r. Use of venetoclax with a moderate CYP3A4 inducer has not been eva luated.
Delavirdine: Avoid the concomitant use of venetoclax and delavirdine; venetoclax is a CYP3A4 substrate and delavirdine is a strong CYP3A4 inhibitor. The concomitant use of these agents together is contraindicated during the initial and dose titration phase of venetoclax. If concomitant use of these drugs is required when the patient is on a steady venetoclax dose (after the titration phase), reduce the venetoclax dosage by at least 75% (maximum dose of 100 mg/day). If delavirdine is discontinued, wait 2 to 3 days and then resume the recommended venetoclax dosage (or prior dosage if less). Monitor patients for signs and symptoms of venetoclax toxicity such as hematologic toxicity, GI toxicity, and tumor lysis syndrome. In a drug interaction study, the venetoclax Cmax and AUC values were increased by 2.3-fold and 6.4-fold, respectively, when a strong CYP3A4 inhibitor was co-administered in NHL patients.
Dexamethasone: Avoid the concomitant use of venetoclax and dexamethasone; venetoclax levels may be decreased and its efficacy reduced. Venetoclax is a CYP3A4 substrate and dexamethasone is a moderate CYP3A4 inducer. Consider alternative agents. In a drug interaction study (n = 11), the venetoclax Cmax and AUC values were decreased by 42% and 71%, respectively, following the co-administration of multiple doses of a strong CYP3A4 inducer. Use of venetoclax with a moderate CYP3A4 inducer has not been eva luated.
Dextromethorphan; Quinidine: Avoid the concomitant use of venetoclax and quinidine; venetoclax is a substrate of P-glycoprotein (P-gp) and quinidine is an inhibitor of P-gp. Consider alternative agents. If concomitant use of these drugs is required, reduce the venetoclax dosage by at least 50% (maximum dose of 200 mg/day). If quinidine is discontinued, wait 2 to 3 days and then resume the recommended venetoclax dosage (or prior dosage if less). Monitor patients for signs and symptoms of venetoclax toxicity such as hematologic toxicity, GI toxicity, and tumor lysis syndrome. In a drug interaction study (n = 11), the venetoclax Cmax and AUC values were increased by 106% and 78%, respectively, when a P-gp inhibitor was co-administered in healthy subjects.
Digoxin: Avoid the concomitant use of venetoclax and digoxin as digoxin levels may be increased. If concomitant use of these drugs is required, administer digoxin at least 6 hours before venetoclax. Monitor patients for signs and symptoms of digoxin toxicity. Venetoclax is an inhibitor of P-glycoprotein (P-gp) and digoxin is a P-gp substrate with a narrow therapeutic index; these agents may interact in the gastrointestinal tract.
Diltiazem: Avoid the concomitant use of venetoclax and diltiazem; venetoclax is a substrate of CYP3A4 and P-glycoprotein (P-gp) and diltiazem is a CYP3A4 (moderate) and P-gp inhibitor. Consider alternative agents. If concomitant use of these drugs is required, reduce the venetoclax dosage by at least 50% (maximum dose of 200 mg/day). If diltiazem is discontinued, wait 2 to 3 days and then resume the recommended venetoclax dosage (or prior dosage if less). Monitor patients for signs and symptoms of venetoclax toxicity such as hematologic toxicity, GI toxicity, and tumor lysis syndrome. In a drug interaction study (n = 11), the venetoclax Cmax and AUC values were increased by 106% and 78%, respectively, when a P-gp inhibitor was co-administered in healthy subjects.
Dronedarone: Avoid the concomitant use of venetoclax an |
