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Drug Interactions between pexidartinib and ramelteon

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

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Interactions between your drugs

Moderate

ramelteon pexidartinib

Applies to: ramelteon and pexidartinib

MONITOR: Coadministration with inducers of CYP450 isoenzymes may decrease the plasma concentrations and pharmacologic effects of ramelteon, which is metabolized by CYP450 1A2 and, to a lesser extent, by CYP450 3A4 and the 2C subfamily of isoenzymes. When a single 32 mg oral dose of ramelteon was administered to healthy volunteers following pretreatment with the potent CYP450 inducer rifampin (600 mg orally once daily for 11 days), total systemic exposure (AUC) to ramelteon and its pharmacologically active metabolite was decreased by an average of approximately 80% (range 40% to 90%). Use with other inducers has not been adequately studied.

MANAGEMENT: The efficacy of ramelteon may be reduced when prescribed with potent inducers of CYP450 isoenzymes such as carbamazepine, enzalutamide, phenobarbital, phenytoin, rifampin, and St. John's wort. Other known inducers include aminoglutethimide, bexarotene, bosentan, dabrafenib, dexamethasone, efavirenz, etravirine, mitotane, modafinil, nafcillin, nevirapine, rifabutin, rifapentine, barbiturates and various other anticonvulsants, although the extent to which they interact with ramelteon is unknown.

References (1)
  1. (2005) "Product Information. Rozerem (ramelteon)." Takeda Pharmaceuticals America

Drug and food interactions

Major

pexidartinib food

Applies to: pexidartinib

ADJUST DOSING INTERVAL: The presence of food may increase the absorption and toxicity of pexidartinib. Administration of pexidartinib with a high-fat meal increased peak plasma concentration (Cmax) and systemic exposure (AUC) by 100% and prolonged the time to reach peak plasma concentration (Tmax) by 2.5 hours.

GENERALLY AVOID: Grapefruit or grapefruit juice may increase the plasma concentration and risk of adverse effects of pexidartinib, including potentially fatal hepatotoxicity. The mechanism is inhibition of CYP450 3A4-mediated metabolism of pexidartinib by certain compounds present in grapefruits. Concomitant administration of itraconazole, a strong CYP450 3A4 inhibitor, increased pexidartinib peak plasma concentration (Cmax) and systemic exposure (AUC) by 48% and 70%, respectively.

MANAGEMENT: Pexidartinib should be administered on an empty stomach, at least one hour before or two hours after a meal or snack. Consumption of grapefruit or grapefruit juice should generally be avoided during pexidartinib therapy. If concomitant use is unavoidable, the dose of pexidartinib should be reduced according to the manufacturer's recommendations. If concomitant use of grapefruit or grapefruit juice is discontinued, the dose of pexidartinib may be increased (after 3 plasma half-lives of a strong CYP450 3A4 inhibitor) to the dose that was used prior to consumption of grapefruit or grapefruit juice.

References (1)
  1. (2019) "Product Information. Turalio (pexidartinib)." Daiichi Sankyo, Inc.
Moderate

ramelteon food

Applies to: ramelteon

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of ramelteon. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

ADJUST DOSING INTERVAL: Administration of ramelteon with or immediately after a high-fat/heavy meal may delay the onset of hypnotic effects. In study subjects, administration of a 16 mg dose of ramelteon with a high-fat meal decreased the peak plasma drug concentration (Cmax) by 22% and delayed the median time to reach peak plasma drug concentration (Tmax) by approximately 45 minutes compared to administration in a fasted state.

MANAGEMENT: Patients receiving ramelteon should be advised to avoid the consumption of alcohol. For faster sleep onset, ramelteon should not be administered with or immediately after a high-fat/heavy meal.

References (1)
  1. (2005) "Product Information. Rozerem (ramelteon)." Takeda Pharmaceuticals America

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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