Nilotinib interactions

Food & lifestyle

• grapefruit juice

  Major

  Metabolism

  Grapefruit juice may increase the plasma concentrations of nilotinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.

  What to do: Patients treated with nilotinib should avoid consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract. In addition, no food should be consumed for at least 2 hours before and 1 hour after a nilotinib dose.

  1 source

  1. "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals (2007):

Conditions

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

• Long QT Syndrome

  Major

  Nilotinib should not be used in patients with hypokalemia, hypomagnesemia or long QT syndrome, as it has shown to prolong QT interval in a concentration-dependent manner. This can cause a ventricular tachycardia called Torsade de Pointes which can result in syncope, seizures, and/or death. Before initiating nilotinib, electrolytes should be tested. Hypokalemia or hypomagnesemia should be corrected before starting treatment and monitored periodically. Patients at risk should be monitored with an EKG before and during treatment as clinically indicated and dose adjustments might be needed.

  1 source

  1. "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals (2007):

• Pancreatitis

  Major

  Nilotinib can cause increases in serum lipase. Patients with a previous history of pancreatitis might be at increased risk and should be monitored carefully for lipase elevations and any abdominal symptoms. Serum lipase should be monitored monthly or as clinically indicated and treatment might need to be interrupted until pancreatitis is excluded as a diagnosis.

  1 source

  1. "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals (2007):

• Bone Marrow Failure Disorders

  Moderate

  Thrombocytopenia, aplastic anemia, agranulocytosis and neutropenia occur with BCR-ABL tyrosine kinase inhibitors. Therapy with these drugs should be administered cautiously in patients with preexisting bone marrow suppression. A complete blood count should be performed every 1-2 weeks for the first month of therapy and then monthly thereafter, or as clinically indicated. To manage myelosuppression, withhold, reduce dose, or discontinue therapy as necessary.

  4 sources

  1. "Product Information. Gleevec (imatinib)." Novartis Pharmaceuticals (2022):
  2. "Product Information. Sprycel (dasatinib)." Bristol-Myers Squibb (2006):
  3. "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals (2007):
  4. "Product Information. Bosulif (bosutinib)." Pfizer U.S. Pharmaceuticals Group (2012):

• Cardiovascular Diseases

  Moderate

  Cardiovascular events, including arterial vascular occlusive events, peripheral arterial occlusive events and ischemic cerebrovascular events have been reported in patients receiving tyrosine kinase inhibitors. If acute signs or symptoms of cardiovascular events occur, patients should seek immediate medical attention. The cardiovascular status and risk factors of patients should be evaluated prior to therapy and cardiovascular monitoring and management should take place during treatment.

  3 sources

  1. "Product Information. Gleevec (imatinib)." Novartis Pharmaceuticals (2022):
  2. "Product Information. Sprycel (dasatinib)." Bristol-Myers Squibb (2006):
  3. "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals (2007):

• Hepatic Insufficiency

  Moderate

  Nilotinib exposure is increased in patients with hepatic impairment. The use of a lower starting dose might be needed. Additionally, there have been reports of hepatotoxicity as measured by elevations in bilirubin, AST, ALT and alkaline phosphatase. Liver function should be monitored before initiation of treatment and regularly during therapy. Dose reduction or interruption might be needed if laboratory abnormalities are found.

  1 source

  1. "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals (2007):

• Lactose Intolerance

  Moderate

  Nilotinib capsules contain lactose, so it is not recommended for patients with rare hereditary problems of galactose intolerance, severe lactase deficiency with a severe degree of intolerance to lactose- containing products, or of glucose-galactose malabsorption.

  1 source

  1. "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals (2007):

• Water-Electrolyte Imbalance

  Moderate

  Fluid retention occurs with BCR-ABL tyrosine kinase inhibitors therapy and may manifest as pericardial effusion, pleural effusion, pulmonary edema, and/or peripheral edema. Caution should be taken when using these drugs in patients with preexisting fluid retention or congestive heart failure. Monitor and manage patients using standards of care. Interrupt, reduce dose or discontinue therapy as necessary.

  4 sources

  1. "Product Information. Gleevec (imatinib)." Novartis Pharmaceuticals (2022):
  2. "Product Information. Sprycel (dasatinib)." Bristol-Myers Squibb (2006):
  3. "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals (2007):
  4. "Product Information. Bosulif (bosutinib)." Pfizer U.S. Pharmaceuticals Group (2012):

• Water-Electrolyte Imbalance

  Moderate

  Nilotinib can cause hypophosphatemia, hypokalemia, hyperkalemia, hypocalcemia, and hyponatremia. Electrolyte abnormalities should be corrected prior to initiating nilotinib and during therapy, and should be monitored periodically.

  1 source

  1. "Product Information. Tasigna (nilotinib)." Novartis Pharmaceuticals (2007):