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Drug Interactions between revefenacin and Rydapt

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

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Interactions between your drugs

Moderate

midostaurin revefenacin

Applies to: Rydapt (midostaurin) and revefenacin

GENERALLY AVOID: Coadministration of revefenacin with inhibitors of organic anion transporting polypeptide (OATP) 1B1 and/or 1B3 may increase systemic exposure to its active metabolite, which has been reported to be a substrate of the hepatic uptake transporters. No pharmacokinetic data are available, but increased anticholinergic adverse effects such as mydriasis, blurred vision, heat intolerance, fever, dry mouth, tachycardia, urinary retention, constipation, and glaucoma (onset or exacerbation) may occur. In study patients, revefenacin was rapidly converted to its active metabolite following inhaled administration, and plasma exposures of the metabolite exceeded those of revefenacin by approximately 4- to 6-fold. The activity of the metabolite at target muscarinic receptors is approximately one-third to one-tenth that of revefenacin and could potentially contribute to systemic antimuscarinic effects at therapeutic doses.

MANAGEMENT: Concomitant use of revefenacin with OATP 1B1 and/or 1B3 inhibitors is not recommended.

References (3)
  1. (2018) "Product Information. Yupelri (revefenacin)." Mylan Specialty
  2. (2020) "Product Information. Nexlizet (bempedoic acid-ezetimibe)." Esperion Therapeutics
  3. (2020) "Product Information. Nexletol (bempedoic acid)." Esperion Therapeutics

Drug and food interactions

Major

midostaurin food

Applies to: Rydapt (midostaurin)

GENERALLY AVOID: Grapefruit juice may significantly increase the plasma concentrations of midostaurin. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. 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. Ketoconazole, a potent CYP450 3A4 inhibitor, has been shown to increase midostaurin systemic exposure (AUC) by greater than 10-fold in healthy volunteers. Increased exposure to midostaurin may increase the risk of adverse effects such as nausea, vomiting, diarrhea, edema, hyperglycemia, hyperuricemia, QT prolongation, neutropenia, lymphopenia, thrombocytopenia, and anemia.

ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of midostaurin. Relative to fasting conditions, midostaurin systemic exposure (AUC) increased by approximately 1.2-fold when administered with a standard meal (457 calories; 50 g fat, 21 g proteins, 18 g carbohydrates) and 1.6-fold when administered with a high-fat meal (1007 calories; 66 g fat, 32 g proteins, 64 g carbohydrates), while midostaurin peak plasma concentration (Cmax ) decreased by 20% and 27%, respectively.

MANAGEMENT: The manufacturer recommends taking midostaurin with food. Midostaurin was administered with food in clinical trials. Patients should avoid consumption of grapefruit and grapefruit juice during treatment with midostaurin.

References (1)
  1. (2017) "Product Information. Rydapt (midostaurin)." Novartis 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

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