Drug Interaction Report

MONITOR: Coadministration with gilteritinib may increase the plasma concentrations and the risk of adverse effects of orally administered drugs that are substrates of the intestinal P-glycoprotein (P-gp), breast cancer resistance protein (BCRP), and/or organic cation transporter 1 (OCT1) transporters, such as dabigatran, digoxin, rosuvastatin, methotrexate, and metformin. The proposed mechanism, based on in vitro data, is decreased clearance due to gilteritinib-mediated inhibition of intestinal P-gp, BCRP, and/or OCT1 efflux transport proteins.

MANAGEMENT: Until more information is available, caution is advised if gilteritinib is used concomitantly with drugs that are substrates of the intestinal P-gp, BCRP, and/or OCT1 transport proteins, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring should be considered whenever gilteritinib is added to or withdrawn from therapy with these drugs. Patients should be monitored for the development of adverse effects.

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.