Drug Interaction Report

MONITOR: Coadministration with sarecycline may increase the plasma concentrations of drugs that are substrates of the P-glycoprotein (P-gp) transporter. The proposed mechanism is decreased clearance in the intestine, kidney, and/or liver due to inhibition of P-gp-mediated efflux by sarecycline. When the probe P-gp substrate digoxin was coadministered with a single 150 mg dose of sarecycline, digoxin peak plasma concentration (Cmax) increased by 26%.

MANAGEMENT: Caution is advised when sarecycline is used concurrently with drugs that are P-gp substrates, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for some drugs whenever sarecycline is added to or withdrawn from therapy.

Administration with food may delay the absorption of modafinil (the racemate) and armodafinil (the R-enantiomer) without significantly affecting their overall bioavailability. According to the product labeling, modafinil's absorption may be delayed by approximately one hour if taken with food. Similarly, the time to reach peak plasma concentration (Tmax) of armodafinil may be delayed by approximately 2 to 4 hours in the fed state.