Drug Interaction Report

MONITOR: Coadministration with danicopan may increase the plasma concentrations of drugs that are substrates of the efflux transporters breast cancer resistance protein (BCRP) and/or P-glycoprotein (P-gp). The proposed mechanism involves decreased clearance due to inhibition of BCRP and P-gp by danicopan. In clinical drug interaction studies, when subjects were coadministered the BCRP substrate rosuvastatin (single 20 mg dose) with danicopan at steady state (200 mg three times daily for 4 days), the peak plasma concentration (Cmax) and systemic exposure (AUC) of rosuvastatin increased by 3.3-fold and 2.2-fold, respectively. In addition, when the P-gp substrate fexofenadine (single 180 mg dose) was coadministered with danicopan (150 mg three times daily for 4 days), the peak plasma concentration (Cmax) and systemic exposure (AUC) of fexofenadine increased by 1.4-fold and 1.6-fold, respectively. Similarly, when subjects were coadministered the P-gp substrate tacrolimus (single 2 mg dose) with danicopan (200 mg three times daily for 5 days), the Cmax and AUC of tacrolimus increased by 1.1-fold and 1.5-fold, respectively.

MANAGEMENT: Caution and clinical monitoring are recommended if danicopan is coadministered with drugs that are substrates of the transporters BCRP and/or P-gp, particularly sensitive substrates, or those with a narrow therapeutic range. Dosage adjustments as well as closer clinical and laboratory monitoring for the development of adverse effects may be appropriate for some drugs whenever danicopan is added to or withdrawn from therapy. Individual product labeling should be consulted for further guidance.

Food prolongs the gastrointestinal absorption of selexipag. When taken with food, the time to peak concentration (Tmax) was delayed and peak plasma concentration (Cmax) was approximately 30% lower. Selexipag systemic exposure (AUC) and that of its active metabolite did not significantly change, however. Selexipag may be taken with or without food. Tolerability may be improved when taken with food.