OBJECT DRUGS

• Flibanserin (Addyi)

PRECIPITANT DRUGS

Enzyme Inducers:

• Barbiturates
• Bosentan (Tracleer)
• Carbamazepine (Tegretol, etc.)
• Dabrafenib (Tafinlar)
• Dexamethasone (Decadron, etc.)
• Efavirenz (Sustiva)
• Lumacaftor (Orkambi)
• Oxcarbazepine (Trileptal, etc.)
• Phenytoin (Dilantin, etc.)
• Primidone (Mysoline)
• Rifabutin (Mycobutin)
• Rifampin (Rifadin, etc.)
• Rifapentine (Priftin)
• St. John's wort

Comment:

Flibanserin is metabolized by CYP3A4, and enzyme inducers may substantially reduce serum flibanserin concentrations. The product information for flibanserin states that enzyme inducers should not be administered with flibanserin.

Class 2: Use only if Benefit Felt to Outweigh Risk

• Use Alternative: The product information states that strong CYP3A4 inducers (phenytoin, carbamazepine, rifampin, St. John's wort) are contraindicated with flibanserin, but it would be best to avoid any enzyme inducer if possible.
• Anticonvulsants: In patients on flibanserin it would be desirable to use anticonvulsants that are not enzyme inducers, but in many cases it may not be reasonable to change the patient's anticonvulsant regimen.
• HIV Medications: Since most antiviral medications are either inducers or inhibitors of CYP3A4, it may not be possible to avoid these interactions in most cases.
• St. John's wort: Given the questionable benefit of St. John's wort, it would be prudent to avoid giving it with flibanserin.
• Circumvent/Minimize: If flibanserin is used with enzyme inducers, it may be necessary to increase the flibanserin dose.
• Monitor: Watch for reduced deferasirox efficacy in patients taking absorption inhibitors.