Drug Interaction Report

MONITOR CLOSELY: Coadministration of loncastuximab tesirine with antineoplastic, immune-modulating, immuno- or myelosuppressive therapies may potentiate the risk of severe infections, myelosuppression, and/or other unintended additive immunosuppressive effects. Serious and fatal infections, including opportunistic infections, as well as myelosuppression, including neutropenia, thrombocytopenia, and anemia have been reported with the use of loncastuximab tesirine. Concomitant use may potentiate these risks. However, clinical data are not available.

MANAGEMENT: The safety and efficacy of loncastuximab tesirine use in combination with other immuno- or myelosuppressive agents have not been evaluated. Patients receiving loncastuximab tesirine should be monitored closely for the development of signs and symptoms of infection and/or myelosuppression. The manufacturers' recommendations and institutional protocols for dosage, treatment regimens, monitoring, and management of toxicities should be consulted.

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of nilotinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Because nilotinib is associated with concentration-dependent prolongation of the QT interval, increased levels may potentiate the risk of ventricular arrhythmias such as torsade de pointes and sudden death.

ADJUST DOSING INTERVAL: Food increases the oral bioavailability of nilotinib. The mechanism of interaction is unknown. Compared to the fast state, nilotinib systemic exposure (AUC) increased by 82% when the dose was given 30 minutes after a high-fat meal. Because nilotinib is associated with concentration-dependent prolongation of the QT interval, increased levels may potentiate the risk of ventricular arrhythmias such as torsade de pointes and sudden death.

MANAGEMENT: Patients treated with nilotinib should avoid consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract. In addition, no food should be consumed for at least 2 hours before and 1 hour after a nilotinib dose.