Drug Interaction Report

MONITOR: Coadministration with gilteritinib may increase the plasma concentrations and the risk of adverse effects of orally administered drugs that are substrates of the intestinal P-glycoprotein (P-gp), breast cancer resistance protein (BCRP), and/or organic cation transporter 1 (OCT1) transporters, such as dabigatran, digoxin, rosuvastatin, methotrexate, and metformin. The proposed mechanism, based on in vitro data, is decreased clearance due to gilteritinib-mediated inhibition of intestinal P-gp, BCRP, and/or OCT1 efflux transport proteins.

MANAGEMENT: Until more information is available, caution is advised if gilteritinib is used concomitantly with drugs that are substrates of the intestinal P-gp, BCRP, and/or OCT1 transport proteins, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring should be considered whenever gilteritinib is added to or withdrawn from therapy with these drugs. Patients should be monitored for the development of adverse effects.

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of ixabepilone. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.

MANAGEMENT: Patients treated with ixabepilone should avoid the consumption of grapefruit or grapefruit juice.