Ceritinib with Fluticasone Interaction Details
Brand Names Associated with Ceritinib
- Ceritinib
- Zykadia®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 06, 2023
Interaction Effect
Increased fluticasone exposure
Interaction Summary
Concomitant use of ceritinib (a strong CYP3A4 inhibitor) and fluticasone (a CYP3A4 substrate) may increase fluticasone exposure and may increase the risk of cardiovascular adverse effects. Avoid coadministration of ceritinib and fluticasone and if coadministration is needed, consider reducing the dose of fluticasone and use caution .
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Concomitant use of ceritinib (a strong CYP3A4 inhibitor) and fluticasone (a CYP3A4 substrate) may increase fluticasone exposure and may increase the risk of cardiovascular adverse effects. Avoid coadministration of ceritinib and fluticasone and if coadministration is needed, consider reducing the dose of fluticasone and use caution .
Mechanism Of Interaction
Inhibition of CYP3A4-mediated metabolism of fluticasone
Literature Reports
A) Coadministration of a single dose of midazolam (a sensitive CYP3A4 substrate) following 3 weeks of ceritinib 750 mg daily under fasted conditions increased the midazolam AUC by 5.4-fold and Cmax by 1.8-fold compared to midazolam administered alone .
B) In an observational study, 10 of 12 patients with cystic fibrosis who received concomitant inhaled fluticasone and oral itraconazole had evidence of hypothalamic-pituitary-adrenal (HPA) axis suppression, which was moderate or severe in 5 subjects. Clinical evidence of Cushing syndrome was present in 1 subject. All participants had reduced basal and peak serum cortisol levels and a blunted challenge response, particularly when compared with cystic fibrosis patients who received fluticasone but not itraconazole .
C) When orally inhaled fluticasone propionate (1000 mcg) was coadministered with ketoconazole 200 mg once daily (n=8), fluticasone AUC increased 1.9-fold and plasma cortisol AUC decreased 45%. There was no effect on urinary cortisol excretion .
D) In a drug interaction study, the fluticasone furoate AUC was increased by 36%, when coadministered with ketoconazole 400 mg compared with placebo. The increase in fluticasone furoate exposure was associated with a 27% reduction in weighted mean serum cortisol (0 to 24 hours) .
Ceritinib Overview
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Ceritinib is used to treat a certain type of non-small cell lung cancer (NSCLC) that has spread to other parts of the body. Ceritinib is in a class of medications called kinase inhibitors. It works by blocking the action of an abnormal protein that signals cancer cells to multiply. This helps slow or stop the spread of cancer cells.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.