OBJECT DRUGS
Kinase Inhibitors:
- Axitinib (Inlyta)
- Bosutinib (Bosulif)
- Cabozantinib (Cometriq)
- Ceritinib (Zykadia)
- Cobimetinib (Cotellic)
- Crizotinib (Xalkori)
- Dabrafenib (Tafinlar)
- Dasatinib (Sprycel)
- Erlotinib (Tarceva)
- Gefitinib (Iressa)
- Ibrutinib (Imbruvica)
- Idelalisib (Zydelig)
- Imatinib (Gleevec)
- Lapatinib (Tykerb)
- Nilotinib (Tasigna)
- Osimertinib (Tagrisso)
- Pazopanib (Votrient)
- Regorafenib (Stivarga)
- Ruxolitinib (Jakafi)
- Sorafenib (Nexavar)
- Sunitinib (Sutent)
- Tofacitinib (Xeljanz)
- Vandetanib (Caprelsa)
- Vemurafenib (Zelboraf)
PRECIPITANT DRUGS
Enzyme Inhibitors:
- Amiodarone (Cordarone, etc.)
- Amprenavir (Agenerase)
- Aprepitant (Emend)
- Atazanavir (Reyataz)
- Boceprevir (Victrelis)
- Cobicistat (Stribild)
- Conivaptan (Vaprisol)
- Cyclosporine (Neoral, etc.)
- Darunavir (Prezista)
- Delavirdine (Rescriptor)
- Diltiazem (Cardizem, etc.)
- Dronedarone (Multaq)
- Grapefruit
- Indinavir (Crixivan)
- Lomitapide (Juxtapid)
- Mifepristone (Korlym)
- Nelfinavir (Viracept)
- Ritonavir (Norvir)
- Saquinavir (Invirase)
- Telaprevir (Incivek)
- Verapamil (Isoptin, etc.)
Comment:
Although data are limited, assume that all CYP3A4 inhibitors may increase the plasma levels of kinase inhibitors. Toxicity including skin rashes, anemia, hemorrhage, and gastrointestinal symptoms could result.
Class 3: Assess Risk & Take Action if Necessary
- Consider Alternative:
- Calcium Channel Blockers: Calcium channel blockers other than diltiazem and verapamil are unlikely to inhibit the metabolism of these kinase inhibitors.
- Grapefruit: Orange juice does not appear to inhibit CYP3A4.
- Monitor: Monitor for altered antineoplastic response if the CYP3A4 inhibitor is initiated, discontinued, or changed in dosage.