OBJECT DRUGS

Chemotherapy agents (CYP3A4 Substrates):

• Abiraterone (Zytiga)
• Anastrozole (Arimidex)
• Aprepitant (Emend)
• Bexarotene (Targretin)
• Bortezomib (Velcade)
• Brentuximab (Adcetris)
• Cabazitaxel (Jevtana)
• Cyclophosphamide (Cytoxan)
• Docetaxel (Taxotere)
• Doxorubicin (Adriamycin)
• Enzalutamide (Xtandi)
• Etoposide (Vepesid)
• Exemestane (Aromasin)
• Ifosfamide (Ifex)
• Ixabepilone (Ixempra)
• Ixazomib (Ninlaro)
• Letrozole (Femara)
• Paclitaxel (Taxol)
• Panobinostat (Farydak)
• Sonidegib (Odomzo)
• Teniposide (Vumon)
• Toremifene (Fareston)
• Trabectedin (Yondelis)
• Venetoclax (Venclexta)

PRECIPITANT DRUGS

Antidepressants:

• Fluvoxamine (Luvox, etc.)
• Nefazodone

Comment:

Although data are limited, these antidepressants may increase the plasma levels of chemotherapy agents. Toxicity will vary with the object drug but neuropathy, myelosuppression, and gastrointestinal toxicity are common. Assume that all CYP3A4 inhibitors interact until proven otherwise.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative:
• Antidepressants: Citalopram (Celexa), desvenlafaxine (Pristiq), paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor) appear to have minimal effects on CYP3A4. Fluoxetine (Prozac) appears to be a weak inhibitor of CYP3A4.
• Monitor: Monitor for altered antineoplastic response if the CYP3A4 inhibitor is initiated, discontinued, or changed in dosage.