125 mg twice daily). The labeling for some sildenafil formulations used for pulmonary arterial hypertension (PAH) reported a population pharmacokinetic analysis of data from patients in clinical trials which indicated an approximately 3-fold increase in sildenafil clearance when co-administered with mild CYP450 3A4 inducers. However, this increased clearance was not reflected in a population pharmacokinetic analysis described in the labeling of some sildenafil formulations indicated for erectile dysfunction. More potent CYP450 3A4 inducers are expected to have greater effects than those observed with bosentan or mild inducers; however, data are not available. Likewise, clinical data regarding this interaction in pediatric patients are also unavailable.
MANAGEMENT: In adult patients being treated for pulmonary arterial hypertension (PAH), the dose of sildenafil may need to be increased when initiating treatment with moderate to potent CYP450 3A4 inducers. Conversely, the manufacturer recommends reducing the dose of sildenafil to 20 mg orally three times daily when discontinuing treatment with moderate to potent CYP450 3A4 inducers. Patients being treated for erectile dysfunction should be monitored closely and may require a dose adjustment of sildenafil if a moderate or strong CYP450 3A4 inducer is initiated or discontinued. Dosing should be guided by the patient's symptoms, ability to tolerate sildenafil, and recommendations provided in the product labeling.
sildenafil ivacaftor
Applies to: Revatio (sildenafil) and Orkambi (ivacaftor / lumacaftor)
Ivacaftor may increase the blood levels and effects of sildenafil. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your condition changes or you experience nausea, shortness of breath, dizziness, lightheadedness, fainting, visual disturbances, ringing in the ears, vision or hearing loss, chest pain or tightness, irregular heartbeat, and/or priapism (prolonged and painful erection unrelated to sexual activity), as these may be signs and symptoms of excessive sildenafil levels. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Drug and food interactions
sildenafil food
Applies to: Revatio (sildenafil)
If you are receiving therapy with sildenafil you should avoid the regular consumption of large amounts of grapefruits and grapefruit juice. Grapefruit can raise the levels of sildenafil in your body and delay the time it takes for the medication to work. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
ivacaftor food
Applies to: Orkambi (ivacaftor / lumacaftor)
Ivacaftor should be taken with fat-containing foods such as eggs, avocados, nuts, meat, butter, peanut butter, cheese pizza, and whole-milk dairy products to help with its absorption. Do not consume grapefruit juice or any food that contains grapefruit or Seville oranges during treatment with ivacaftor unless directed otherwise by your doctor. Grapefruit juice can significantly increase the blood levels of ivacaftor. This may increase the risk and/or severity of serious side effects such as liver damage. Call your doctor immediately if you have fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark urine, pale stools, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
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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