Drug Interaction Report

GENERALLY AVOID: Coadministration of deucravacitinib with other immunosuppressive agents may potentiate the risk of infections as well as lymphoma and other malignancies. Serious infections have been reported in patients with psoriasis who received deucravacitinib. The most common serious infections reported with deucravacitinib included pneumonia and COVID-19. Herpes zoster and herpes simplex viral reactivation were also reported during clinical studies with deucravacitinib, as well as malignancies including lymphoma.

MANAGEMENT: The safety and efficacy of deucravacitinib in combination with immunosuppressive agents has not been evaluated. The manufacturer recommends that the concomitant use of deucravacitinib with potent immunosuppressants (e.g., azathioprine, cyclosporine) should be avoided. Patients receiving deucravacitinib should be closely monitored for the development of signs and symptoms of infection during and after treatment, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy. If a serious infection develops, deucravacitinib should be interrupted until the infection is controlled.

ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of bosutinib. When given with a high-fat meal, bosutinib peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 1.8- and 1.7-fold, respectively.

GENERALLY AVOID: Coadministration with grapefruit juice is likely to increase the plasma concentrations of bosutinib, which is primarily metabolized by CYP450 3A4. However, the interaction has not been studied. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit.

MANAGEMENT: Bosutinib should be administered with a meal. The consumption of grapefruit, grapefruit juice, and supplements that contain grapefruit extract should be avoided.