Lomitapide and Asciminib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lomitapide
No brand names on recordAsciminib
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
Increased lomitapide exposure and an increased risk of lomitapide-related adverse reactions
Interaction Deep Dive
Coadministration of asciminib and lomitapide may increase lomitapide exposure and risk of adverse reactions. Avoid coadministration of asciminib 200 mg twice daily with lomitapide. Closely monitor in patients receiving a total dose of asciminib 80 mg/day1. Maximum recommended dosage (MRD) of lomitapide with asciminib is 10 mg for 2 to 10 years, 20 mg for 11 to 17 years and 30 mg for 18 years and older. Titration schedule with concomitant use as followed: Age 2 to 10 years: Titration progresses from 2 mg (weeks 0 to 8), 5 mg (weeks 9 to 12), 10 mg (weeks 13 to 16), to 20 mg starting week 17 and beyond. Higher doses are not recommended. Age 11 to 15 years: Titration begins at 2 mg (weeks 0 to 4), then 5 mg (weeks 5 to 8), 10 mg (weeks 9 to 12), 20 mg (weeks 13 to 16), and 40 mg starting week 17 and beyond. 60 mg dose is not recommended. For age 16 to 17 years: Begins with 2 mg (weeks 0 to 2), 5 mg (weeks 3 to 6), 10 mg (weeks 7 to 10), 20 mg (weeks 11 to 14), and 40 mg starting week 15 and beyond. 60 mg dose is not recommended. For age 18 years and older: Same titration pattern as the 16 to 17 group, 60 mg dose is allowed after week 15. Asciminib initiation in patients with a stable lomitapide dosage, reduce lomitapide by half. Careful titration may then be considered based on LDL-C response and safety/tolerability to half the MRD except when coadministered with oral contraceptives only, in which case the MRD of lomitapide is approximately two thirds the MRD 2.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of lomitapide
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) The concomitant administration of atorvastatin (weak CYP3A4 inhibitor) 80 mg daily with a single 20 mg dose of lomitapide increased the AUC of lomitapide 2-fold and Cmax 2.1-fold compared with lomitapide administered alone 2.
Common questions
Can I take Lomitapide and Asciminib together?
Increased lomitapide exposure and an increased risk of lomitapide-related adverse reactions Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lomitapide 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 Lomitapide 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 (2)
Keep reading about Lomitapide
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.
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