Palbociclib with Verapamil Interaction Details
Brand Names Associated with Palbociclib
- Ibrance®
- Palbociclib
Brand Names Associated with Verapamil
- Calan®
- Calan® SR
- Covera® HS
- Iproveratril Hydrochloride
- Isoptin®
- Tarka® (as a combination product containing trandolapril and verapamil)
- Verapamil
- Verelan®
- Verelan® PM
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 26, 2023
Interaction Effect
Increased levels of palbociclib and increased palbociclib toxicity
Interaction Summary
Concomitant use of palbociclib (CYP3A4 and P-gp substrate) and verapamil (moderate CYP3A inhibitor and P-gp inhibitor) may lead to increased levels of palbociclib and increased risk for palbociclib toxicity. A case report describes febrile neutropenia, Grade 3 stomatitis, and periorbital and lip swelling with concomitant use of palbociclib and verapamil . Consider avoiding concomitant use.
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Concomitant use of palbociclib (CYP3A4 and P-gp substrate) and verapamil (moderate CYP3A inhibitor and P-gp inhibitor) may lead to increased levels of palbociclib and increased risk for palbociclib toxicity. A case report describes febrile neutropenia, Grade 3 stomatitis, and periorbital and lip swelling with concomitant use of palbociclib and verapamil . Consider avoiding concomitant use.
Mechanism Of Interaction
Inhibition of CYP3A4-mediated palbociclib metabolism and P-gp-mediated efflux transport
Literature Reports
A) A 68-year-old female treated with verapamil for hypertension and palbociclib and letrozole for stage 4, Grade 3, estrogen-receptor positive, progestin-receptor positive, HER2 nonamplified invasive ductal carcinoma developed febrile neutropenia, Grade 3 stomatitis, and periorbital and lip swelling 1 day following her second course of palbociclib. Verapamil was discontinued and amlodipine was initiated for blood pressure control; pablocicilib was later resumed at a reduced dose. One month later, the patient reported no side effects and WBC and absolute neutrophils were within normal limits .
Palbociclib Overview
-
Palbociclib is used in combination with anastrozole (Arimidex), exemestane (Aromasin), or letrozole (Femara) to treat a certain type of hormone receptor–positive, advanced breast cancer (breast cancer that depends on hormones such as estrogen to grow) or breast cancer that has spread to other parts of the body in women who have experienced menopause (change of life; end of monthly menstrual periods) or in men. Palbociclib is also used along with fulvestrant (Faslodex) to treat a certain type of hormone receptor–positive, advanced breast cancer (breast cancer that depends on hormones such as estrogen to grow) or breast cancer that has spread to other parts of the body in people who have been treated with an antiestrogen medication such as tamoxifen (Nolvadex). Palbociclib is in a class of medications called kinase inhibitors. It works by blocking the action of the abnormal protein that signals cancer cells to multiply. This helps stop or slow the spread of cancer cells.
Verapamil Overview
-
Verapamil is used to treat high blood pressure and to control angina (chest pain). The immediate-release tablets are also used alone or with other medications to prevent and treat irregular heartbeats. Verapamil is in a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart and slows electrical activity in the heart to control the heart rate.
-
High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
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:
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.