e; ribociclib is a moderate CYP3A4 inhibitor. When ibrutinib was administered with multiple doses of another moderate CYP3A4 inhibitor, the Cmax and AUC values of ibrutinib were increased by 3.4-fold and 3-fold, respectively.
Ibuprofen; Oxycodone: (Moderate) Use caution if coadministration of ribociclib with oxycodone is necessary, as the systemic exposure of oxycodone may be increased resulting in increase in treatment-related adverse reactions including sedation and respiratory depression; adjust the dose of oxycodone if necessary. Ribociclib is a moderate CYP3A4 inhibitor and oxycodone is a CYP3A4 substrate.
Ibutilide: (Major) Avoid coadministration of ribociclib with ibutilide 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. Ibutilide administration can also cause QT prolongation and TdP; proarrhythmic events should be anticipated. The potential for proarrhythmic events with ibutilide increases with the coadministration of other drugs that prolong the QT interval.
Idarubicin: (Major) Avoid coadministration of ribociclib with idarubicin 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 idarubicin; 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.
Idelalisib: (Major) Avoid coadministration of ribociclib with idelalisib, as the systemic exposure of ribociclib may be increased resulting in an increase in ribociclib-related adverse reactions (e.g., neutropenia, QT prolongation); consider an alternative treatment with less potential for CYP3A inhibition. If concomitant use is unavoidable, reduce the dose of ribociclib to 400 mg once daily; if idelalisib is discontinued, the original dose of ribociclib may be resumed after at least 5 half-lives of idelalisib. Ribociclib is extensively metabolized by CYP3A4 and idelalisib is a strong CYP3A4 inhibitor.
Ifosfamide: (Moderate) Use caution if coadministration of ribociclib with ifosfamide is necessary, as the metabolism of ifosfamide to its active alkylating metabolites may be decreased, decreasing the effectiveness of ifosfamide treatment. Ribociclib is a CYP3A4 inhibitor and ifosfamide is a prodrug that is activated via CYP3A4.
Iloperidone: (Major) Avoid coadministration of ribociclib with iloperidone due to an increased risk for QT prolongation. Systemic exposure of iloperidone may also be increased resulting in increase in treatment-related adverse reactions. Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. Iloperidone has also been associated with QT prolongation. Concomitant use may increase the risk for QT prolongation. Ribociclib is also a moderate CYP3A4 inhibitor and iloperidone is a CYP3A4 substrate.
Imatinib, STI-571: (Moderate) Use caution if coadministration of ribociclib with imatinib is necessary, as the systemic exposure of imatinib may be increased resulting in increase in treatment-related adverse reactions. Exposure to ribociclib may also increase, increasing the potential for ribociclib-related adverse reactions (e.g., neutropenia, QT prolongation). Ribocicl |
