Ivosidenib and Bedaquiline: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ivosidenib
Bedaquiline
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 bedaquiline exposure, reduced efficacy of bedaquiline and an increased risk of QT interval prolongation
Interaction Deep Dive
Avoid the concomitant use of bedaquiline (a CYP3A4 substrate) with strong CYP3A4 inducers that prolong QT interval, as it may decrease the systemic bedaquiline exposure and may reduce the therapeutic effect of bedaquiline. And, concomitant use may also result in additive prolongation effects on the QT interval. Monitor ECG before initiation of treatment, 2 weeks after initiation and during treatment. Obtain electrolytes at baseline and during treatment and correct electrolytes. Discontinue bedaquiline if there is evidence of serious ventricular arrhythmia or QTc interval greater than 500 ms1.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism of bedaquiline; additive QT interval prolongation
Literature reports
2 reports — tap to read
a) Mean bedaquiline exposure (eg, AUC) was reduced by 52% (90% CI, -57% to -46% change) in a drug interaction study in which healthy subjects received a single dose of bedaquiline 300 mg concomitantly with the strong CYP3A4 inducer, rifAMPin, at a dose of 600 mg once daily for 21 days 1.
b) In a study, where bedaquiline was administered with the QTc prolonging drugs clofazimine and levoFLOXacin, 5% of patients in the 40-week bedaquiline treatment group experienced a QTc 500 ms or greater and 43% of patients experienced an increase in QTc 60 ms or greater over baseline. Of the clofazimine-and levoFLOXacin-treated patients in the 40-week control arm, 7% of patients experienced a QTc 500 ms or greater and 39% experienced an increase in QTc 60 ms or greater over baseline 1.
Common questions
Can I take Ivosidenib and Bedaquiline together?
Reduced bedaquiline exposure, reduced efficacy of bedaquiline and an increased risk of QT interval prolongation Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ivosidenib and Bedaquiline 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 "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Ivosidenib or Bedaquiline 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: SIRTURO(R) oral tablets, bedaquiline oral tablets. Janssen Products, LP (per FDA), Horsham, PA, 2024. DailyMed
Keep reading about Ivosidenib
Keep reading about Bedaquiline
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