Ivosidenib with Risperidone Interaction Details

Brand Names Associated with Ivosidenib

Brand Names Associated with Risperidone

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Dec 20, 2023

Interaction Effect

An increased risk of QT interval prolongation, reduced risperiDONE exposure, reduced 9-hydroxyrisperiDONE exposure and reduced efficacy of risperiDONE

Interaction Summary

Avoid coadministration of ivosidenib with risperiDONE. If ivosidenib is initiated, closely monitor during the first 4 to 8 weeks. In patients receiving PERSERIS(TM) 90 mg, consider increasing the dose to 120 mg. In patients receiving UZEDY(TM) at a specific dose, consider increasing to the next highest dose. In patients receiving PERSERIS(TM) 120 mg or UZEDY(TM) 125 mg once monthly or 250 mg once every 2 months, additional oral risperiDONE may be necessary. Upon discontinuation of the ivosidenib, re-evaluate risperiDONE dosage and decrease as necessary. If the patient is already receiving PERSERIS(TM) 90 mg or UZEDY(TM) 50 mg once monthly or 100 mg once every 2 months, continue treatment at the current dose unless clinical judgement necessitates interruption . For risperiDONE IM, decrease dose 2 to 4 weeks before the discontinuation of ivosidenib. If patients are receiving risperiDONE 25 mg IM, treatment may be continued unless the clinician deems it necessary to interrupt or lower the risperiDONE dosage; a risperiDONE 12.5 mg IM dose may be considered, but efficacy is not established .

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Coadministration of ivosidenib (a strong CYP3A4 inducer) and risperiDONE may lead to reduced risperiDONE and 9-hydroxyrisperiDONE (active metabolite) combined exposure. If ivosidenib is initiated, closely monitor during the first 4 to 8 weeks. In patients receiving PERSERIS(TM) 90 mg, consider increasing the dose to 120 mg. In patients receiving UZEDY(TM) at a specific dose, consider increasing to the next highest dose. In patients receiving PERSERIS(TM) 120 mg or UZEDY(TM) 125 mg once monthly or 250 mg once every 2 months, additional oral risperiDONE may be necessary. Upon discontinuation of ivosidenib, re-evaluate risperiDONE dosage and decrease as necessary. If the patient is already receiving PERSERIS(TM) 90 mg or UZEDY(TM) 50 mg once monthly or 100 mg once every 2 months, continue treatment at the current dose unless clinical judgement necessitates interruption. For risperiDONE IM, decrease dose 2 to 4 weeks before the discontinuation of ivosidenib. If patients are receiving risperiDONE 25 mg IM, treatment may be continued unless the clinician deems it necessary to interrupt or to lower the risperiDONE dosage; a risperiDONE 12.5 mg IM dose may be considered, but efficacy has not been established .

Mechanism Of Interaction

Additive QT interval prolongation; induction of CYP3A4-mediated metabolism of risperiDONE

Ivosidenib Overview

• Ivosidenib is used to treat a certain type of acute myeloid leukemia (AML; a type of cancer that begins in the white blood cells) that has returned or that has not improved after previous treatment(s). Ivosidenib is also used alone or in combination with azacitidine (Onureg) to treat a certain type of AML in some adults older than 75 years of age as a first treatment. Ivosidenib is also used in adults who have already received previous treatment(s) to treat a certain type of cholangiocarcinoma (bile duct cancer) that has spread to nearby tissues or other parts of the body. Ivosidenib is in a class of medications called IDH1 inhibitors. It works by slowing or stopping the growth of cancer cells.

Risperidone Overview

• Risperidone is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat episodes of mania (frenzied, abnormally excited, or irritated mood) or mixed episodes (symptoms of mania and depression that happen together) in adults and in teenagers and children 10 years of age and older with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Risperidone is also used to treat behavior problems such as aggression, self-injury, and sudden mood changes in teenagers and children 5 to 16 years of age who have autism (a condition that causes repetitive behavior, difficulty interacting with others, and problems with communication). Risperidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.