Drug Interaction Report

MONITOR: Based on in vitro data, coadministration with enasidenib may increase the plasma concentrations of drugs that are substrates of the transporters, organic anion transporting polypeptides (OATP) 1B1/1B3 and breast cancer resistance protein (BCRP). The proposed mechanism is decreased clearance due to enasidenib -mediated inhibition of OATP1B1/1B3 and BCRP transporters. There are no clinical data regarding the use of enasidenib with these substrates.

MANAGEMENT: Caution is advised when enasidenib is used concurrently with medications that are substrates of OATP 1B1/1B3 and/or BCRP, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for some drugs whenever enasidenib is added to or withdrawn from therapy.

ADJUST DOSING INTERVAL: Oral cladribine may increase the bioavailability of other drugs, which may increase the risk or severity of adverse reactions. Cladribine tablets may contain hydroxypropyl betadex, which could form a complex with the active ingredients of other drugs, especially agents with low solubility. The clinical relevance of this interaction remains unknown.

MANAGEMENT: Administration of oral cladribine should be separated from any other oral drug by at least 3 hours.