Drug Interaction Report

MONITOR: Coadministration with inhibitors of organic anion transporting polypeptides (OATP) 1B1 and/or 1B3 may increase the plasma concentrations and effects of momelotinib, which is a substrate of the hepatic uptake transporters. Clinical studies have demonstrated that concomitant use with a single dose of the OATP1B1/B3 inhibitor rifampin increased the peak plasma concentration (Cmax) and systemic exposure (AUC) of momelotinib by 40% and 57% respectively. The Cmax and AUC of the active metabolite of momelotinib, M21, was also increased, by 6% and 12%, respectively.

MANAGEMENT: Caution is advised if momelotinib is used in combination with inhibitors of OATP1B1 and/or 1B3. Dosage adjustments of momelotinib may be required. Patients should be advised to report any momelotinib-related adverse reactions such as bacterial or viral infection, thrombocytopenia, neutropenia, hepatotoxicity, thrombosis, and adverse cardiovascular events.

CONTRAINDICATED: Consumption of more than 3 alcoholic beverages per day may increase the risk of acute pancreatitis during treatment with eluxadoline. Pancreatitis has been reported rarely during clinical trials of eluxadoline, and may or may not be related to sphincter of Oddi spasm.

ADJUST DOSING INTERVAL: High-fat meals may reduce the oral bioavailability of eluxadoline. In 28 healthy volunteers, administration of a single 100 mg dose of eluxadoline with a high-fat meal (approximately 800 to 1000 total calories, 50% from fat) decreased eluxadoline peak plasma concentration (Cmax) and systemic exposure (AUC) by 50% and 60%, respectively, compared to administration in the fasted state. There was no significant effect on the time to peak concentration (Tmax). The clinical relevance of this interaction is unknown. It should be noted that phase 3 clinical trials were conducted under fed conditions.

MANAGEMENT: Chronic or acute excessive use of alcohol should be avoided during treatment with eluxadoline. Alcoholism, alcohol abuse, alcohol addiction, and consumption of more than 3 alcoholic beverages per day are considered contraindications to the use of eluxadoline. The product labeling recommends taking eluxadoline with food. Patients should be advised to stop taking eluxadoline and seek medical attention if they experience potential symptoms of pancreatitis such as persistent nausea, vomiting, abdominal tenderness, and upper abdominal pain, especially that which is made worse after eating or radiates to the back or shoulders.