Panobinostat with Atazanavir Interaction Details
Brand Names Associated with Panobinostat
- Farydak®
- Panobinostat
Brand Names Associated with Atazanavir
- Atazanavir
- ATZ
- Reyataz®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Feb 29, 2024
Interaction Effect
Increased risk of QT-interval prolongation; increased panobinostat exposure
Interaction Summary
The Cmax and AUC of panobinostat (a CYP3A substrate) increased by 62% and 73%, respectively, among patients with advanced cancer when ketoconazole (a strong CYP3A inhibitor) was added to an existing panobinostat regimen. Avoid concurrent use of panobinostat with strong CYP3A inhibitors that prolong the QT interval, as additive QT-interval prolongation and increased panobinostat exposure may result. If coadministration is required, reduce the starting panobinostat dose to 10 mg. Assess ECG and electrolytes at baseline and periodically during therapy. Interrupt treatment if the Fridericia-corrected QT interval increases to 480 msecs or more. Discontinue panobinostat if QT-interval prolongation does not resolve after any electrolyte abnormalities are corrected[1].
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Avoid concurrent use of panobinostat (a CYP3A substrate) with strong CYP3A inhibitors as increased panobinostat exposure may result. Additionally, concomitant administration of panobinostat and this drug may result in additive effects on the QT interval. If coadministration is required, reduce the starting panobinostat dose to 10 mg. Assess ECG and electrolytes at baseline and periodically during therapy. Interrupt treatment if the Fridericia-corrected QT interval increases to 480 msecs or more. Discontinue panobinostat if QT-interval prolongation does not resolve after any electrolyte abnormalities are corrected[1].
Mechanism Of Interaction
Additive effects on the QT interval; inhibition of CYP3A-mediated panobinostat metabolism
Literature Reports
A) The Cmax and AUC of panobinostat increased by 62% and 73%, respectively, among patients with advanced cancer when ketoconazole 200 mg twice daily was added to a 20 mg panobinostat regimen for 14 days. Panobinostat is a CYP3A substrate, while ketoconazole is a strong CYP3A inhibitor [1].
References
1 ) Product Information: FARYDAK(R) oral capsules, panobinostat oral capsules. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2015.
Panobinostat Overview
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Panobinostat is used in combination with bortezomib (Velcade) and dexamethasone to treat people with multiple myeloma (a type of cancer of the bone marrow) who have already been treated two other medications, including bortezomib (Velcade). Panobinostat is in a class of medications called histone deacetylase (HDAC) inhibitors. It works by killing cancer cells.
Atazanavir Overview
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Atazanavir is used along with other medications to treat human immunodeficiency virus (HIV) infection in adults and children who are at least 3 months of age and weigh at least 22 lb (10 kg). Atazanavir is in a class of medications called protease inhibitors. It works by decreasing the amount of HIV in the blood. Although atazanavir does not cure HIV, it may decrease your chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer. Atazanavir must be given with other medications that treat HIV infection to completely treat the infection. Taking these medications along with practicing safer sex and making other lifestyle changes may decrease the risk of transmitting the HIV virus to other people.
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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:
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.