▶Cobicistatslightly increases the exposure tocabozantinib.
oStudy
▶Cabozantinibis predicted to increase the risk of bleeding
events when given withcoumarins.rTheoretical
▶Crizotinibis predicted to increase the exposure to
cabozantinib.oTheoretical→Also seeTABLE 15p. 850→
Also seeTABLE 9p. 849
▶Efavirenzis predicted to decrease the exposure to
cabozantinib.oTheoretical→Also seeTABLE 9p. 849
▶Enzalutamidemoderately decreases the exposure to
cabozantinib. Avoid.oStudy
▶Grapefruit juiceis predicted to increase the exposure to
cabozantinib.oTheoretical
▶HIV-protease inhibitorsslightly increase the exposure to
cabozantinib.oStudy→Also seeTABLE 9p. 849
▶Idelalisibslightly increases the exposure tocabozantinib.
oStudy→Also seeTABLE 15p. 850
▶Imatinibis predicted to increase the exposure tocabozantinib.
oTheoretical→Also seeTABLE 15p. 850
▶Macrolides(clarithromycin)slightly increase the exposure to
cabozantinib.oStudy→Also seeTABLE 9p. 849
▶Macrolides(erythromycin)are predicted to increase the
exposure tocabozantinib.oTheoretical→Also seeTABLE 9
p. 849
▶Mitotanemoderately decreases the exposure tocabozantinib.
Avoid.oStudy→Also seeTABLE 15p. 850
▶Netupitantis predicted to increase the exposure to
cabozantinib.oTheoretical
▶Nevirapineis predicted to decrease the exposure to
cabozantinib.oTheoretical
▶Nilotinibis predicted to increase the exposure tocabozantinib.
oTheoretical→Also seeTABLE 15p. 850→Also seeTABLE 9
p. 849
▶Cabozantinibis predicted to increase the risk of bleeding
events when given withphenindione.rTheoretical
▶Rifampicinmoderately decreases the exposure tocabozantinib.
Avoid.oStudy
▶St John’s Wortis predicted to decrease the exposure to
cabozantinib.oTheoretical
Caffeine citrate
▶Caffeine citratedecreases the efficacy ofantiarrhythmics
(adenosine). Separate administration by 24 hours.nStudy
▶Antiepileptics(fosphenytoin, phenytoin)are predicted to
moderately increase the clearance ofcaffeine citrate. Monitor
and adjust dose.oStudy
▶HIV-protease inhibitors(ritonavir)are predicted to moderately
increase the clearance ofcaffeine citrate. Monitor and adjust
dose.oStudy
▶Leflunomideis predicted to moderately increase the clearance
ofcaffeine citrate. Monitor and adjust dose.oStudy
▶Rifampicinis predicted to moderately increase the clearance of
caffeine citrate. Monitor and adjust dose.oStudy
▶SSRIs(fluvoxamine)markedly decrease the clearance of
caffeine citrate. Monitor and adjust dose.rStudy
▶Teriflunomideis predicted to moderately increase the
clearance ofcaffeine citrate. Monitor and adjust dose.
oStudy
▶Caffeine citratedecreases the clearance oftheophylline.
oStudy
Calcipotriol→see vitamin D substances
Calcitonin (salmon)
▶Calcitonin (salmon)decreases the concentration oflithium.
Monitor concentration and adjust dose.oStudy
Calcitriol→see vitamin D substances
Calcium acetate→see calcium salts
Calcium carbonate→see calcium salts
Calcium channel blockers→seeTABLE 6p. 848 (bradycardia),
TABLE 8p. 848 (hypotension)
amlodipine.clevidipine.diltiazem.felodipine.lacidipine.
lercanidipine.nicardipine.nifedipine.nimodipine.verapamil..▶Verapamilis predicted to increase the exposure toafatinib.
Separate administration by 12 hours.oStudy
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure toaldosterone antagonists(eplerenone).
Adjusteplerenonedose.rStudy→Also seeTABLE 8p. 848
▶Verapamilmoderately increases the exposure toaliskiren.
oStudy→Also seeTABLE 8p. 848
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure toalpha blockers(tamsulosin).o
Theoretical→Also seeTABLE 8p. 848
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure toalprazolam.rStudy
▶Verapamilmoderately increases the exposure toanthracyclines
(doxorubicin).oStudy
▶Antiarrhythmics(disopyramide)are predicted to increase the
risk of cardiodepression when given withverapamil.r
Theoretical
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure tocalcium channel blockers(amlodipine, felodipine,
lacidipine, lercanidipine, nicardipine, nifedipine, nimodipine).
Monitor and adjust dose.oStudy
▶Antiarrhythmics(amiodarone)are predicted to increase the risk
of cardiodepression when given withcalcium channel blockers
(diltiazem, verapamil). Avoid.rTheoretical→Also see
TABLE 6p. 848
▶Calcium channel blockers(diltiazem, verapamil)increase the
exposure toantiarrhythmics(dronedarone)andantiarrhythmics
(dronedarone)increase the exposure tocalcium channel
blockers(diltiazem, verapamil).oStudy
▶Verapamilincreases the risk of cardiodepression when given
withantiarrhythmics(flecainide).rAnecdotal→Also see
TABLE 6p. 848
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure toantiarrhythmics(propafenone).
Monitor and adjust dose.oStudy
▶Calcium channel blockers(diltiazem, verapamil)increase the risk
of bradycardia when given withanticholinesterases, centrally
acting.oAnecdotal→Also seeTABLE 6p. 848
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tocalcium channel blockers(amlodipine, felodipine, lacidipine,
lercanidipine, nicardipine, nifedipine, nimodipine). Monitor and
adjust dose.oStudy
▶Diltiazemincreases the concentration ofantiepileptics
(carbamazepine)andantiepileptics(carbamazepine)are
predicted to decrease the exposure todiltiazem. Monitor
concentration and adjust dose.rAnecdotal
▶Verapamilincreases the concentration ofantiepileptics
(carbamazepine)andantiepileptics(carbamazepine)are
predicted to decrease the exposure toverapamil.r
Anecdotal
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure tocalcium channel blockers(diltiazem,
verapamil).rStudy
▶Calcium channel blockers(diltiazem, verapamil)potentially
increase the concentration ofantiepileptics(fosphenytoin,
phenytoin)andantiepileptics(fosphenytoin, phenytoin)are
predicted to decrease the exposure tocalcium channel blockers
(diltiazem, verapamil).rStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to markedly increase the exposure tolercanidipine.
Avoid.rStudy
▶Antifungals, azoles(miconazole)are predicted to increase the
exposure tocalcium channel blockers(amlodipine, clevidipine,
felodipine, lacidipine, lercanidipine, nicardipine, nifedipine,
nimodipine, verapamil). Use with caution and adjust dose.
oTheoretical
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole,
voriconazole)are predicted to increase the exposure tocalcium
channel blockers(amlodipine, felodipine, lacidipine,
lercanidipine, nicardipine, nifedipine, nimodipine). Monitor and
adjust dose.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure tocalcium channel blockers
(amlodipine, felodipine, lacidipine, nicardipine, nifedipine,
nimodipine). Monitor and adjust dose.oStudy
▶Antifungals, azoles(fluconazole)(high-dose) are predicted to
increase the exposure tocalcium channel blockers(diltiazem,
verapamil).oTheoreticalBNFC 2018 – 2019 Cabozantinib—Calcium channel blockers 889
Interactions|Appendix 1A1