Zanubrutinib with Erythromycin Interaction Details

Brand Names Associated with Zanubrutinib

  • Brukinsa®
  • Zanubrutinib

Brand Names Associated with Erythromycin

  • EES®
  • ERY-C®
  • Ery-Tab®
  • Erythrocin®
  • Erythromycin
  • PCE®
  • Pediamycin®

Medical Content Editor
Last updated Dec 22, 2023

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Interaction Effect

Increased zanubrutinib exposure and risk of toxicity

Interaction Summary

Zanubrutinib is primarily metabolized by CYP3A, and concomitant use of zanubrutinib with a CYP3A inhibitor increases zanubrutinib exposure, which may increase the risk of zanubrutinib toxicities. Coadministration of zanubrutinib with erythromycin 500 mg 4 times daily (a moderate CYP3A inhibitor) is predicted to increase zanubrutinib Cmax by 284% and AUC by 317%. When zanubrutinib and a moderate CYP3A inhibitor are coadministered, reduce zanubrutinib to 80 mg twice daily and further modify the dosage as required for adverse reactions. After discontinuation of a CYP3A inhibitor, resume previous dosage of zanubrutinib.

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Concomitant use of zanubrutinib (a CYP3A substrate) and a CYP3A inhibitor increases zanubrutinib exposure, which may increase the risk of zanubrutinib toxicities. When coadministered with a moderate CYP3A inhibitor, reduce zanubrutinib to 80 mg twice daily and further modify the dosage as required for adverse reactions. After discontinuation of a CYP3A inhibitor, resume previous dosage of zanubrutinib.

Mechanism Of Interaction

Inhibition of CYP3A-mediated zanubrutinib metabolism

Literature Reports

A) The predicted increase in zanubrutinib exposure when coadministered with erythromycin 500 mg 4 times daily, is a 284% increase in zanubrutinib Cmax and a 317% increase in AUC .

B) The predicted increase in zanubrutinib exposure when coadministered with diltiazem 60 mg 3 times daily, is a 151% increase in zanubrutinib Cmax and a 157% increase in AUC .

C) The predicted increases in zanubrutinib exposure when coadministered with fluconazole 200 mg/day is a 179% increase in zanubrutinib Cmax and a 177% increase in AUC and with fluconazole 400 mg/day is a 270% increase in zanubrutinib Cmax and a 284% increase in AUC .

Zanubrutinib Overview

  • Zanubrutinib is used to treat mantle cell lymphoma (MCL; a fast-growing cancer that begins in the cells of the immune system) in adults who have already been treated with at least one other chemotherapy medication. Zanubrutinib is also used to treat adults with Waldenstrom's macroglobulinemia (WM; a slow-growing cancer that begins in certain white blood cells in your bone marrow), chronic lymphocytic leukemia (CLL; a type of cancer that begins in the white blood cells), and small lymphocytic lymphoma (SLL; a type of cancer that begins mostly in the lymph nodes). It is also used to treat marginal zone lymphoma (MZL; a slow growing cancer that begins in a type of white blood cells that normally fight infection) in adults whose cancer has returned or did not respond to a certain type of medication. Zanubrutinib 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 the spread of cancer cells.

See More information Regarding Zanubrutinib

Erythromycin Overview

  • Erythromycin is used to treat certain infections caused by bacteria, such as infections of the respiratory tract, including bronchitis, pneumonia, Legionnaires' disease (a type of lung infection), and pertussis (whooping cough; a serious infection that can cause severe coughing); diphtheria (a serious infection in the throat); sexually transmitted diseases (STD), including syphilis; and ear, intestine, gynecological, urinary tract, and skin infections. It also is used to prevent recurrent rheumatic fever. Erythromycin is in a class of medications called macrolide antibiotics. It works by stopping the growth of bacteria.

  • Antibiotics such as erythromycin will not work for colds, flu, or other viral infections. Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

See More information Regarding Erythromycin

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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.