OBJECT DRUGS

• Bedaquiline (Sirturo)

PRECIPITANT DRUGS

Calcium Channel Blockers:

• Diltiazem (Cardizem, etc.)
• Verapamil (Isoptin, etc.)

Comment:

Bedaquiline is a CYP3A4 substrate, and CYP3A4, inhibitors such as diltiazem and verapamil 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: Calcium channel blockers other than diltiazem and verapamil are unlikely to inhibit the metabolism of bedaquiline.
• Monitor: If the combination is used, monitor for evidence of hepatotoxicity and monitor the ECG for evidence of QTc prolongation.