ives of itraconazole. Both itraconazole and ribociclib have been reported to prolong the QT interval. Concomitant use may increase the risk for QT prolongation. Ribociclib is extensively metabolized by CYP3A4 and itraconazole is a strong CYP3A4 inhibitor. Additionally, ribociclib is a moderate CYP3A4 inhibitor and itraconazole is a CYP3A4 substrate.
Ivabradine: (Major) Avoid coadministration of ivabradine and ribociclib, as increased concentrations of ivabradine are possible, resulting in increase in treatment-related adverse reactions such as bradycardia exacerbation and conduction disturbances. Ribociclib is a moderate CYP3A4 inhibitor and ivabradine is a CYP3A4 substrate.
Ivacaftor: (Major) If ribociclib and ivacaftor are taken together, administer ivacaftor at the usual recommended dose but reduce the frequency to once daily. Monitor for an increase in ivacaftor-related adverse reactions. Exposure to ribociclib may also increase, increasing in ribociclib-related adverse reactions (e.g., neutropenia, QT prolongation). Ribociclib is a moderate CYP3A4 inhibitor and ivacaftor is a CYP3A4 substrate. Ribociclib is also extensively metabolized by CYP3A4 and ivacaftor is a weak CYP3A4 inhibitor.
Ixabepilone: (Major) Use caution if coadministration of ribociclib with ixabepilone is necessary, as the systemic exposure of ixabepilone may be increased resulting in an increase in treatment-related adverse reactions; consider the use of alternative agents that do not inhibit CYP3A4. Patients receiving concomitant use of ribociclib with ixabepilone should be monitored closely for acute toxicities (e.g., frequent monitoring of peripheral blood counts between cycles of ixabepilone). Ribociclib is a moderate CYP3A4 inhibitor and ixabepilone is a CYP3A4 substrate.
Ketoconazole: (Major) Avoid coadministration of ribociclib with ketoconazole due to the potential for additive effects on the QT interval and significantly increased exposure to ribociclib; exposure to ketoconazole may also increase. If coadministration cannot be avoided, reduce the ribociclib dose to 400 mg once daily. If ketoconazole is discontinued, resume the previous ribociclib dose after at least 5 half-lives of ketoconazole. Both ketoconazole and ribociclib have been reported to prolong the QT interval. Concomitant use may increase the risk for QT prolongation. Ribociclib is extensively metabolized by CYP3A4 and ketoconazole is a strong CYP3A4 inhibitor. Additionally, ribociclib is a moderate CYP3A4 inhibitor and ketoconazole is a CYP3A4 substrate.
Lanreotide: (Moderate) Use caution if coadministration of ribociclib with lanreotide 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. Somatostatin analogs, such as lanreotide, decrease growth hormone secretion which in turn may inhibit CYP3A4.
Lapatinib: (Major) Avoid coadministration of ribociclib with lapatinib due to an increased risk for QT prolongation. Additionally, the systemic exposure of both drugs may be increased resulting in an increase in treatment-related adverse reactions (e.g., neutropenia, QT prolongation). Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. Lapatinib can also prolong the QT interval. Concomitant use may increase the risk for QT prolongation. Ribociclib is also |
