gation has occurred during therapeutic use of atomoxetine and following overdose. Concomitant use may increase the risk for QT prolongation.
Atorvastatin: (Moderate) Use caution if coadministration of ribociclib, a moderate CYP3A4 inhibitor, with atorvastatin, a CYP3A4 substrate, is necessary, as the systemic exposure of atorvastatin may be increased resulting in an increase in atorvastatin-related adverse reactions.
Atorvastatin; Ezetimibe: (Moderate) Use caution if coadministration of ribociclib, a moderate CYP3A4 inhibitor, with atorvastatin, a CYP3A4 substrate, is necessary, as the systemic exposure of atorvastatin may be increased resulting in an increase in atorvastatin-related adverse reactions.
Atropine; Hyoscyamine; Phenobarbital; Scopolamine: (Major) Avoid coadministration of ribociclib with phenobarbital, as the systemic exposure of ribociclib may be decreased resulting in decreased efficacy; consider an alternative treatment with less potential to induce CYP3A. Ribociclib is extensively metabolized by CYP3A4 and phenobarbital is a strong CYP3A4 inducer.
Avanafil: (Major) Use caution if coadministration of ribociclib, a moderate CYP3A4 inhibitor, with avanafil, a CYP3A4 substrate, is necessary, as the systemic exposure of avanafil may be increased resulting in an increase in avanafil-related adverse reactions. The maximum recommended dose of avanafil when used in combination with ribociclib is 50 mg, not to exceed once every 24 hours.
Axitinib: (Moderate) Use caution if coadministration of ribociclib, a moderate CYP3A4 inhibitor, with axitinib, a CYP3A4 substrate, is necessary, as the systemic exposure of axitinib may be increased resulting in an increase in axitinib-related adverse reactions.
Azelastine; Fluticasone: (Minor) Use caution if coadministration of ribociclib with fluticasone is necessary, as the systemic exposure of fluticasone may be increased resulting in increase in treatment-related adverse reactions. Ribociclib is a moderate CYP3A4 inhibitor and fluticasone is a CYP3A4 substrate. Although given by topical or inhalation routes, fluticasone may be systemically absorbed resulting in a potential for increased systemic exposure.
Azithromycin: (Major) Avoid coadministration of ribociclib with azithromycin due to an increased risk for QT prolongation and torsade de pointes (TdP). Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. There have been case reports of QT prolongation and Td with the use of azithromycin in postmarketing reports. Concomitant use may increase the risk for QT prolongation.
Basiliximab: (Moderate) Use caution if coadministration of ribociclib with basiliximab is necessary, as the systemic exposure of ribociclib may be increased resulting in an increase in ribociclib-related adverse reactions (e.g., neutropenia, QT prolongation). Ribociclib is extensively metabolized by CYP3A4. Basiliximab acts as an IL-2 receptor antagonist. Binding of basiliximab to the IL-2 receptors on activated T cells may allow circulating IL-2 to bind to IL-2 receptors on hepatic and intestinal cells, which may cause a down-regulation of CYP3A4 enzyme activity. Reduced CYP3A4 activity may increase concentrations of CYP3A4 substrates such as ribociclib.
Bedaquiline: (Major) Avoid coadministration of ribociclib with bedaquiline due to an increased risk for QT prolongation. Systemic exposure of bedaquiline may also be increased resulting in a |
