OBJECT DRUGS

• Bedaquiline (Sirturo)

PRECIPITANT DRUGS

Antidepressants:

• Fluvoxamine (Luvox, etc.)
• Nefazodone

Comment:

Bedaquiline is a CYP3A4 substrate, and CYP3A4, inhibitors such as fluvoxamine or nefazodone may increase the risk of bedaquiline toxicity. Bedaquiline can produce hepatotoxicity and can prolong the QTc interval, thus increasing the risk of ventricular arrhythmias.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative: Sertraline (Zoloft), venlafaxine (Effexor), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro) are not known to inhibit CYP3A4. Fluoxetine (Prozac) appears to be a weak CYP3A4 inhibitor.
• Monitor: If the combination is used, monitor for evidence of hepatotoxicity and monitor the ECG for evidence of QTc prolongation.