Idelalisib with Budesonide Interaction Details
Brand Names Associated with Idelalisib
- Idelalisib
- Zydelig®
Brand Names Associated with Budesonide
- Budesonide
- Entocort® EC
- Tarpeyo ®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 06, 2023
Interaction Effect
Increased exposure of CYP3A substrate
Interaction Summary
Avoid coadministration of idelalisib (a strong CYP3A inhibitor) and a sensitive CYP3A substrate as this may increase exposure of the CYP3A substrate and increase the risk of adverse effects. During a drug interaction study, coadministration of idelalisib and midazolam (CYP3A substrate) resulted in a 5.4-fold increase in midazolam AUC and a 2.4 fold increase in midazolam Cmax.
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Coadministration of idelalisib (a strong CYP3A inhibitor) and a sensitive CYP3A substrate should be avoided, as this may increase exposure of the CYP3A substrate and increase the risk of adverse effects.
Mechanism Of Interaction
Inhibition of CYP3A-mediated metabolism by idelalisib
Literature Reports
A) In a pharmacokinetic study (N=23), administration of a single midazolam 5 mg dose following multiple doses of idelalisib 150 mg orally twice daily resulted in significant increases in midazolam exposure (138% increase in Cmax and 437% increase in AUC) compared with midazolam alone .
B) Coadministration of diazepam and idelalisib for 10 days in a 71-year-old woman resulted in altered mental status and respiratory failure. She was receiving diazepam 5 mg twice daily, venlafaxine XL 300 mg daily, and had initiated idelalisib 150 mg twice daily 10 days prior to presentation. The patient presented with lethargy, speaking difficulty, and progressive weakness inhibiting her ability to stand. Arterial blood gas analysis revealed respiratory acidosis and type II respiratory failure (pH 7.3, PO2 113 mmHg, PCO2 63 mmHg, and bicarbonate 31 mEq/L). Venlafaxine was reduced to 37.5 mg daily, diazepam was changed to lorazepam 0.5 mg twice daily, and full-dose idelalisib was restarted with no further sequelae .
Idelalisib Overview
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Idelalisib is used along with another medication rituximab (Rituxan) to treat chronic lymphocytic leukemia (CLL; a type of cancer that begins in the white blood cells) in people whose cancer came back after receiving other cancer treatments. It is also used to treat certain types of follicular lymphoma (FL; a type of cancer that begins in the white blood cells) and small lymphocytic lymphoma (SLL:a type of cancer that begins in the white blood cells) in people whose cancer came back after being treated with at least 2 other cancer treatments. Idelalisib is in a class of medications called kinase inhibitors. It works by blocking the action of the abnormal protein that signals cancer cells to multiply. This helps stop the spread of cancer cells.
Budesonide Overview
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Budesonide (Entocort EC) is used to treat Crohn's disease (a condition in which the body attacks the lining of the digestive tract, causing pain, diarrhea, weight loss, and fever). Budesonide (Tarpeyo) is used to decrease protein in the urine in patients with primary immunoglobulin A nephropathy (kidney disease that occurs in some people when too much immunoglobin A builds up in the kidney, causing inflammation). Budesonide is in a class of medications called corticosteroids. It works by decreasing inflammation (swelling) in the digestive tract of people who have Crohn's disease or in the kidney of people with nephropathy.
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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.