Drug Interaction Report

MONITOR: Coadministration with niraparib may increase the plasma concentrations of drugs that are substrates of the breast cancer resistance protein (BCRP) transporter. The proposed mechanism is BCRP inhibition by niraparib. In vitro studies have shown that niraparib is able to inhibit BCRP, but a clinically meaningful interaction is unlikely.

MANAGEMENT: Caution is recommended if niraparib is used in combination with substrates of the breast cancer resistance protein (BCRP) transporter such as irinotecan, rosuvastatin, simvastatin, atorvastatin, and/or methotrexate. Monitoring for signs and symptoms of increased exposure to the BCRP substrate should be considered whenever niraparib is added to or withdrawn from therapy.

ADJUST DOSING INTERVAL: Food may reduce the oral bioavailability of afatinib. According to the product labeling, administration of afatinib with a high-fat meal decreased peak plasma concentration (Cmax) by 50% and systemic exposure (AUC) by 39% compared to administration in the fasted state.

MANAGEMENT: Afatinib should be taken at least 1 hour before or 2 hours after a meal.