Drug Interaction Report
8 potential interactions and/or warnings found for the following 2 drugs:
- dextromethorphan / quinidine
- deutivacaftor / tezacaftor / vanzacaftor
Interactions between your drugs
quiNIDine dextromethorphan
Applies to: dextromethorphan / quinidine, dextromethorphan / quinidine
Using dextromethorphan together with quiNIDine may increase the effects of dextromethorphan. Contact your doctor if you experience difficulty breathing, dizziness, drowsiness, anxiety, restless feeling, nervousness, confusion, or diarrhea. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. 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.
quiNIDine tezacaftor
Applies to: dextromethorphan / quinidine, deutivacaftor / tezacaftor / vanzacaftor
Consumer information for this interaction is not currently available.
MONITOR: Coadministration with tezacaftor and/or deutivacaftor may increase the plasma concentrations of drugs that are substrates of the P-glycoprotein (P-gp) efflux transporter. The mechanism is decreased clearance via inhibition of the transporter by tezacaftor and/or deutivacaftor. In study subjects, digoxin (single 0.5 mg dose) systemic exposure (AUC) increased by 1.3-fold when it was administered with tezacaftor 25 mg and ivacaftor 50 mg daily. No pharmacokinetic data are available for deutivacaftor, but increased exposures of certain P-gp substrates are expected according to prescribing information.
MANAGEMENT: Caution is advised when tezacaftor and/or deutivacaftor are used with drugs that are P-gp substrates, particularly those where minimal concentration changes may lead to serious adverse reactions.
quiNIDine deutivacaftor
Applies to: dextromethorphan / quinidine, deutivacaftor / tezacaftor / vanzacaftor
Consumer information for this interaction is not currently available.
MONITOR: Coadministration with tezacaftor and/or deutivacaftor may increase the plasma concentrations of drugs that are substrates of the P-glycoprotein (P-gp) efflux transporter. The mechanism is decreased clearance via inhibition of the transporter by tezacaftor and/or deutivacaftor. In study subjects, digoxin (single 0.5 mg dose) systemic exposure (AUC) increased by 1.3-fold when it was administered with tezacaftor 25 mg and ivacaftor 50 mg daily. No pharmacokinetic data are available for deutivacaftor, but increased exposures of certain P-gp substrates are expected according to prescribing information.
MANAGEMENT: Caution is advised when tezacaftor and/or deutivacaftor are used with drugs that are P-gp substrates, particularly those where minimal concentration changes may lead to serious adverse reactions.
Drug and food interactions
quiNIDine food
Applies to: dextromethorphan / quinidine
Do not consume grapefruit or grapefruit juice during treatment with quiNIDine unless specifically directed otherwise by your doctor. Grapefruit and grapefruit juice can interact with quiNIDine and increase the levels of quiNIDine in your body. If you are already consuming grapefruit products, do not increase or decrease the amount of these products in your diet without first talking to your doctor.
dextromethorphan food
Applies to: dextromethorphan / quinidine
Alcohol can increase the nervous system side effects of dextromethorphan such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with dextromethorphan. Do not use more than the recommended dose of dextromethorphan, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.
tezacaftor food
Applies to: deutivacaftor / tezacaftor / vanzacaftor
Consumer information for this interaction is not currently available.
GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of tezacaftor, deutivacaftor, and vanzacaftor. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. 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. The risk and/or severity of serious side effects such as liver damage may be increased.
ADJUST DOSING INTERVAL: Administration with fat-containing food may increase the oral bioavailability of vanzacaftor and deutivacaftor. Administration with a fat containing meal increased vanzacaftor systemic exposure (AUC) by 4- (low-fat meal) to 6- (high-fat meal) fold. While deutivacaftor AUC increased approximately 3- (low-fat meal) to 4- (high-fat meal) fold, relative to administration in a fasting state. Tezacaftor exposure is not significantly affected by administration of fat-containing foods.
MANAGEMENT: Patients treated with tezacaftor, deutivacaftor, vanzacaftor -containing medications should avoid consumption of grapefruit juice and any food that contains grapefruit. To improve absorption, patients should be advised to take vanzacaftor and/or deutivacaftor containing medications with fat-containing foods such as eggs, avocados, nuts, meat, butter, peanut butter, cheese pizza, and whole-milk dairy products at approximately the same time of the day. A typical cystic fibrosis diet will satisfy this requirement.
vanzacaftor food
Applies to: deutivacaftor / tezacaftor / vanzacaftor
Consumer information for this interaction is not currently available.
GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of tezacaftor, deutivacaftor, and vanzacaftor. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. 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. The risk and/or severity of serious side effects such as liver damage may be increased.
ADJUST DOSING INTERVAL: Administration with fat-containing food may increase the oral bioavailability of vanzacaftor and deutivacaftor. Administration with a fat containing meal increased vanzacaftor systemic exposure (AUC) by 4- (low-fat meal) to 6- (high-fat meal) fold. While deutivacaftor AUC increased approximately 3- (low-fat meal) to 4- (high-fat meal) fold, relative to administration in a fasting state. Tezacaftor exposure is not significantly affected by administration of fat-containing foods.
MANAGEMENT: Patients treated with tezacaftor, deutivacaftor, vanzacaftor -containing medications should avoid consumption of grapefruit juice and any food that contains grapefruit. To improve absorption, patients should be advised to take vanzacaftor and/or deutivacaftor containing medications with fat-containing foods such as eggs, avocados, nuts, meat, butter, peanut butter, cheese pizza, and whole-milk dairy products at approximately the same time of the day. A typical cystic fibrosis diet will satisfy this requirement.
deutivacaftor food
Applies to: deutivacaftor / tezacaftor / vanzacaftor
Consumer information for this interaction is not currently available.
GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of tezacaftor, deutivacaftor, and vanzacaftor. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. 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. The risk and/or severity of serious side effects such as liver damage may be increased.
ADJUST DOSING INTERVAL: Administration with fat-containing food may increase the oral bioavailability of vanzacaftor and deutivacaftor. Administration with a fat containing meal increased vanzacaftor systemic exposure (AUC) by 4- (low-fat meal) to 6- (high-fat meal) fold. While deutivacaftor AUC increased approximately 3- (low-fat meal) to 4- (high-fat meal) fold, relative to administration in a fasting state. Tezacaftor exposure is not significantly affected by administration of fat-containing foods.
MANAGEMENT: Patients treated with tezacaftor, deutivacaftor, vanzacaftor -containing medications should avoid consumption of grapefruit juice and any food that contains grapefruit. To improve absorption, patients should be advised to take vanzacaftor and/or deutivacaftor containing medications with fat-containing foods such as eggs, avocados, nuts, meat, butter, peanut butter, cheese pizza, and whole-milk dairy products at approximately the same time of the day. A typical cystic fibrosis diet will satisfy this requirement.
Therapeutic duplication warnings
No duplication 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.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
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