Ponatinib Hydrochloride interactions

Food & lifestyle

• grapefruit juice

  Moderate

  Metabolism

  Coadministration with grapefruit juice is likely to increase the plasma concentrations of ponatinib, which is primarily metabolized by CYP450 3A4. However, the interaction has not been studied. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit.

  What to do: The consumption of grapefruit, grapefruit juice, and supplements that contain grapefruit extract should be avoided during treatment with ponatinib.

  1 source

  1. "Product Information. Iclusig (ponatinib)." Ariad Pharmaceuticals Inc (2012):

Conditions

Conditions in which Ponatinib Hydrochloride needs care, as documented in this source.

• Liver Failure

  Major

  Hepatotoxicity, liver failure and death have occurred in ponatinib-treated patients. Interrupt ponatinib if hepatotoxicity is suspected. It is recommended to monitor hepatic function and to administer ponatinib at a dose of 30 mg once daily in patients with hepatic impairment. Care should be exercised when using ponatinib in patients with hepatic impairment as the safety of multiple doses, or doses higher than 30 mg have not been studied in these patients.

  1 source

  1. "Product Information. Iclusig (ponatinib)." Ariad Pharmaceuticals Inc (2012):

• 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):

• 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):

• 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):