Ribociclib interactions

Food & lifestyle

• grapefruit juice

  Moderate

  Metabolism

  Pomegranates and grapefruit may increase the systemic exposure to ribociclib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in these fruits.

  What to do: Patients receiving ribociclib should avoid consumption of pomegranates or pomegranate juice and grapefruit or grapefruit juice during treatment.

  1 source

  1. "Product Information. Kisqali (ribociclib)." Novartis Pharmaceuticals (2017):

• pomegranates

  Moderate

  Metabolism

  Pomegranates and grapefruit may increase the systemic exposure to ribociclib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in these fruits.

  What to do: Patients receiving ribociclib should avoid consumption of pomegranates or pomegranate juice and grapefruit or grapefruit juice during treatment.

  1 source

  1. "Product Information. Kisqali (ribociclib)." Novartis Pharmaceuticals (2017):

Conditions

Conditions in which Ribociclib needs care, as documented in this source.

• Arrhythmias, Cardiac

  Major

  Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. It is recommended to assess ECG prior to initiation of treatment and to correct any electrolyte abnormality. Initiate treatment only in patients with QTcF values less than 450 ms. Repeat ECG at approximately two weeks of the first cycle and the beginning of the second cycle, and as clinically indicated. Monitor serum electrolytes (including potassium, calcium, phosphorous, and magnesium) before the initiation of treatment, at the beginning of the first 6 cycles, and as clinically indicated. Therapy may require dose interruption, reduction, or discontinuation according to observed QT prolongation. Avoid the use of this drug in patients with or at risk of developing QT prolongation, including those with uncontrolled long QT syndrome or significant cardiac disease including recent myocardial infarction, congestive heart failure, unstable angina, bradyarrhythmias, and electrolyte abnormalities.

  1 source

  1. "Product Information. Kisqali (ribociclib)." Novartis Pharmaceuticals (2017):

• Hepatic Insufficiency

  Moderate

  Ribociclib undergoes extensive hepatic metabolism mainly via CYP450 3A4 in humans. Increase transaminases have been observed in clinical studies. It is recommended to reduce the starting dose to 400 mg in patients with moderate (Child-Pugh class B) and severe hepatic impairment (Child-Pugh class C). Consider performing liver function tests (LFTs) before initiating therapy and monitoring LFTs every 2 weeks for the first 2 cycles, at the beginning of each subsequent 4 cycles, and as clinically indicated. Dose interruption, reduction, or discontinuation may be necessary based on the severity of LFTs. No dose adjustment is necessary for patients with mild hepatic impairment (Child-Pugh class A).

  1 source

  1. "Product Information. Kisqali (ribociclib)." Novartis Pharmaceuticals (2017):

• Kidney Diseases

  Moderate

  It is recommended to reduce the starting dose to 200 mg in patients with severe renal impairment. Care is recommended as this drug has not been studied in breast cancer patients with severe renal impairment. Based on a population pharmacokinetic analysis, no dose adjustment is necessary in patients with mild or moderate renal impairment.

  1 source

  1. "Product Information. Kisqali (ribociclib)." Novartis Pharmaceuticals (2017):

• Lung Diseases

  Moderate

  The use of certain multikinase inhibitors has been associated with pulmonary toxicity. Serious cases of interstitial lung disease (ILD), including fatal cases and interstitial pneumonitis or pulmonary fibrosis have been reported. Caution is recommended when using these agents in patients with a history of interstitial pneumonitis or pulmonary fibrosis or those patients presenting with acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever pending diagnostic evaluation. If ILD is confirmed, permanently discontinue these agents and institute appropriate measures. Immediately withhold treatment in patients diagnosed with ILD/pneumonitis and permanently discontinue therapy if no other potential causes of ILD/pneumonitis have been identified.

  7 sources

  1. "Product Information. Vandetanib (vandetanib)." Astra-Zeneca Pharmaceuticals (2011):
  2. "Product Information. Zelboraf (vemurafenib)." Genentech (2011):
  3. "Product Information. Xalkori (crizotinib)." Pfizer U.S. Pharmaceuticals Group (2011):
  4. "Product Information. Mekinist (trametinib)." GlaxoSmithKline (2013):
  5. "Product Information. Zykadia (ceritinib)." Novartis Pharmaceuticals (2014):
  6. "Product Information. Zydelig (idelalisib)." Gilead Sciences (2014):
  7. "Product Information. Alecensa (alectinib)." Genentech (2015):

• Neutropenia

  Moderate

  The use of ribociclib may result in a decrease in neutrophil count. Care should be exercised when using this drug in neutropenic patients. It is recommended to perform a complete blood count (CBC) before initiating therapy and to monitor CBC every 2 weeks for the first 2 cycles, at the beginning of each subsequent 4 cycles, and as clinically indicated. Ribociclib may require dose interruption, reduction or discontinuation of treatment based on the severity of the neutropenia.

  1 source

  1. "Product Information. Kisqali (ribociclib)." Novartis Pharmaceuticals (2017):

• Stevens-Johnson Syndrome

  Moderate

  Patients receiving ribociclib have developed severe cutaneous adverse reactions (SCARs), including Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS). It is recommended to interrupt treatment if signs or symptoms of severe cutaneous reactions occur until a definitive etiology by a qualified health care professional has been determined. Permanently discontinue treatment if confirmed SJS, TEN, or DiHS/DRESS and do not reintroduce therapy in patients who have experienced SCARs or other life-threatening cutaneous reactions during treatment.

  1 source

  1. "Product Information. Kisqali (ribociclib)." Novartis Pharmaceuticals (2017):