Drug Interaction Report

GENERALLY AVOID: Coadministration of ritlecitinib with other immunosuppressive agents may potentiate the risk of infections as well as malignancies, including non-melanoma skin cancer (NMSC). Serious infections have been reported in patients who have received ritlecitinib. The most common serious infections reported with ritlecitinib included appendicitis, pneumonia, COVID-19, and sepsis. Herpes virus reactivation (e.g., herpes zoster) was also reported during clinical studies with ritlecitinib, as well as malignancies including NMSC.

MANAGEMENT: The safety and efficacy of ritlecitinib in combination with immunosuppressive agents has not been evaluated. It is recommended that the concomitant use of ritlecitinib with other Janus Kinase (JAK) inhibitors, biologic immunomodulators, cyclosporine, or other potent immunosuppressants be avoided. Some authorities recommend avoiding ritlecitinib with all systemic immunosuppressive agents. Patients receiving ritlecitinib 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, ritlecitinib therapy should be interrupted until the infection is controlled.

ADJUST DOSING INTERVAL: Administration of trifluridine-tipiracil with a standardized high-fat, high-calorie meal has been shown to decrease trifluridine peak plasma concentration (Cmax) as well as tipiracil Cmax and systemic exposure (AUC) by approximately 40% compared to administration in a fasting state in patients with cancer given a single 35 mg/m2 dose. No change in trifluridine AUC was observed.

MANAGEMENT: Based on the observed correlation between increases in the Cmax of trifluridine and decreases in neutrophil counts, trifluridine-tipiracil should be taken within one hour after completion of the morning and evening meals.