Skip to main content

Drug Interactions between pemigatinib and Stribild

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

Edit list (add/remove drugs)

Interactions between your drugs

Major

cobicistat pemigatinib

Applies to: Stribild (cobicistat / elvitegravir / emtricitabine / tenofovir) and pemigatinib

GENERALLY AVOID: Coadministration with potent inhibitors of CYP450 3A4 may increase the plasma concentrations of pemigatinib, which is primarily metabolized by the isoenzyme in vitro. When itraconazole, a potent CYP450 3A4 inhibitor, was administered following a single oral pemigatinib dose of 4.5 mg, pemigatinib peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 17% and 88%, respectively. Concomitant use of moderate CYP450 3A4 inhibitors is predicted to increase pemigatinib exposure by approximately 50% to 80%. Increased exposure to pemigatinib may increase the incidence and severity of serious adverse reactions such as hyperphosphatemia (which can cause precipitation of calcium-phosphate crystals over time that can lead to hypocalcemia, soft tissue mineralization such as cutaneous calcification and calcinosis, secondary hyperparathyroidism, anemia, muscle cramps, seizures, QT prolongation, and arrhythmias), serous retinal detachment (which may cause symptoms such as blurred vision, visual floaters, or photopsia), palmar-plantar erythrodysesthesia syndrome (hand-foot syndrome), arthralgia, stomatitis, diarrhea, nausea, vomiting, and constipation.

MANAGEMENT: Concomitant use of pemigatinib with potent CYP450 3A4 inhibitors should be avoided. If coadministration is required, a reduction in the dosage of pemigatinib is recommended. Patients receiving 13.5 mg of pemigatinib should have the dosage reduced to 9 mg, and those receiving 9 mg should have the dosage reduced to 4.5 mg. After discontinuation of the potent CYP450 3A4 inhibitor for 3 plasma half-lives, the pemigatinib dosage that was taken prior to initiating the inhibitor may be resumed.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. (2020) "Product Information. Pemazyre (pemigatinib)." Incyte Corporation

Switch to consumer interaction data

Moderate

tenofovir cobicistat

Applies to: Stribild (cobicistat / elvitegravir / emtricitabine / tenofovir) and Stribild (cobicistat / elvitegravir / emtricitabine / tenofovir)

MONITOR: Concomitant use of tenofovir with cobicistat may increase the risk for tenofovir-related renal adverse effects, including renal impairment, renal failure, elevated creatinine, and Fanconi syndrome. The mechanism of this interaction has not been described. Cobicistat may decrease estimated creatinine clearance via inhibition of tubular secretion of creatinine; however, renal glomerular function does not appear to be affected. When given concomitantly with cobicistat, the systemic exposure (AUC) and trough plasma concentrations (Cmin) of tenofovir was also increased by 23% and 55%, respectively. However, data are lacking to determine whether concomitant use of tenofovir with cobicistat-containing regimens is associated with a greater risk of renal complications compared with regimens that do not include cobicistat.

MANAGEMENT: Initiation of cobicistat or cobicistat-containing regimens is not recommended in patients with CrCl less than 70 mL/min if any coadministered medicine requires dose adjustment based on renal function (including tenofovir), or is nephrotoxic. If concomitant therapy is necessary, monitoring of renal function is recommended, particularly in patients with risk factors for renal impairment.

References

  1. (2001) "Product Information. Viread (tenofovir)." Gilead Sciences
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."
  4. (2014) "Product Information. Tybost (cobicistat)." Gilead Sciences
View all 4 references

Switch to consumer interaction data

Moderate

tenofovir pemigatinib

Applies to: Stribild (cobicistat / elvitegravir / emtricitabine / tenofovir) and pemigatinib

ADJUST DOSING INTERVAL: Coadministration with pemigatinib may increase the systemic exposure of orally administered drugs that are substrates of the P-glycoprotein (P-gp) efflux transporter. The pharmacologic effect and toxicity of the substrate may be increased. Pemigatinib has been shown in in vitro studies to be a P-gp inhibitor in vitro. However, no pharmacokinetic data are available from drug interaction studies.

MANAGEMENT: Caution is recommended with the concomitant use of pemigatinib with medications that are substrates of P-gp, particularly those with a narrow therapeutic range. The manufacturer advises that if concomitant use is required, pemigatinib should be administered either 6 hours before or after the P-gp substrate.

References

  1. (2020) "Product Information. Pemazyre (pemigatinib)." Incyte Corporation
  2. (2022) "Product Information. Pemazyre (pemigatinib)." Specialised Therapeutics Alim Pty Ltd
  3. (2023) "Product Information. Pemazyre (pemigatinib)." Incyte Biosciences UK Ltd

Switch to consumer interaction data

Moderate

emtricitabine cobicistat

Applies to: Stribild (cobicistat / elvitegravir / emtricitabine / tenofovir) and Stribild (cobicistat / elvitegravir / emtricitabine / tenofovir)

GENERALLY AVOID: Cobicistat may increase the plasma concentrations of antiretroviral agents. The plasma concentrations of cobicistat may also be increased or reduced in the presence of antiretroviral agents. The proposed mechanism is cobicistat inhibition of the CYP450 3A4 isoenzyme, of which antiretroviral agents may be substrates, and the inhibition or induction of CYP450 3A4 by concomitant antiretroviral medications. Cobicistat is a mechanism-based inhibitor and substrate of CYP450 3A4 with no antiretroviral activity of its own. Rather, it is indicated in its capacity as a pharmacokinetic booster of CYP450 3A4 to increase the systemic exposure of some antiretroviral medications such as atazanavir, darunavir, and elvitegravir, which are substrates of this isoenzyme. Concomitant use of other antiretroviral agents with cobicistat may also increase the plasma levels and risk of side effects associated with these medicines. In contrast, concomitant use of cobicistat-boosted atazanavir or darunavir with CYP450 3A4 inducers nevirapine, etravirine, or efavirenz may reduce the plasma concentrations of cobicistat, darunavir, and atazanavir, leading to a potential loss of therapeutic effect and development of resistance to darunavir and atazanavir. Pharmacokinetic data are not available.

MANAGEMENT: Cobicistat is not intended for use with more than one antiretroviral medication that requires pharmacokinetic enhancement, such as two protease inhibitors or elvitegravir in combination with a protease inhibitor. In addition, cobicistat should not be used concomitantly with ritonavir due to their similar effects on CYP450 3A4. According to some authorities, use of the antiretroviral combinations of atazanavir-cobicistat or darunavir-cobicistat concomitantly with the CYP450 3A4 inducers efavirenz, etravirine, or nevirapine is also not recommended. Other authorities consider the administration of atazanavir-cobicistat with efavirenz or nevirapine to be contraindicated. Since dosing recommendations have only been established for a number of antiretroviral medications, product labeling and current antiretroviral treatment guidelines should be consulted.

References

  1. (2001) "Product Information. Viramune (nevirapine)." Boehringer-Ingelheim
  2. (2001) "Product Information. Sustiva (efavirenz)." DuPont Pharmaceuticals
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. (2006) "Product Information. Prezista (darunavir)." Ortho Biotech Inc
  5. (2008) "Product Information. Intelence (etravirine)." Ortho Biotech Inc
  6. Cerner Multum, Inc. "Australian Product Information."
  7. (2012) "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofov)." Gilead Sciences
  8. (2014) "Product Information. Tybost (cobicistat)." Gilead Sciences
  9. (2014) "Product Information. Prezcobix (cobicistat-darunavir)." Janssen Pharmaceuticals
  10. (2015) "Product Information. Evotaz (atazanavir-cobicistat)." Bristol-Myers Squibb
View all 10 references

Switch to consumer interaction data

Drug and food interactions

Major

pemigatinib food

Applies to: pemigatinib

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of pemigatinib, which is primarily metabolized by CYP450 3A4 in vitro. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Inhibition of hepatic CYP450 3A4 may also contribute. The interaction has not been studied with grapefruit juice but has been reported for other CYP450 3A4 inhibitors. When itraconazole, a potent CYP450 3A4 inhibitor, was administered following a single oral pemigatinib dose of 4.5 mg, pemigatinib peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 17% and 88%, respectively. Concomitant use of moderate CYP450 3A4 inhibitors is predicted to increase pemigatinib exposure by approximately 50% to 80%. 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 exposure to pemigatinib may increase the incidence and severity of serious adverse reactions such as hyperphosphatemia (which can cause precipitation of calcium-phosphate crystals over time that can lead to hypocalcemia, soft tissue mineralization such as cutaneous calcification and calcinosis, secondary hyperparathyroidism, anemia, muscle cramps, seizures, QT prolongation, and arrhythmias), serous retinal detachment (which may cause symptoms such as blurred vision, visual floaters, or photopsia), palmar-plantar erythrodysesthesia syndrome (hand-foot syndrome), arthralgia, stomatitis, diarrhea, nausea, vomiting, and constipation.

Pemigatinib pharmacokinetics were not significantly affected by coadministration of a high-fat, high-calorie meal (approximately 1000 calories; 500 to 600 calories from fat).

MANAGEMENT: Pemigatinib may be administered with or without food. Patients should avoid consumption of grapefruit, grapefruit juice, or supplements that contain grapefruit extract during treatment with pemigatinib.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. (2020) "Product Information. Pemazyre (pemigatinib)." Incyte Corporation
  3. (2022) "Product Information. Pemazyre (pemigatinib)." Specialised Therapeutics Alim Pty Ltd

Switch to consumer interaction data

Moderate

elvitegravir food

Applies to: Stribild (cobicistat / elvitegravir / emtricitabine / tenofovir)

ADJUST DOSING INTERVAL: Food enhances the oral bioavailabilities of both elvitegravir and tenofovir. When a single dose of cobicistat/elvitegravir/emtricitabine/tenofovir (trade name Stribild) was given with a light meal (approximately 373 kcal; 20% fat), mean elvitegravir and tenofovir systemic exposures (AUCs) increased by 34% and 24%, respectively, relative to fasting conditions. When administered with a high-fat meal (approximately 800 kcal; 50% fat), the mean AUC of elvitegravir and tenofovir increased by 87% and 23%, respectively, relative to fasting conditions. The alterations in mean AUCs of cobicistat and emtricitabine were not clinically significant with either the light or high-fat meal.

MANAGEMENT: Cobicistat/elvitegravir/emtricitabine/tenofovir as a fixed-dose preparation should be administered once daily with food. Elvitegravir as a single-ingredient preparation should also be administered once daily with food.

References

  1. (2012) "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofov)." Gilead Sciences
  2. (2014) "Product Information. Vitekta (elvitegravir)." Gilead Sciences

Switch to consumer interaction data

Minor

tenofovir food

Applies to: Stribild (cobicistat / elvitegravir / emtricitabine / tenofovir)

Food enhances the oral absorption and bioavailability of tenofovir, the active entity of tenofovir disoproxil fumarate. According to the product labeling, administration of the drug following a high-fat meal increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of tenofovir by approximately 14% and 40%, respectively, compared to administration in the fasting state. However, administration with a light meal did not significantly affect the pharmacokinetics of tenofovir compared to administration in the fasting state. Food delays the time to reach tenofovir Cmax by approximately 1 hour. Tenofovir disoproxil fumarate may be administered without regard to meals.

References

  1. (2001) "Product Information. Viread (tenofovir)." Gilead Sciences

Switch to consumer interaction data

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.


Report options

Loading...
QR code containing a link to this page

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.