Drug Interaction Report

MONITOR: Coadministration with talquetamab may increase the plasma concentrations of drugs that are substrates of CYP450 isoenzymes. Treatment with talquetamab causes release of cytokines that may suppress the activity of CYP450 isoenzymes, although the potential for interactions has not been studied. According to the manufacturer, the highest drug-drug interaction risk would likely be observed from the initiation of talquetamab up to 14 days after the first treatment dose as well as during and after cytokine release syndrome.

MANAGEMENT: Caution is advised when talquetamab is coadministered with drugs that are primarily metabolized by CYP450 isoenzymes, particularly those with a narrow therapeutic index (e.g., antiarrhythmics, anticonvulsants, immunosuppressants, theophylline, warfarin) or sensitive substrates where increases in plasma levels may be substantial or undesirable (e.g., antineoplastic agents, benzodiazepines, ergot alkaloids, opioids, statins). Clinical and/or laboratory monitoring should be considered following the initiation or withdrawal of talquetamab, and the individual dosage of the concomitant agents may be adjusted as needed.

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including oliceridine. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

GENERALLY AVOID: Grapefruit or grapefruit juice may increase the plasma concentrations of oliceridine by inhibiting the CYP450 3A4-mediated metabolism of oliceridine, although the interaction has not been studied. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Patients should not consume alcoholic beverages or use drug products that contain alcohol during treatment with oliceridine. Any history of alcohol or illicit drug use should be considered when prescribing oliceridine, and therapy initiated at a lower dosage if necessary. Patients should be closely monitored for signs and symptoms of sedation, respiratory depression, and hypotension. Due to a high degree of interpatient variability with respect to grapefruit juice interactions, patients treated with oliceridine should preferably avoid the consumption of grapefruit and grapefruit juice.