Drug Interaction Report

MONITOR: The concomitant use of anticoagulants may theoretically increase the risk of sunitinib-induced bleeding. Severe and life-threatening tumor hemorrhage, hemoptysis, and pulmonary hemorrhage, and nonserious epistaxis have occurred during treatment with sunitinib.

MANAGEMENT: Monitoring for clinical and laboratory signs of bleeding is recommended during concomitant therapy, including INR/PT and complete blood counts. Patients should be advised to promptly report any potential signs of bleeding to their doctor, including nosebleeds, pain, swelling, or headache.

GENERALLY AVOID: Consumption of grapefruit or grapefruit juice during sunitinib therapy may increase the plasma concentrations of sunitinib. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism by certain compounds present in grapefruit.

MANAGEMENT: Although clinical data are lacking, it may be advisable to avoid the consumption of large amounts of grapefruit or grapefruit juice during sunitinib therapy.