ease the risk for QT prolongation. Ribociclib is also extensively metabolized by CYP3A4; while fluoxetine is a weak inhibitor of CYP3A4, its metabolite norfluoxetine is a moderate CYP3A4 inhibitor. (Major) Avoid coadministration of ribociclib with olanzapine due to an increased risk for QT prolongation. Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval. Concomitant use may increase the risk for QT prolongation.
Fluphenazine: (Minor) Fluphenazine is associated with a possible risk for QT prolongation. Theoretically, fluphenazine may increase the risk of QT prolongation if coadministered with other drugs that have a risk of QT prolongation, such as ribociclib.
Flurazepam: (Moderate) Use caution if coadministration of ribociclib with flurazepam is necessary, as the systemic exposure of flurazepam may be increased resulting in increase in treatment-related adverse reactions; adjust the dose of flurazepam if necessary. Ribociclib is a moderate CYP3A4 inhibitor and flurazepam is a CYP3A4 substrate.
Flutamide: (Moderate) Use caution if ribociclib is coadministered with flutamide as the systemic exposure of flutamide may increase resulting in adverse reactions. Exposure to ribociclib may also decrease, resulting in reduced efficacy. Ribociclib is extensively metabolized by CYP3A4 and is also a moderate CYP3A4 inhibitor; flutamide is minor CYP3A4 substrate and a CYP3A4 inducer.
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.
Fluticasone; Salmeterol: (Moderate) Due to a possible risk for QT prolongation, ribociclib and long-acting beta-agonists should be used together cautiously. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval like ribociclib. This risk may be more clinically significant with long-acting beta-agonists such as salmeterol as compared to short-acting beta-agonists. (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.
Fluticasone; Vilanterol: (Moderate) Due to a possible risk for QT prolongation, ribociclib and long-acting beta-agonists should be used together cautiously. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval like ribociclib. This risk may be more clinically significant with long-acting beta-agonists such as |
