OBJECT DRUGS
Vinca Alkaloids:
- Vinblastine (Velban)
- Vincristine (Oncovin)
- Vinorelbine (Navelbine)
PRECIPITANT DRUGS
Enzyme Inhibitors:
- Amiodarone (Cordarone, etc.)
- Amprenavir (Agenerase)
- Aprepitant (Emend)
- Atazanavir (Reyataz)
- Boceprevir (Victrelis)
- Ceritinib (Zykadia)
- Cobicistat (Stribild)
- Conivaptan (Vaprisol)
- Cyclosporine (Neoral, etc.)
- Darunavir (Prezista)
- Delavirdine (Rescriptor)
- Dronedarone (Multaq)
- Fluvoxamine (Luvox, etc.)
- Grapefruit
- Imatinib (Gleevec)
- Indinavir (Crixivan)
- Lapatinib (Tykerb)
- Lomitapide (Juxtapid)
- Mifepristone (Korlym)
- Nefazodone
- Nelfinavir (Viracept)
- Ritonavir (Norvir)
- Saquinavir (Invirase)
- Telaprevir (Incivek)
Comment:
Vinca alkaloids appear to be metabolized by CYP3A4 and several reports have described severe vincristine toxicity in patients receiving CYP3A4 inhibitors. P-glycoprotein inhibition may also be involved in these interactions.
Class 2: Use Only if Benefit Felt to Outweigh Risk
- Use Alternative: Use an alternative to the enzyme inhibitor if possible.
- Antidepressants: Sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), venlafaxine (Effexor), and paroxetine (Paxil) appear less likely to inhibit CYP3A4. Fluoxetine (Prozac) appears to be only a weak inhibitor of CYP3A4.
- Grapefruit: Orange juice does not appear to inhibit CYP3A4.
- Monitor: Monitor for toxicity from vincristine (primarily peripheral neuropathy symptoms: paresthesias, neuritic pain, muscle pain, constipation sometimes progressing to paralytic ileus) or vinblastine and vinorelbine (primarily bone marrow suppression).