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Interactions between Ubrelvy and Vandetanib

1 drug interaction and 15 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

vandetanib ubrogepant

Applies to: vandetanib and Ubrelvy (ubrogepant)
Adjust dose

Coadministration with inhibitors of CYP450 3A4, breast cancer resistance protein (BCRP), and/or P-glycoprotein (P-gp) may increase the plasma concentrations of ubrogepant based on in vivo and in vitro data. The proposed mechanism involves enhanced oral bioavailability as well as reduced clearance of ubrogepant due to inhibition of CYP450 3A4-mediated metabolism and BCRP/P-gp-mediated efflux in the intestine and liver. When ubrogepant was administered with the potent CYP450 3A4 inhibitor ketoconazole during in vivo studies, ubrogepant peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 5.3- and 9.7-fold, respectively. When administered with the moderate CYP450 3A4 inhibitor verapamil, ubrogepant Cmax and AUC increased by 2.8- and 3.5-fold, respectively. Dedicated drug interaction studies have not been conducted to assess concomitant use of ubrogepant with weak CYP450 3A4 inhibitors and inhibitors of BCRP or P-gp transporters. Ubrogepant exposure is not expected to increase by more than 2-fold when used with weak CYP450 3A4 inhibitors per a conservative prediction from the manufacturer.

Management

The recommended dose of ubrogepant is 50 mg during concomitant treatment with weak CYP450 3A4 inhibitors and/or inhibitors of BCRP or P-gp. If needed, a second 50 mg ubrogepant dose may be administered at least 2 hours after the initial dose.

References (2)
  1. (2023) "Product Information. Ubrelvy (ubrogepant)." Allergan Inc
  2. (2022) "Product Information. Ubrelvy (ubrogepant)." AbbVie Corporation

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

ubrogepant Food/Lifestyle

Applies to: Ubrelvy (ubrogepant)
Adjust dose

Grapefruit and grapefruit juice may increase the plasma concentrations of ubrogepant. 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 but has been reported for other CYP450 3A4 inhibitors. When ubrogepant was administered with the potent CYP450 3A4 inhibitor ketoconazole during in vivo studies, ubrogepant peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 5.3- and 9.7-fold, respectively. When administered with the moderate CYP450 3A4 inhibitor verapamil, ubrogepant Cmax and AUC increased by 2.8- and 3.5-fold, respectively. 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. When administered with a high-fat meal, ubrogepant time to maximum plasma concentration (Tmax) was delayed by 2 hours, which resulted in a 22% decrease in Cmax and no change in AUC. Ubrogepant was administered without regard to food in clinical efficacy studies.

Management

Ubrogepant may be administered with or without food. When coadministered with grapefruit or grapefruit juice, the manufacturer recommends an initial ubrogepant dose of 50 mg. A second dose, if needed, should not be administered within 24 hours of the initial dose.

References (1)
  1. (2019) "Product Information. Ubrelvy (ubrogepant)." Allergan Inc

Disease interactions

14 potential interactions Applies to: 12 conditions, including High Blood Pressure, Underactive Thyroid, Heart Failure, Arrhythmia, and Liver Disease.

Arrhythmia

Major:

vandetanib

Vandetanib has a major potential interaction with Arrhythmia.

Vandetanib can prolong the QT interval, and its use is contraindicated in patients with congenital long QT syndrome. Additionally, vandetanib should not be used in patients with hypocalcemia, hypokalemia, hypomagnesemia, or long QT syndrome. Care should be exercised when using this agent in patients with ventricular arrhythmias or recent myocardial infarction. It is recommended to correct hypocalcemia, hypokalemia and/or hypomagnesemia prior to starting therapy with vandetanib. Obtain an ECG and serum potassium, calcium, magnesium and TSH at baseline, during treatment, and frequently as necessary.

Bleeding Disorder

Moderate:

vandetanib

Vandetanib has a moderate potential interaction with Bleeding Disorder.

Serious hemorrhagic events, including fatalities, have occurred in patients treated with vandetanib. Do not administer vandetanib to patients with a recent history of hemoptysis of >= 1/2 teaspoon of red blood. Discontinue treatment in patients with severe hemorrhage.

Electrolyte Abnormalities

Major:

vandetanib

Vandetanib has a major potential interaction with Electrolyte Abnormalities.

Vandetanib can prolong the QT interval, and its use is contraindicated in patients with congenital long QT syndrome. Additionally, vandetanib should not be used in patients with hypocalcemia, hypokalemia, hypomagnesemia, or long QT syndrome. Care should be exercised when using this agent in patients with ventricular arrhythmias or recent myocardial infarction. It is recommended to correct hypocalcemia, hypokalemia and/or hypomagnesemia prior to starting therapy with vandetanib. Obtain an ECG and serum potassium, calcium, magnesium and TSH at baseline, during treatment, and frequently as necessary.

Heart Failure

Moderate:

vandetanib

Vandetanib has a moderate potential interaction with Heart Failure.

Heart failure, including fatalities have occurred in patients treated with vandetanib. Monitor for signs and symptoms of heart failure. Consider discontinuation of therapy in patients with heart failure. Close monitoring is recommended.

High Blood Pressure

Moderate:

vandetanib

Vandetanib has a moderate potential interaction with High Blood Pressure.

Hypertension, including hypertensive crisis, has occurred in patients treated with vandetanib. Monitor all patients for hypertension and a dose reduction or interruption may be necessary. If hypertension cannot be controlled, do not resume vandetanib. Care should be taken when using this agent in hypertensive patients. Close monitoring is recommended.

Interstitial Lung Disease

Moderate:

vandetanib

Vandetanib has a moderate potential interaction with Interstitial Lung Disease.

The use of certain multikinase inhibitors has been associated with pulmonary toxicity. Serious cases of interstitial lung disease (ILD), including fatal cases and interstitial pneumonitis or pulmonary fibrosis have been reported. Caution is recommended when using these agents in patients with a history of interstitial pneumonitis or pulmonary fibrosis or those patients presenting with acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever pending diagnostic evaluation. If ILD is confirmed, these agents should be permanently discontinued and appropriate measures should be instituted. Treatment should be immediately withheld in patients diagnosed with ILD/pneumonitis and permanently discontinued if no other potential causes of ILD/pneumonitis have been identified.

Ischemic Heart Disease

Moderate:

vandetanib

Vandetanib has a moderate potential interaction with Ischemic Heart Disease.

Ischemic cerebrovascular events, including fatalities, occurred in patients treated with vandetanib. The safety of resumption of vandetanib therapy after resolution of an ischemic cerebrovascular event has not been studied. Care should be taken when prescribing this agent to patients at risk. Discontinue treatment in patients who experience a severe ischemic cerebrovascular event.

Liver Disease

Moderate:

Ubrelvy

The ubrogepant in Ubrelvy has a moderate potential interaction with Liver Disease.

Care should be exercised when using ubrogepant in patients with severe hepatic impairment. Dose adjustment is recommended for these patients. No dose adjustment is recommended for patients with mild or moderate hepatic impairment.

Moderate:

vandetanib

Vandetanib has a moderate potential interaction with Liver Disease.

The use of vandetanib is not recommended for patients with moderate and severe hepatic impairment, as the safety and efficacy of this agent have not been established.

Posterior Reversible Encephalopathy Syndrome

Moderate:

vandetanib

Vandetanib has a moderate potential interaction with Posterior Reversible Encephalopathy Syndrome.

Reversible posterior leukoencephalopathy syndrome (RPLS), a syndrome of subcortical vasogenic edema diagnosed by an MRI of the brain, has occurred in patients treated with vandetanib. Consider this syndrome in any patient presenting with seizures, headache, visual disturbances, confusion or altered mental function. It is recommended to discontinue therapy in patients developing RPLS.

Pulmonary Impairment

Moderate:

vandetanib

Vandetanib has a moderate potential interaction with Pulmonary Impairment.

The use of certain multikinase inhibitors has been associated with pulmonary toxicity. Serious cases of interstitial lung disease (ILD), including fatal cases and interstitial pneumonitis or pulmonary fibrosis have been reported. Caution is recommended when using these agents in patients with a history of interstitial pneumonitis or pulmonary fibrosis or those patients presenting with acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever pending diagnostic evaluation. If ILD is confirmed, these agents should be permanently discontinued and appropriate measures should be instituted. Treatment should be immediately withheld in patients diagnosed with ILD/pneumonitis and permanently discontinued if no other potential causes of ILD/pneumonitis have been identified.

Renal Dysfunction

Moderate:

Ubrelvy

The ubrogepant in Ubrelvy has a moderate potential interaction with Renal Dysfunction.

It is recommended to avoid the use of ubrogepant in patients with end-stage renal disease (CrCl <15 mL/min). No dosing recommendations can be made for these patients. A dose adjustment is recommended for patients with severe renal impairment (CrCl 15-29 mL/min). No dose adjustments are recommended for patients with mild or moderate renal impairment.

Moderate:

vandetanib

Vandetanib has a moderate potential interaction with Renal Dysfunction.

Vandetanib exposure is increased in patients with impaired renal function. It is recommended to reduce the starting dose in patients with moderate to severe renal impairment and monitor the QT interval closely. There is no information available for patients with end-stage renal disease requiring dialysis.

Underactive Thyroid

Moderate:

vandetanib

Vandetanib has a moderate potential interaction with Underactive Thyroid.

Increased dosing of thyroid replacement therapy was required in patients with a prior thyroidectomy. It is recommended to obtain Thyroid-stimulating hormone (TSH) at baseline, during therapy and thereafter as clinically indicated. If signs or symptoms of hypothyroidism occur, examine thyroid hormone levels and adjust thyroid replacement therapy accordingly.

More resources

Ubrelvy

A total of 268 drugs are known to interact with Ubrelvy.

vandetanib

A total of 343 drugs are known to interact with vandetanib.

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.