Drug Interaction Report

MONITOR: Cladribine exposure may be decreased by potent inducers of breast cancer resistance protein (BCRP) or P-glycoprotein (P-gp). The mechanism involves induction of BCRP and/or P-gp as cladribine is a substrate of each of these transporter systems. The clinical relevance remains unknown.

MANAGEMENT: Possible decreases in cladribine exposure and efficacy should be considered if potent inducers of BCRP or P-gp are coadministered.

ADJUST DOSING INTERVAL: Oral cladribine may increase the bioavailability of other drugs, which may increase the risk or severity of adverse reactions. Cladribine tablets may contain hydroxypropyl betadex, which could form a complex with the active ingredients of other drugs, especially agents with low solubility. The clinical relevance of this interaction remains unknown.

MANAGEMENT: Administration of oral cladribine should be separated from any other oral drug by at least 3 hours.