on and torsade de pointes (TdP). Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. Quinolones have been associated with a risk of QT prolongation and TdP. Although extremely rare, torsade de pointes has been reported during postmarketing surveillance of ofloxacin. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. Concomitant use may increase the risk for QT prolongation.
Olanzapine: (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.
Olaparib: (Major) Avoid the coadministration of olaparib with ribociclib due to the risk of increased olaparib-related adverse reactions; if concomitant use is necessary, decrease the dose of olaparib to 200 mg by mouth twice daily. Olaparib is a CYP3A4 substrate and ribociclib is a moderate CYP3A4 inhibitor.
Olodaterol: (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 olodaterol as compared to short-acting beta-agonists.
Ombitasvir; Paritaprevir; Ritonavir: (Severe) Coadministration of ribociclib with ritonavir is contraindicated, as elevated plasma concentrations of ribociclib may be associated with QT prolongation; exposure to ritonavir may also increase. Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. Ritonavir has also been associated with QT prolongation. Ribociclib is also extensively metabolized by CYP3A4 and ritonavir is a strong CYP3A4 inhibitor; exposure to ribociclib may be increased. Coadministration with ritonavir, a strong CYP3A4 inhibitor increased the ribociclib AUC and Cmax by 3.2-fold and 1.7-fold, respectively, in healthy volunteers. Additionally, ribociclib is a moderate CYP3A4 inhibitor and ritonavir is a CYP3A4 substrate. (Moderate) Use caution if coadministration of ribociclib with paritaprevir is necessary, as the systemic exposure of paritaprevir may be increased resulting in increase in treatment-related adverse reactions. Ribociclib is a moderate CYP3A4 inhibitor and paritaprevir is a CYP3A4 substrate.
Omeprazole: (Minor) Use caution if coadministration of ribociclib with omeprazole is necessary, as the systemic exposure of omeprazole may be increased resulting in increase in treatment-related adverse reactions. Ribociclib is a moderate CYP3A4 inhibitor and omeprazole is a CYP3A4 substrate.
Omeprazole; Sodium Bicarbonate: (Minor) Use caution if coadministration of ribociclib with omeprazole is necessary, as the systemic exposure of omeprazole may be increased resulting in increase in treatment-related adverse reactions. Ribociclib is a moderate CYP3A4 inhibitor and omeprazole is a CYP3A4 substrate.
Ondansetron: (Major) Avoid coadministrat |
