Abemaciclib and Omaveloxolone: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Omaveloxolone
Abemaciclib
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Here's what's going on. Omaveloxolone (Skyclarys) can speed up the enzyme in your body that breaks down abemaciclib (Verzenio), your cancer medicine. When that enzyme works faster, your body may clear the abemaciclib more quickly, so there could be less of it in your system.
The concern is that abemaciclib might not work as well as it should. I want to be clear that this is based mostly on theory, not on strong real-world proof. Please don't change or stop either medicine on your own. Your care team can manage this by keeping a close eye on how your treatment is working and adjusting things if needed. Bring it up at your next visit.
Mechanism: Omaveloxolone is a weak CYP3A4 inducer. Abemaciclib is a CYP3A4 substrate (not a prodrug), so induction increases its clearance and lowers exposure (AUC/Cmax), potentially reducing antineoplastic efficacy.
- Direction: reduced abemaciclib exposure and efficacy.
- Magnitude: in a midazolam probe study, omaveloxolone reduced substrate AUC by ~45%; abemaciclib-specific data not available.
- Evidence: theoretical; onset unspecified.
- Management: monitor for reduced oncologic efficacy. Dose may need individualization by the oncology team; consider alternatives if clinically warranted.
What happens
Reduced CYP3A4 substrate exposure and reduced efficacy of CYP3A4 substrate
Interaction Deep Dive
Taking omaveloxolone, which acts as a weak CYP3A4 inducer, together with CYP3A4 substrates can lower the exposure of those substrates, potentially diminishing their effectiveness. When a CYP3A4 substrate is administered at the same time, watch for reduced efficacy of that co-administered therapy. A drug interaction study showed that coadministering omaveloxolone with midazolam (a CYP3A4 substrate) lowered midazolam's AUC by roughly 45%1.
Why it happens (mechanism)
Induction of CYP3A4 substrate metabolism by omaveloxolone
How to manage this interaction
The good news: your care team can manage this by watching how well your treatment is working.
- Keep taking both exactly as prescribed unless your oncologist tells you otherwise.
- Your team may monitor you more closely to make sure abemaciclib is still doing its job.
- The dose may need to be adjusted and individualized by your care team, or they may consider an alternative if needed.
- Tell your pharmacist and oncologist that you take both drugs, and report any signs your treatment may not be working as expected.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a study evaluating drug interactions, coadministration of omaveloxolone with midazolam reduced the AUC of midazolam (a CYP3A4 substrate) by roughly 45% 1.
Common questions
Can I take Abemaciclib and Omaveloxolone together?
Omaveloxolone may lower abemaciclib levels and make it less effective, so keep taking both as prescribed and let your oncology team monitor your treatment and adjust if needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abemaciclib and Omaveloxolone interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Abemaciclib and Omaveloxolone interaction managed?
The good news: your care team can manage this by watching how well your treatment is working. Keep taking both exactly as prescribed unless your oncologist tells you otherwise. Your team may monitor you more closely to make sure abemaciclib is still doing its job. The dose may need to be adjusted and individualized by your care team, or they may consider an alternative if needed. Tell your pharmac… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Abemaciclib or Omaveloxolone need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: Skyclarys® oral capsules, omaveloxolone oral capsules. Biogen U.S. Corporation, Cambridge, MA, 2026. DailyMed
Keep reading about Omaveloxolone
Keep reading about Abemaciclib
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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