Topotecan and Midostaurin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Topotecan
Midostaurin
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 BCRP substrate exposure
Interaction Deep Dive
Coadministration of midostaurin and a BCRP substrate may increase the exposure of the BCRP substrate. Coadministration of midostaurin with rosuvastatin (BCRP and OATP1B1 substrate) increased the exposure of rosuvastatin by 48%. Dose adjustments of the coadministered BCRP substrate may be necessary with midostaurin1.
Why it happens (mechanism)
Inhibition of BCRP substrate transport by midostaurin
Literature reports
1 report — tap to read
a) Coadministration of a single dose of midostaurin 100 mg with a single dose of rosuvastatin (BCRP and OATP1B1 substrate) increased the AUC(last) of rosuvastatin by 48% 1.
Common questions
Can I take Topotecan and Midostaurin together?
Increased BCRP substrate exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Topotecan and Midostaurin 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 Topotecan or Midostaurin 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: RYDAPT(R) oral capsules, midostaurin oral capsules. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2021. DailyMed
Keep reading about Topotecan
Keep reading about Midostaurin
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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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