OBJECT DRUGS

• Bedaquiline (Sirturo)

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)
• Dronedarone (Multaq)
• Grapefruit
• Imatinib (Gleevec)
• Indinavir (Crixivan)
• Lapatinib (Tykerb)
• Lomitapide (Juxtapid)
• Mifepristone (Korlym)
• Nelfinavir (Viracept)
• Ritonavir (Norvir)
• Saquinavir (Invirase)
• Telaprevir (Incivek)

Comment:

Bedaquiline is metabolized by CYP3A4 and concurrent administration with CYP3A4 inhibitors 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:
• Grapefruit: Orange juice does not appear to inhibit CYP3A4.
• Monitor: If bedaquiline is used with CYP3A4 inhibitors, monitor for evidence of hepatotoxicity and monitor the ECG for evidence of QTc prolongation.