Neratinib and Dronedarone: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Dronedarone
Neratinib
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 neratinib exposure and risk of toxicity
Interaction Deep Dive
Concomitant use of neratinib (a CYP3A4 substrate) with a dual moderate CYP3A4 and P-gp inhibitor increases neratinib exposure and may increase the risk of toxicity and therefore should be avoided. Simulations using physiologically based pharmacokinetic models suggested that verapamil (a moderate CYP3A4 and P-gp dual inhibitor) may increase neratinib Cmax by 203% and AUC by 299%1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of neratinib; inhibition of P-gp-mediated efflux transport of neratinib
Literature reports
1 report — tap to read
a) Simulations using physiologically based pharmacokinetic models suggested that concomitant use of a moderate CYP3A4 and P-gp dual inhibitor (verapamil) with neratinib may increase neratinib Cmax by 203% and AUC by 299% 1.
Common questions
Can I take Neratinib and Dronedarone together?
Increased neratinib exposure and risk of toxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Neratinib and Dronedarone 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 Neratinib or Dronedarone 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: NERLYNX(R) oral tablets, neratinib oral tablets. Puma Biotechnology Inc (per manufacturer), Los Angeles, CA, 2020. DailyMed
Keep reading about Dronedarone
Keep reading about Neratinib
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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