Drug Interaction Report

Imatinib may significantly increase the blood levels of bosutinib. This can increase side effects such as nausea, vomiting, abdominal pain, diarrhea, liver problems, fluid retention, and impaired bone marrow function resulting in low numbers of different types of blood cells. You may also be more likely to develop anemia, bleeding problems, or infections due to low blood cell counts. You should seek medical attention if you develop paleness, fatigue, dizziness, fainting, unusual bruising or bleeding, fever, chills, diarrhea, sore throat, muscle aches, shortness of breath, blood in phlegm, weight loss, red or inflamed skin, body sores, and pain or burning during urination. Talk to your doctor if you have any questions or concerns. You may be advised not to take bosutinib until you have completed treatment with imatinib, or you may require a dose adjustment and more frequent monitoring to safely use both medications together. Your doctor may also be able to prescribe alternatives that do not interact. 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.

Grapefruit juice may increase the blood levels of certain medications such as imatinib. You should avoid consumption of grapefruit and grapefruit juice during treatment with imatinib. However, if you have been regularly consuming grapefruit or grapefruit juice with the medication, then it is advisable for you to talk with your doctor before changing the amounts of these products in your diet, as this may alter the effects of your medication. Contact your doctor if your condition changes or you experience increased side effects. Orange juice is not expected to interact.

Bosutinib should be taken with a meal to help with its absorption. Do not consume grapefruit, grapefruit juice, or any supplements that contain grapefruit extract during treatment with bosutinib unless directed otherwise by your doctor. Grapefruit juice can significantly increase the blood levels of bosutinib. You may be more likely to experience side effects such as nausea, vomiting, abdominal pain, diarrhea, liver damage, and impaired bone marrow function resulting in low numbers of different types of blood cells, which can increase the risk of anemia, bleeding problems, and infections. 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.

The recommended maximum number of medicines in the 'BCR-ABL tyrosine kinase inhibitors' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'BCR-ABL tyrosine kinase inhibitors' category:

• bosutinib
• Gleevec (imatinib)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.