Midostaurin and Tovorafenib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Midostaurin
Tovorafenib
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 CYP3A substrate with NTI exposure and reduced efficacy of CYP3A substrate with NTI
Interaction Deep Dive
Avoid coadministration of tovorafenib (CYP3A inducer) with certain CYP3A substrates where minimal concentration changes may lead to serious therapeutic failures. Concomitant use of tovorafenib and CYP3A substrates with NTI may reduce CYP3A substrate with NTI exposure and may reduce efficacy of CYP3A4 substrate with NTI. If coadministration is unavoidable, monitor patients for loss of efficacy. In a model informed approach drug interaction study, midazolam (CYP3A4 substrate) steady-state Cmax and AUC are predicted to decrease by at least 20% following coadministration with tovorafenib1.
Why it happens (mechanism)
Induction of CYP3A-mediated metabolism by tovorafenib
Literature reports
1 report — tap to read
a) In a model informed approach drug interaction study, midazolam (CYP3A4 substrate) steady-state Cmax and AUC are predicted to decrease by at least 20% following coadministration with tovorafenib 1.
Common questions
Can I take Midostaurin and Tovorafenib together?
Reduced CYP3A substrate with NTI exposure and reduced efficacy of CYP3A substrate with NTI Always confirm with your pharmacist or prescriber before making any change.
How serious is the Midostaurin and Tovorafenib 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 Midostaurin or Tovorafenib 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: OJEMDA oral tablets, oral suspension, tovorafenib oral tablets, oral suspension. Day One Biopharmaceuticals, Inc.(Per FDA), Brisbane, CA, 2024. DailyMed
Keep reading about Midostaurin
Keep reading about Tovorafenib
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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