ith felodipine is necessary, as the systemic exposure of felodipine may be increased resulting in an increase in treatment-related adverse reactions (e.g., hypotension). Ribociclib is a moderate CYP3A4 inhibitor and felodipine is a CYP3A4 substrate.
Enflurane: (Major) Avoid coadministration of ribociclib with halogenated anesthetics due to an increased risk for QT prolongation. Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. Halogenated anesthetics can also prolong the QT interval. Concomitant use may increase the risk for QT prolongation.
Enzalutamide: (Major) Avoid coadministration of ribociclib with enzalutamide, 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 enzalutamide is a strong CYP3A4 inducer.
Epirubicin: (Major) Avoid coadministration of ribociclib with epirubicin due to an increased risk for QT prolongation. Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. Acute cardiotoxicity can occur during the administration of epirubicin; although, the incidence is rare. Acute ECG changes during anthracycline therapy are usually transient and include ST-T wave changes, QT prolongation, and changes in QRS voltage. Concomitant use may increase the risk for QT prolongation.
Eplerenone: (Major) Adjust the dose of eplerenone if coadministration with ribociclib is necessary. In patients with hypertension, initiate eplerenone at 25 mg once daily; increase to a maximum of 25 mg twice daily for inadequate blood pressure response. In post-MI patients with congestive heart failure (CHF), the maximum dose of eplerenone is 25 mg once daily. Systemic exposure of eplerenone may be increased resulting in increase in treatment-related adverse reactions. Ribociclib is a moderate CYP3A4 inhibitor; eplerenone is primarily metabolized by CYP3A4.
Ergotamine: (Major) Use caution if coadministration of ribociclib, a moderate CYP3A4 inhibitor, with ergotamine, a CYP3A4 substrate, is necessary, as the systemic exposure of ergotamine may be increased resulting in an increase in ergotamine-related adverse reactions including the risk for vasospasm leading to cerebral ischemia and/or ischemia of the extremities; adjust the dose of ergotamine if necessary.
Eribulin: (Major) Avoid coadministration of ribociclib with eribulin due to an increased risk for QT prolongation. Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner; eribulin has also been associated with QT prolongation. If eribulin and ribociclib must be coadministered, ECG monitoring is recommended.
Erlotinib: (Moderate) Use caution if coadministration of ribociclib with erlotinib is necessary, as the systemic exposure of erlotinib may be increased resulting in increase in treatment-related adverse reactions; avoid coadministration if the patient is additionally taking a CYP1A2 inhibitor. If the patient is taking ribociclib, erlotinib, and a CYP1A2 inhibitor and severe reactions occur, reduce the dose of erlotinib by 50 mg decrements. Ribociclib is a moderate CYP3A4 inhibitor. Erlotinib is primarily metabolized by CYP3A4, and to a lesser extent by CYP1A2. Coadministration with a moderate inhibitor of CYP3A4 and CYP1A2 increased the erlotinib AUC by 39% and the Cmax by 17%.
Erythromycin: (Major) Avoid coadm |
