x and St. John's wort; venetoclax levels may be significantly decreased and its efficacy reduced. Venetoclax is a CYP3A4 substrate and St. John's wort is a strong CYP3A4 inducer. Consider alternative agents. In a drug interaction study in healthy subjects (n = 10), 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.
Streptogramins: Avoid the concomitant use of venetoclax and dalfopristin; quinupristin. Venetoclax is a CYP3A4 substrate and quinupristin 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 dalfopristin; quinupristin 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.
Suvorexant: Avoid the concomitant use of venetoclax and suvorexant; venetoclax is a substrate of P-glycoprotein (P-gp) and suvorexant 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 suvorexant 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.
Tacrolimus: Avoid the concomitant use of venetoclax and tacrolimus, as levels for both drugs may increase. 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) and administer tacrolimus at least 6 hours before venetoclax. If tacrolimus 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 and tacrolimus toxicity. Venetoclax is a substrate of P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) and may be a P-gp inhibitor at therapeutic dose levels in the gut; tacrolimus is an inhibitor of P-gp and BCRP and a P-gp substrate with a narrow therapeutic index. 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.
Tamoxifen: Avoid the concomitant use of venetoclax and tamoxifen; venetoclax is a substrate of CYP3A4 and P-glycoprotein (P-gp) and tamoxifen is a CYP3A4 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 tamoxifen is discontinued, wait 2 to 3 days and then resume the recommended venetoclax dosage (or prior dosage if less). |
