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Drug Interactions between Xofigo and Zytiga

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

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Interactions between your drugs

Major

abiraterone radium Ra 223 dichloride

Applies to: Zytiga (abiraterone) and Xofigo (radium 223 dichloride)

GENERALLY AVOID: The concomitant use of radium Ra 223 dichloride and abiraterone acetate plus a corticosteroid may increase the risk of death and fractures in patients with castration-resistant prostate cancer who have bone metastases. At the primary analysis of the ERA-223 trial (n=806), an increased incidence of mortality (39% vs 36%) and fractures (29% vs 11%) was observed in patients who received abiraterone acetate plus prednisone/prednisolone in combination with radium Ra 223 dichloride compared to patients who received placebo in combination with abiraterone acetate plus prednisone.

MANAGEMENT: The use of abiraterone acetate plus a corticosteroid in combination with radium Ra 223 dichloride is not recommended. Some authorities consider this combination to be contraindicated. It has been recommended that radium Ra 223 dichloride not be initiated for at least 5 days following the last administration of abiraterone acetate in combination with a corticosteroid. Continued monitoring for fractures should be considered in patients previously treated with this combination.

References

  1. (2019) "Product Information. Xofigo (radium Ra 223 dichloride)." Bayer Pharmaceutical Inc
  2. EMA. European Medicines Agency. European Union (2013) EMA - List of medicines under additional monitoring. http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000366.jsp&mid=WC0b01ac058067c852
  3. Bayer HealthCare Pharmaceuticals, Inc (2018) Important Drug Warning: Xofigo. https://hcp.xofigo-us.com/downloads/pdf/PP-600-US-3282%20Xofigo%20November%202017%20DHCP%20Letter%20-%20Digital%20Version.pdf
  4. European Medicines Agency (2018) Prostate cancer medicine Xofigo must not be used with Zytiga and prednisone/prednisolone. http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Xofigo_20/Under_evaluation/WC500245467.pdf
  5. (2023) "Product Information. Akeega (abiraterone-niraparib)." Janssen Biotech, Inc.
  6. (2021) "Product Information. Zytiga (abiraterone)." Janssen Biotech, Inc.
  7. (2022) "Product Information. Yonsa (abiraterone)." Sun Pharmaceutical Industries
  8. (2023) "Product Information. Apo-Abiraterone (abiraterone)." Apotex Inc
  9. (2021) "Product Information. Zytiga (abiraterone)." Janssen-Cilag Pty Ltd
  10. (2023) "Product Information. Abiraterone (abiraterone)." Wockhardt UK Ltd
  11. (2023) "Product Information. Yonsa Mpred (abiraterone-methylprednisolone)." Sun Pharma ANZ Pty Ltd
View all 11 references

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Drug and food interactions

Moderate

abiraterone food

Applies to: Zytiga (abiraterone)

ADJUST DOSING INTERVAL: Food may significantly increase the oral bioavailability of some formulations of abiraterone acetate. Compared to administration in the fasted state, abiraterone peak plasma concentration (Cmax) and systemic exposure (AUC) were approximately 7- and 5-fold higher, respectively, when a single dose of abiraterone acetate was administered with a low-fat meal (7% fat; 300 calories) and approximately 17- and 10-fold higher, respectively, when it was administered with a high-fat meal (57% fat; 825 calories). Given the normal variation in the content and composition of meals, taking abiraterone acetate with meals has the potential to result in increased and highly variable exposures. The safety of these increased exposures during multiple dosing has not been assessed. However, the abiraterone acetate 125 mg tablet, commonly marketed as Yonsa, was found to have an approximately 6.5-fold higher Cmax and 4.4-fold higher AUC when a single dose of 500 mg (4 tablets) was administered with a high-fat meal (56% - 60% fat, 900 - 1000 calories) compared to overnight fasting in healthy volunteers. These differences were not considered clinically significant for this formulation.

MANAGEMENT: Some formulations of abiraterone acetate must be taken on an empty stomach. No food should be consumed for at least two hours before and one hour after the abiraterone acetate dose. However, the abiraterone acetate 125 mg tablet, commonly marketed as Yonsa, can be taken with or without food. The manufacturer's product labeling should be consulted for specific guidance.

References

  1. (2011) "Product Information. Zytiga (abiraterone)." Centocor Inc
  2. (2023) "Product Information. Akeega (abiraterone-niraparib)." Janssen Biotech, Inc.
  3. (2023) "Product Information. Akeega (abiraterone-niraparib)." Janssen Inc
  4. (2021) "Product Information. Zytiga (abiraterone)." Janssen Biotech, Inc.
  5. (2022) "Product Information. Yonsa (abiraterone)." Sun Pharmaceutical Industries
  6. (2023) "Product Information. Apo-Abiraterone (abiraterone)." Apotex Inc
  7. (2021) "Product Information. Zytiga (abiraterone)." Janssen-Cilag Pty Ltd
  8. (2023) "Product Information. Abiraterone (abiraterone)." Wockhardt UK Ltd
  9. (2023) "Product Information. Yonsa Mpred (abiraterone-methylprednisolone)." Sun Pharma ANZ Pty Ltd
View all 9 references

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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

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