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Drug Interactions between Pomalyst and Viekira XR

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

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Interactions between your drugs

Moderate

ritonavir pomalidomide

Applies to: Viekira XR (dasabuvir / ombitasvir / paritaprevir / ritonavir) and Pomalyst (pomalidomide)

GENERALLY AVOID: Coadministration with potent inhibitors of CYP450 1A2, CYP450 3A4, and P-glycoprotein may increase the plasma concentrations of pomalidomide, which has been shown to be primarily metabolized by these isoenzymes and also a substrate of the efflux transporter. Pomalidomide exposure is increased when given with a strong CYP450 1A2 inhibitor (e.g., fluvoxamine) in the presence of a strong CYP450 3A4 and P-gp inhibitor (e.g., ketoconazole). Coadministration with ketoconazole alone did not have a clinically significant effect on exposure to pomalidomide. However, the combination of pomalidomide and fluvoxamine in the presence of ketoconazole increased exposure to pomalidomide by 104% compared to pomalidomide plus ketoconazole.

MANAGEMENT: The use of pomalidomide with potent inhibitors of CYP450 1A2 (e.g., ciprofloxacin, fluvoxamine, tiabendazole) in the presence of strong CYP450 3A4 and P-gp inhibitors should generally be avoided. If coadministration is considered clinically necessary, the pomalidomide dose should be reduced by 50%. Dose reduction may also be required if pomalidomide is given with a strong inhibitor of CYP450 1A2 in the absence of a coadministered CYP450 3A4 and P-gp inhibitor. Patients should be monitored for occurrence of pomalidomide-related side effects, including nausea, diarrhea, and neutropenia.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. (2013) "Product Information. Pomalyst (pomalidomide)." QLT Phototherapeutics Inc

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Drug and food interactions

Moderate

ritonavir food

Applies to: Viekira XR (dasabuvir / ombitasvir / paritaprevir / ritonavir)

ADJUST DOSING INTERVAL: Administration with food may modestly affect the bioavailability of ritonavir from the various available formulations. When the oral solution was given under nonfasting conditions, peak ritonavir concentrations decreased 23% and the extent of absorption decreased 7% relative to fasting conditions. Dilution of the oral solution (within one hour of dosing) with 240 mL of chocolate milk or a nutritional supplement (Advera or Ensure) did not significantly affect the extent and rate of ritonavir absorption. When a single 100 mg dose of the tablet was administered with a high-fat meal (907 kcal; 52% fat, 15% protein, 33% carbohydrates), approximately 20% decreases in mean peak concentration (Cmax) and systemic exposure (AUC) were observed relative to administration after fasting. Similar decreases in Cmax and AUC were reported when the tablet was administered with a moderate-fat meal. In contrast, the extent of absorption of ritonavir from the soft gelatin capsule formulation was 13% higher when administered with a meal (615 KCal; 14.5% fat, 9% protein, and 76% carbohydrate) relative to fasting.

MANAGEMENT: Ritonavir should be taken with meals to enhance gastrointestinal tolerability.

References

  1. (2001) "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical

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Moderate

pomalidomide food

Applies to: Pomalyst (pomalidomide)

MONITOR: Cigarette smoking may reduce pomalidomide exposure due to induction of CYP450 1A2, the isoenzyme that is responsible for the metabolic clearance of pomalidomide along with CYP450 3A4.

MANAGEMENT: Patients should be advised that smoking may reduce the efficacy of pomalidomide therapy. Pomalidomide should be taken on an empty stomach, at least 2 hours before or 2 hours after a meal.

References

  1. (2013) "Product Information. Pomalyst (pomalidomide)." QLT Phototherapeutics Inc

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Moderate

paritaprevir food

Applies to: Viekira XR (dasabuvir / ombitasvir / paritaprevir / ritonavir)

ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of ombitasvir, paritaprevir, ritonavir, and dasabuvir. Relative to fasting conditions, administration of ombitasvir, paritaprevir, ritonavir, and dasabuvir with a moderate-fat meal (approximately 600 Kcal; 20% to 30% calories from fat) increased the mean systemic exposure (AUC) by 82%, 211%, 49%, and 30%, respectively. Relative to fasting conditions, administration of ombitasvir, paritaprevir, ritonavir, and dasabuvir with a high-fat meal (approximately 900 Kcal; with 60% calories from fat) increased the mean AUC by 76%, 180%, 44%, and 22%, respectively.

MANAGEMENT: Ombitasvir/paritaprevir/ritonavir plus dasabuvir should always be administered with a meal. The fat or calorie content does not matter.

References

  1. (2022) "Product Information. Viekira Pak (dasabuvir/ombitasvir/paritaprev/ritonav)." AbbVie US LLC

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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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