r QT prolongation and torsade de pointes (TdP). Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. Sotalol administration is also associated with QT prolongation and TdP, with proarrhythmic events anticipated after initiation of therapy and after each upward dosage adjustment. Concomitant use may increase the risk for QT prolongation.
St. John's Wort, Hypericum perforatum: (Major) Avoid coadministration of ribociclib with St. John's Wort, 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 St. John's Wort is a strong CYP3A4 inducer; however, the amount of individual constituents in various products may alter the inhibiting or inducing effects, making drug interactions unpredictable.
Streptogramins: (Major) Avoid coadministration of ribociclib, a CYP3A4 substrate, with dalfopristin; quinupristin, a strong CYP3A4 inhibitor, 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. Ribociclib may also cause concentration-dependent QT prolongation, and the manufacturer of dalfopristin; quinupristin recommends avoidance with medications metabolized by CYP3A that may prolong the QTc interval.
Sufentanil: (Moderate) Use caution if coadministration of ribociclib with sufentanil is necessary, as the systemic exposure of sufentanil may be increased resulting in increased or prolonged effects. Ribociclib is a moderate CYP3A4 inhibitor and sufentanil is a CYP3A4 substrate.
Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole: (Major) Avoid coadministration of ribociclib with sulfamethoxazole; trimethoprim 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. QT prolongation resulting in ventricular tachycardia and TdP has been reported during postmarketing use of sulfamethoxazole; trimethoprim. Concomitant use may increase the risk for QT prolongation. (Major) Avoid coadministration of ribociclib with sulfamethoxazole; trimethoprim 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. QT prolongation resulting in ventricular tachycardia and torsade de pointes (TdP) has been reported during postmarketing use of sulfamethoxazole; trimethoprim. Concomitant use may increase the risk for QT prolongation.
Sunitinib: (Major) Avoid coadministration of ribociclib with sunitinib due to an increased risk for QT prolongation. Systemic exposure of sunitinib 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. Sunitinib has also been associated with QT prolongation. Concomitant use may increase the risk for QT prolongation. Ribociclib is also a moderate CYP3A4 inhibitor and sunitinib is a CYP3A4 substrate.
Suvorexant: (Major) If coadministration of ribociclib, a moderate CYP3A4 inhibitor, with suvorexant, a CYP3A4 substrate, is necessary, the recommended dose of suvorexant is 5 mg (maximum, 10 mg). |
