Drug Interaction Report

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Ivosidenib can cause prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. Based on an analysis of 171 patients with an isocitrate dehydrogenase-1 mutation who received ivosidenib 500 mg daily, a concentration-dependent QTc interval prolongation of approximately 16.1 msec was observed at steady-state peak plasma concentration (Cmax). In a clinical trial of 258 patients treated with ivosidenib, 9% were found to have a QTc interval greater than 500 msec and 14% had an increase from baseline QTc greater than 60 msec. One patient developed ventricular fibrillation attributed to ivosidenib. The clinical trial excluded patients with baseline QTc >=450 msec and those with a history of long QT syndrome or uncontrolled or significant cardiovascular disease. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia, hypocalcemia). Moreover, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).

MANAGEMENT: Coadministration of ivosidenib with other drugs that can prolong the QT interval should generally be avoided. Otherwise, close monitoring of electrocardiograms and electrolytes is recommended. If QT prolongation occurs during treatment, withhold and/or reduce dose in accordance with the product labeling. Ivosidenib should be permanently discontinued in patients who develop QT prolongation with signs or symptoms of life-threatening arrhythmia.

Do not consume grapefruit or grapefruit juice during treatment with ivosidenib unless directed otherwise by your doctor. Grapefruit juice can increase the blood levels of ivosidenib. This may increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. You may take ivosidenib with or without food, but avoid taking it with a high-fat meal, as this can also increase blood levels of the medication. An example of a high-fat meal includes 2 eggs fried in butter, 2 strips of bacon, 2 slices of white bread with butter, 1 croissant with 1 slice of cheese, and 8 ounces of whole milk (approximately 1,000 calories and 58 grams of fat). You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.