Selected Antineoplastics/Strong CYP3A4 Inhibitors Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Your medicine may slow down how quickly your body processes your cancer medicine.

What might happen:

The amount of cancer medicine in your blood may increase and cause more side effects than expected and some expected side effects to be more severe.

What you should do about this interaction:

Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to change your medicine or the timing of your cancer medicine.Let your doctor know right away if you experience nausea, vomiting, abdominal pain (especially in the right upper area of your abdomen), yellowing of the eyes or skin, dark urine, itching, loss of appetite, shortness of breath, coughing, swelling of the ankles/legs, rapid/fast/irregular heartbeat, dizziness, loss of consciousness,or if you gain more than 5 pounds in 24 hours.Let your doctor know if you have an increase in diarrhea, nausea, stomach upset, or vomiting; if you have any unusual bleeding; if you have any chest pain or pressure, numbness or weakness on one side or your body, trouble talking, or severe headache; if you have any swelling, weight gain, or shortness of breath; have a fever; develop an increased thirst, urinate more often than normal, or if your breath smells like fruit; develop eye pain/swelling/redness or blurred vision or other vision changes; or if you notice an irregular heartbeat or have dizziness or fainting episodes.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Inlyta (axitinib) US prescribing information. Pfizer Inc. August, 2018. 2.Jevtana (cabazitaxel) US prescribing information. Sanofi-Aventis U.S. LLC January 9, 2018.
  • 2.Cabometyx (cabozantinib) tablets, US prescribing information. Exelixis Inc. December, 2017.
  • 3.Cometriq (cabozantinib) US prescribing information. Exelixix, Inc. January, 2018.
  • 4.Cotellic (cobimetinib) US prescribing information. Genentech, Inc. May, 2016.
  • 5.Tafinlar (dabrafenib) US prescribing information. Novartis Pharmaceuticals Corporation July, 2019.
  • 6.Taxotere (docetaxel) US prescribing information. Sanofi-Aventis U.S. LLC June, 2019.
  • 7.Doxorubicin US prescribing information. Pfizer Labs August, 2019. 9.Tarceva (erlotinib) US prescribing information. Genentech, Inc. October, 2016.
  • 8.Zydelig (idelalisib) US prescribing information. Gilead Sciences, Inc. October, 2018.
  • 9.Ixempra (ixabepilone) US prescribing information. Bristol-Myers Squibb Company October, 2011.
  • 10.Lynparza (olaparib) capsules US prescribing information. AstraZenica Pharmaceuticals October 23, 2017.
  • 11.Lynparza (olaparib) tablets US prescribing information. AstraZenica Pharmaceuticals August 17, 2017.
  • 12.Taxol (paclitaxel) US prescribing information. Bristol-Myers Squibb Company August, 2010.
  • 13.Ibrance (palbociclib) US prescribing information. Pfizer Labs April, 2019.
  • 14.Iclusig (ponatinib) US prescribing information. ARIAD Pharmaceuticals Inc. October 18, 2018.
  • 15.Jakafi (ruxolitinib) US prescribing information. Incyte Corporation May, 2019.
  • 16.Odomzo (sonidegib) US prescribing information. Novartis Pharmaceuticals May, 2019.
  • 17.Xeljanz (tofacitinib) US prescribing information. Pfizer Inc. July, 2019. 20.Vinblastine US prescribing information. APP Pharmaceuticals, LLC January, 2012.
  • 18.Marqibo (vincristine sulfate) US prescribing information. Talon Therapeutics, Inc October, 2012.
  • 19.Kadcyla (ado-trastuzumab emtansine) US prescribing information. Genentech, Inc. May, 2019.
  • 20.Engels FK, Mathot RA, Loos WJ, van Schaik RH, Verweij J. Influence of high-dose ketoconazole on the pharmacokinetics of docetaxel. Cancer Biol Ther 2006 Jul;5(7):833-9.
  • 21.Engels FK, Loos WJ, Mathot RA, van Schaik RH, Verweij J. Influence of ketoconazole on the fecal and urinary disposition of docetaxel. Cancer Chemother Pharmacol 2007 Sep;60(4):569-79.
  • 22.Yong WP, Wang LZ, Tham LS, Wong CI, Lee SC, Soo R, Sukri N, Lee HS, Goh BC. A phase I study of docetaxel with ketoconazole modulation in patients with advanced cancers. Cancer Chemother Pharmacol 2008 Jul;62(2):243-51.
  • 23.Figg WD, Woo S, Zhu W, Chen X, Ajiboye AS, Steinberg SM, Price DK, Wright JJ, Parnes HL, Arlen PM, Gulley JL, Dahut WL. A phase I clinical study of high dose ketoconazole plus weekly docetaxel for metastatic castration resistant prostate cancer. J Urol 2010 Jun;183(6):2219-26.
  • 24.Lim YW, Goh BC, Wang LZ, Tan SH, Chuah BY, Lim SE, Iau P, Buhari SA, Chan CW, Sukri NB, Cordero MT, Soo R, Lee SC. Pharmacokinetics and pharmacodynamics of docetaxel with or without ketoconazole modulation in chemonaive breast cancer patients. Ann Oncol 2010 Apr 29.
  • 25.Oostendorp RL, Huitema A, Rosing H, Jansen RS, Ter Heine R, Keessen M, Beijnen JH, Schellens JH. Coadministration of ritonavir strongly enhances the apparent oral bioavailability of docetaxel in patients with solid tumors. Clin Cancer Res 2009 Jun 15;15(12):4228-33.
  • 26.Koolen SL, Oostendorp RL, Beijnen JH, Schellens JH, Huitema AD. Population pharmacokinetics of intravenously and orally administered docetaxel with or without co-administration of ritonavir in patients with advanced cancer. Br J Clin Pharmacol 2010 May;69(5):465-74.
  • 27.Mir O, Dessard-Diana B, Louet AL, Loulergue P, Viard JP, Langlois A, Durdux C, Le Beller C. Severe toxicity related to a pharmacokinetic interaction between docetaxel and ritonavir in HIV-infected patients. Br J Clin Pharmacol 2010 Jan;69(1):99-101.
  • 28.Loulergue P, Mir O, Allali J, Viard JP. Possible pharmacokinetic interaction involving ritonavir and docetaxel in a patient with Kaposi's sarcoma. AIDS 2008 Jun 19;22(10):1237-9.
  • 29.Rakhit A, Pantze MP, Fettner S, Jones HM, Charoin JE, Riek M, Lum BL, Hamilton M. The effects of CYP3A4 inhibition on erlotinib pharmacokinetics: computer-based simulation (SimCYP) predicts in vivo metabolic inhibition. Eur J Clin Pharmacol 2008 Jan;64(1):31-41.
  • 30.Dirix L, Swaisland H, Verheul HM. Effect of Itraconazole and Rifampin on the Pharmacokinetics of Olaparib in Patients With Advanced Solid Tumors: Results of Two Phase I Open-label Studies. Clin Ther 2016 Oct; 38(10):2286-2299.
  • 31.Makinson A, Martelli N, Peyriere H, Turriere C, Le Moing V, Reynes J. Profound neutropenia resulting from interaction between antiretroviral therapy and vinblastine in a patient with HIV-associated Hodgkin's disease. Eur J Haematol 2007 Apr;78(4):358-60.
  • 32.Kotb R, Vincent I, Dulioust A, Peretti D, Taburet AM, Delfraissy JF, Goujard C. Life-threatening interaction between antiretroviral therapy and vinblastine in HIV-associated multicentric Castleman's disease. Eur J Haematol 2006 Mar;76(3):269-71.
  • 33.US Food and Drug Administration (FDA). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and -drug-interactions-table-substrates-inhibitors-and-inducers. Updated 11/14/2017.
  • 34.This information is based on or an extract from the UW Metabolism and Transport Drug Interaction Database (DIDB) Platform, Copyright University of Washington 1999-2019..

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.