Ivosidenib and Asciminib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ivosidenib
Asciminib
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.
What happens
Reduced asciminib exposure, reduced efficacy of asciminib, an increased risk of ivosidenib exposure and an increased risk of ivosidenib-related adverse reactions
Interaction Deep Dive
Concomitant use of asciminib (CYP3A4 substrate and CYP3A4 inhibitor) with ivosidenib (strong CYP3A4 inducer and CYP3A4 substrate with NTI) may reduce asciminib exposure, which may reduce the efficacy of asciminib and may also increase ivosidenib exposure, which may increase the risk of adverse reactions. Avoid coadministration of asciminib 200 mg twice daily with ivosidenib where minimal concentration changes may lead to serious adverse reactions. In patients receiving a total dose of asciminib 80 mg/day, closely monitor for adverse reactions when coadministered with ivosidenib where minimal concentration changes may lead to serious adverse reactions1.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism of asciminib; inhibition of CYP3A4-mediated metabolism of ivosidenib
Literature reports
2 reports — tap to read
a) Coadministration of asciminib 40 mg twice daily with midazolam (a CYP3A4 substrate) resulted in an increase in the AUC(inf) of midazolam by 28% and an increase in its Cmax of 11%. When coadministered with asciminib 80 mg once daily, the midazolam AUC(inf) and Cmax increased by 24% and 17%, respectively, and when coadministered with asciminib 200 mg twice daily, the midazolam AUC(inf) and Cmax increased by 88% and 58%, respectively 1.
b) In a drug interaction study, coadministration of asciminib dose of 200 mg with a strong CYP3A4 inducer (phenytoin) 100 mg three times daily decreased asciminib AUC (inf) by 34% and Cmax decreased by 22%. The asciminib AUC inf decreased by 15% while Cmax increased by 9%, following coadministration of a single asciminib dose of 40 mg with a strong CYP3A4 inducer (rifampicin) 1.
Common questions
Can I take Ivosidenib and Asciminib together?
Reduced asciminib exposure, reduced efficacy of asciminib, an increased risk of ivosidenib exposure and an increased risk of ivosidenib-related adverse reactions Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ivosidenib and Asciminib 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 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 Ivosidenib or Asciminib 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: SCEMBLIX® oral tablets, asciminib oral tablets. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2025. DailyMed
Keep reading about Ivosidenib
Keep reading about Asciminib
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist