Risk Factor C (Monitor therapy)

Apalutamide

CYP3A4 Inducers (Strong) may decrease the serum concentration of Apalutamide.

Benperidol

CYP3A4 Inducers (Strong) may decrease the serum concentration of Benperidol.

Bictegravir

CYP3A4 Inducers (Strong) may decrease the serum concentration of Bictegravir. Management: Rifampin is specifically contraindicated, and the use of carbamazepine, phenytoin, or phenobarbital is not recommended when alternatives are acceptable

Brentuximab Vedotin

CYP3A4 Inducers (Strong) may decrease the serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be decreased.

Calcifediol

CYP3A4 Inducers (Strong) may decrease the serum concentration of Calcifediol.

Cannabidiol

CYP3A4 Inducers (Strong) may decrease the serum concentration of Cannabidiol.

Cannabis

CYP3A4 Inducers (Strong) may decrease the serum concentration of Cannabis. More specifically, tetrahydrocannabinol and cannabidiol serum concentrations may be decreased.

ChlorproPAMIDE

CYP3A4 Inducers (Strong) may decrease the serum concentration of ChlorproPAMIDE.

Clindamycin (Systemic)

CYP3A4 Inducers (Strong) may decrease the serum concentration of Clindamycin (Systemic). Refer to the specific clindamycin (systemic) - rifampin drug interaction monograph for information concerning that combination.

Codeine

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Codeine.

Dabrafenib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Dabrafenib.

Diethylstilbestrol

CYP3A4 Inducers (Strong) may decrease the serum concentration of Diethylstilbestrol.

Doxercalciferol

CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Doxercalciferol.

Dronabinol

CYP3A4 Inducers (Strong) may decrease the serum concentration of Dronabinol.

Elagolix

CYP3A4 Inducers (Strong) may decrease the serum concentration of Elagolix.

Enfortumab Vedotin

CYP3A4 Inducers (Strong) may decrease the serum concentration of Enfortumab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be decreased.

Estriol (Systemic)

CYP3A4 Inducers (Strong) may decrease the serum concentration of Estriol (Systemic).

Estriol (Topical)

CYP3A4 Inducers (Strong) may decrease the serum concentration of Estriol (Topical).

Evogliptin

CYP3A4 Inducers (Strong) may decrease the serum concentration of Evogliptin.

FentaNYL

CYP3A4 Inducers (Strong) may decrease the serum concentration of FentaNYL.

Glecaprevir and Pibrentasvir

CYP3A4 Inducers (Strong) may decrease the serum concentration of Glecaprevir and Pibrentasvir.

Ifosfamide

CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Ifosfamide. CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Ifosfamide.

Meperidine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Meperidine.

Oxcarbazepine

CYP3A4 Inducers (Strong) may decrease the serum concentration of OXcarbazepine. Specifically, the concentrations of the 10-monohydroxy active metabolite of oxcarbazepine may be decreased.

Polatuzumab Vedotin

CYP3A4 Inducers (Strong) may decrease the serum concentration of Polatuzumab Vedotin. Exposure to unconjugated MMAE, the cytotoxic small molecule component of polatuzumab vedotin, may be decreased.

Propafenone

CYP3A4 Inducers (Strong) may decrease the serum concentration of Propafenone.

Ramelteon

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ramelteon.

Reboxetine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Reboxetine.

Ruxolitinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ruxolitinib.

SAXagliptin

CYP3A4 Inducers (Strong) may decrease the serum concentration of SAXagliptin.

Sertraline

CYP3A4 Inducers (Strong) may decrease the serum concentration of Sertraline.

SUFentanil

CYP3A4 Inducers (Strong) may decrease the serum concentration of SUFentanil.

Tetrahydrocannabinol

CYP3A4 Inducers (Strong) may decrease the serum concentration of Tetrahydrocannabinol.

Tetrahydrocannabinol and Cannabidiol

CYP3A4 Inducers (Strong) may decrease the serum concentration of Tetrahydrocannabinol and Cannabidiol.

Tropisetron

CYP3A4 Inducers (Strong) may decrease the serum concentration of Tropisetron.

Udenafil

CYP3A4 Inducers (Strong) may decrease the serum concentration of Udenafil.

Zuclopenthixol

CYP3A4 Inducers (Strong) may decrease the serum concentration of Zuclopenthixol.

Risk Factor D (Consider therapy modification)

Abiraterone Acetate

CYP3A4 Inducers (Strong) may decrease the serum concentration of Abiraterone Acetate. Management: Avoid whenever possible. If such a combination cannot be avoided, increase abiraterone acetate dosing frequency from once daily to twice daily during concomitant use.

Acalabrutinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Acalabrutinib. Management: Avoid co-administration of strong CYP3A inducers in patients taking acalabrutinib. If strong CYP3A inducers cannot be avoided, increase the dose of acalabrutinib to 200 mg twice daily.

Apixaban

CYP3A4 Inducers (Strong) may decrease the serum concentration of Apixaban. Management: Avoid concurrent use of apixaban with strong CYP3A4 inducers whenever possible. Use of a strong CYP3A4 inducer with apixaban should be strictly avoided in any patient who is using an agent (either the CYP3A4 inducer or a third drug) that induces P-gp.

ARIPiprazole

CYP3A4 Inducers (Strong) may decrease the serum concentration of ARIPiprazole. Management: Double the oral aripiprazole dose and closely monitor. Reduce oral aripiprazole dose to 10-15 mg/day (for adults) if the inducer is discontinued. Avoid use of strong CYP3A4 inducers for more than 14 days with extended-release injectable aripiprazole.

ARIPiprazole Lauroxil

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of ARIPiprazole Lauroxil. Management: Patients taking the 441 mg dose of aripiprazole lauroxil increase their dose to 662 mg if used with a strong CYP3A4 inducer for more than 14 days. No dose adjustment is necessary for patients using the higher doses of aripiprazole lauroxil.

Brexpiprazole

CYP3A4 Inducers (Strong) may decrease the serum concentration of Brexpiprazole. Management: If brexpiprazole is used together with a strong CYP3A4 inducer, the brexpiprazole dose should gradually be doubled over the course of 1 to 2 weeks.

BusPIRone

CYP3A4 Inducers (Strong) may decrease the serum concentration of BusPIRone. Management: Consider alternatives to this combination. If coadministration of these agents is deemed necessary, monitor patients for reduced buspirone effects and increase buspirone doses as needed.

Cabozantinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Cabozantinib. Management: Avoid use of strong CYP3A4 inducers with cabozantinib if possible. If combined, cabozantinib dose adjustments are recommended and vary based on the cabozantinib product used and the indication for use. See monograph for details.

Clarithromycin

CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Clarithromycin. Clarithromycin may increase the serum concentration of CYP3A4 Inducers (Strong). CYP3A4 Inducers (Strong) may decrease the serum concentration of Clarithromycin. Management: Consider alternative antimicrobial therapy for patients receiving a CYP3A inducer. Drugs that enhance the metabolism of clarithromycin into 14hydroxyclarithromycin may alter the clinical activity of clarithromycin and may impair clarithromycin efficacy.

Corticosteroids (Systemic)

Mitotane may decrease the serum concentration of Corticosteroids (Systemic).

CYP3A4 Substrates (High risk with Inducers)

Mitotane may decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.

Dasatinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Dasatinib. Management: Avoid when possible. If such a combination cannot be avoided, consider increasing dasatinib dose and monitor clinical response and toxicity closely.

DexAMETHasone (Systemic)

CYP3A4 Inducers (Strong) may decrease the serum concentration of DexAMETHasone (Systemic). Management: Consider dexamethasone dose increases in patients receiving strong CYP3A4 inducers and monitor closely for reduced dexamethasone efficacy. Consider avoiding this combination when treating life threatening conditions (ie, multiple myeloma).

DOXOrubicin (Conventional)

CYP3A4 Inducers (Strong) may decrease the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to strong CYP3A4 inducers in patients treated with doxorubicin. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided.

Enzalutamide

CYP3A4 Inducers (Strong) may decrease the serum concentration of Enzalutamide. Management: Consider using an alternative agent that has no or minimal CYP3A4 induction potential when possible. If this combination cannot be avoided, increase the dose of enzalutamide from 160 mg daily to 240 mg daily.

Eravacycline

CYP3A4 Inducers (Strong) may decrease the serum concentration of Eravacycline. Management: Increase the eravacycline dose to 1.5 mg/kg every 12 hours when combined with strong CYP3A4 inducers.

Erlotinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Erlotinib. Management: Avoid combination if possible. If combination must be used, increase erlotinib dose by 50 mg increments every 2 weeks as tolerated, to a maximum of 450 mg/day.

Etoposide

CYP3A4 Inducers (Strong) may decrease the serum concentration of Etoposide. Management: When possible, seek alternatives to strong CYP3A4-inducing medications in patients receiving etoposide. If combined, monitor patients closely for diminished etoposide response and need for etoposide dose increases.

Etoposide Phosphate

CYP3A4 Inducers (Strong) may decrease the serum concentration of Etoposide Phosphate. Management: When possible, seek alternatives to strong CYP3A4inducing medications in patients receiving etoposide phosphate. If these combinations cannot be avoided, monitor patients closely for diminished etoposide phosphate response.

Everolimus

CYP3A4 Inducers (Strong) may decrease the serum concentration of Everolimus. Management: Avoid concurrent use of strong CYP3A4 inducers if possible. If coadministration cannot be avoided, double the daily dose of everolimus using increments of 5 mg or less. Monitor everolimus serum concentrations closely when indicated.

Exemestane

CYP3A4 Inducers (Strong) may decrease the serum concentration of Exemestane. Management: Exemestane U.S. product labeling recommends using an increased dose (50 mg/day) in patients receiving concurrent strong CYP3A4 inducers. The Canadian product labeling does not recommend a dose adjustment with concurrent use of strong CYP3A4 inducers.

Gefitinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Gefitinib. Management: In the absence of severe adverse reactions, increase gefitinib dose to 500 mg daily in patients receiving strong CYP3A4 inducers; resume 250 mg dose 7 days after discontinuation of the strong inducer. Carefully monitor clinical response.

GuanFACINE

CYP3A4 Inducers (Strong) may decrease the serum concentration of GuanFACINE. Management: Increase the guanfacine dose by up to double when initiating guanfacine in a patient taking a strong CYP3A4 inducer. Increase guanfacine dose gradually over 1 to 2 weeks if initiating strong CYP3A4 inducer therapy in a patient already taking guanfacine.

Imatinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Imatinib. Management: Avoid concurrent use of imatinib with strong CYP3A4 inducers when possible. If such a combination must be used, increase imatinib dose by at least 50% and monitor the patient's clinical response closely.

Ixabepilone

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ixabepilone. Management: Avoid this combination whenever possible. If this combination must be used, a gradual increase in ixabepilone dose from 40 mg/m to 60 mg/m (given as a 4-hour infusion), as tolerated, should be considered.

Larotrectinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Larotrectinib. Management: Avoid use of strong CYP3A4 inducers with larotrectinib. If this combination cannot be avoided, double the larotrectinib dose. Reduced to previous dose after stopping the inducer after a period of 3 to 5 times the inducer half-life.

Lefamulin

CYP3A4 Inducers (Strong) may decrease the serum concentration of Lefamulin. Management: Avoid concomitant use of lefamulin with strong CYP3A4 inducers unless the benefits outweigh the risks.

Lefamulin (Intravenous)

CYP3A4 Inducers (Strong) may decrease the serum concentration of Lefamulin (Intravenous). Management: Avoid concomitant use of lefamulin intravenous infusion with strong CYP3A4 inducers unless the benefits outweigh the risks.

LinaGLIPtin

CYP3A4 Inducers (Strong) may decrease the serum concentration of LinaGLIPtin. Management: Strongly consider using an alternative to any strong CYP3A4 inducer in patients who are being treated with linagliptin. If this combination is used, monitor patients closely for evidence of reduced linagliptin effectiveness.

Manidipine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Manidipine. Management: Consider avoiding concomitant use of manidipine and strong CYP3A4 inducers. If combined, monitor closely for decreased manidipine effects and loss of efficacy. Increased manidipine doses may be required.

Maraviroc

CYP3A4 Inducers (Strong) may decrease the serum concentration of Maraviroc. Management: Increase maraviroc adult dose to 600 mg twice daily when used with strong CYP3A4 inducers. This does not apply to patients also receiving strong CYP3A4 inhibitors. Do not use maraviroc with strong CYP3A4 inducers in patients with CrCl less than 30 mL/min.

MethylPREDNISolone

CYP3A4 Inducers (Strong) may decrease the serum concentration of MethylPREDNISolone. Management: Consider methylprednisolone dose increases in patients receiving strong CYP3A4 inducers and monitor closely for reduced steroid efficacy.

Mirodenafil

CYP3A4 Inducers (Strong) may decrease the serum concentration of Mirodenafil. Management: Consider avoiding the concomitant use of mirodenafil and strong CYP3A4 inducers. If combined, monitor for decreased mirodenafil effects. Mirodenafil dose increases may be required to achieve desired effects.

Osimertinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Osimertinib.

Perampanel

CYP3A4 Inducers (Strong) may decrease the serum concentration of Perampanel. Management: Increase the perampanel starting dose to 4 mg/day when perampanel is used concurrently with moderate and strong CYP3A4 inducers.

Pitolisant

CYP3A4 Inducers (Strong) may decrease the serum concentration of Pitolisant. Management: For patients who are stable on pitolisant doses of 8.9 mg or 17.8 mg/day and who are also taking a strong CYP3A4 inducer, increase the pitolisant dose over 7 days to double the original dose (ie, to either 17.8 mg/day or 35.6 mg/day, respectively).

QUEtiapine

CYP3A4 Inducers (Strong) may decrease the serum concentration of QUEtiapine. Management: An increase in quetiapine dose (as much as 5 times the regular dose) may be required to maintain therapeutic benefit. Reduce the quetiapine dose back to the previous/regular dose within 7-14 days of discontinuing the inducer.

Radotinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Radotinib. Management: Consider alternatives to this combination when possible as the risk of radotinib treatment failure may be increased.

RisperiDONE

CYP3A4 Inducers (Strong) may decrease the serum concentration of RisperiDONE. Management: Consider increasing the dose of oral risperidone (to no more than double the original dose) if a strong CYP3A4 inducer is initiated. For patients on IM risperidone, consider an increased IM dose or supplemental doses of oral risperidone.

Rolapitant

CYP3A4 Inducers (Strong) may decrease the serum concentration of Rolapitant. Management: Avoid rolapitant use in patients requiring chronic administration of strong CYP3A4 inducers. Monitor for reduced rolapitant response and the need for alternative or additional antiemetic therapy even with shorter-term use of such inducers.

Sirolimus

CYP3A4 Inducers (Strong) may decrease the serum concentration of Sirolimus. Management: Avoid concomitant use of strong CYP3A4 inducers and sirolimus if possible. If combined, monitor for reduced serum sirolimus concentrations. Sirolimus dose increases will likely be necessary to prevent subtherapeutic sirolimus levels.

Spironolactone

May diminish the therapeutic effect of Mitotane. Management: Consideration should be given to discontinuing spironolactone prior to initiating mitotane in order to eliminate the risk of therapeutic failure of the mitotane.

SUNItinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of SUNItinib. Management: Avoid when possible. If such a combination cannot be avoided, sunitinib dose increases are recommended, and vary by indication. See full monograph for details.

Tadalafil

CYP3A4 Inducers (Strong) may decrease the serum concentration of Tadalafil. Management: Erectile dysfunction: monitor for decreased effectiveness - no standard dose adjustments recommended. Avoid use of tadalafil for pulmonary arterial hypertension in patients receiving a strong CYP3A4 inducer.

Tamoxifen

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Tamoxifen. CYP3A4 Inducers (Strong) may decrease the serum concentration of Tamoxifen. Management: Consider alternatives to concomitant use of strong CYP3A4 inducers and tamoxifen. If the combination cannot be avoided, monitor for reduced therapeutic effects of tamoxifen.

Temsirolimus

CYP3A4 Inducers (Strong) may decrease the serum concentration of Temsirolimus. Management: Consider increasing the dose of temsirolimus to 50 mg IV/week (from 25 mg IV/week) if a concomitant CYP3A4 strong inducer is necessary.

Thiotepa

CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Thiotepa. CYP3A4 Inducers (Strong) may decrease the serum concentration of Thiotepa. Management: Thiotepa prescribing information recommends avoiding concomitant use of thiotepa and strong CYP3A4 inducers. If concomitant use is unavoidable, monitor for adverse effects.

TiaGABine

CYP3A4 Inducers (Strong) may decrease the serum concentration of TiaGABine. Management: Approximately 2-fold higher tiagabine doses and a more rapid dose titration will likely be required in patients concomitantly taking a strong CYP3A4 inducer.

Vemurafenib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Vemurafenib. Management: Avoid concurrent use of vemurafenib with a strong CYP3A4 inducer and replace with another agent when possible. If a strong CYP3A4 inducer is indicated and unavoidable, the dose of vemurafenib may be increased by 240 mg (1 tablet) as tolerated.

Vilazodone

CYP3A4 Inducers (Strong) may decrease the serum concentration of Vilazodone. Management: Consider increasing vilazodone dose by as much as 2-fold (do not exceed 80 mg/day), based on response, in patients receiving strong CYP3A4 inducers for > 14 days. Reduce to the original vilazodone dose over 1-2 weeks after inducer discontinuation.

Vortioxetine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Vortioxetine. Management: Consider increasing the vortioxetine dose to no more than 3 times the original dose when used with a strong drug metabolism inducer for more than 14 days. The vortioxetine dose should be returned to normal within 14 days of stopping the strong inducer.

Voxelotor

CYP3A4 Inducers (Strong) may decrease the serum concentration of Voxelotor. Management: Avoid concomitant use of voxelotor and strong CYP3A4 inducers. If concomitant use is unavoidable, increase the voxelotor dose to 2,500 mg once daily.

Zaleplon

CYP3A4 Inducers (Strong) may decrease the serum concentration of Zaleplon. Management: Consider the use of an alternative hypnotic that is not metabolized by CYP3A4 in patients receiving strong CYP3A4 inducers. If zalephon is combined with a strong CYP3A4 inducer, monitor for decreased effectiveness of zaleplon.

Risk Factor X (Avoid combination)

Abemaciclib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Abemaciclib.

Alpelisib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Alpelisib.

Antihepaciviral Combination Products

CYP3A4 Inducers (Strong) may decrease the serum concentration of Antihepaciviral Combination Products.

Apremilast

CYP3A4 Inducers (Strong) may decrease the serum concentration of Apremilast.

Aprepitant

CYP3A4 Inducers (Strong) may decrease the serum concentration of Aprepitant.

Artemether

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Artemether. Specifically, dihydroartemisinin concentrations may be reduced. CYP3A4 Inducers (Strong) may decrease the serum concentration of Artemether.

Asunaprevir

CYP3A4 Inducers (Strong) may decrease the serum concentration of Asunaprevir.

Avapritinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Avapritinib.

Axitinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Axitinib.

Bedaquiline

CYP3A4 Inducers (Strong) may decrease the serum concentration of Bedaquiline.

Bortezomib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Bortezomib.

Bosutinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Bosutinib.

Brigatinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Brigatinib.

Cariprazine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Cariprazine.

Ceritinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ceritinib.

CloZAPine

CYP3A4 Inducers (Strong) may decrease the serum concentration of CloZAPine.

Cobimetinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Cobimetinib.

Copanlisib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Copanlisib.

Crizotinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Crizotinib.

Daclatasvir

CYP3A4 Inducers (Strong) may decrease the serum concentration of Daclatasvir.

Dasabuvir

CYP3A4 Inducers (Strong) may decrease the serum concentration of Dasabuvir.

Deflazacort

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Deflazacort.

Delamanid

CYP3A4 Inducers (Strong) may decrease the serum concentration of Delamanid.

Dienogest

CYP3A4 Inducers (Strong) may decrease the serum concentration of Dienogest. Management: Avoid use of dienogest for contraception when using medications that induce CYP3A4 and for at least 28 days after discontinuation of a CYP3A4 inducer. An alternative form of contraception should be used during this time.

Doravirine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Doravirine.

Dronedarone

CYP3A4 Inducers (Strong) may decrease the serum concentration of Dronedarone.

Duvelisib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Duvelisib.

Elbasvir

CYP3A4 Inducers (Strong) may decrease the serum concentration of Elbasvir.

Eliglustat

CYP3A4 Inducers (Strong) may decrease the serum concentration of Eliglustat.

Encorafenib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Encorafenib.

Entrectinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Entrectinib.

Erdafitinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Erdafitinib.

Etravirine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Etravirine.

Fedratinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Fedratinib.

Flibanserin

CYP3A4 Inducers (Strong) may decrease the serum concentration of Flibanserin.

Fosaprepitant

CYP3A4 Inducers (Strong) may decrease the serum concentration of Fosaprepitant. Specifically, CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite aprepitant.

Fosnetupitant

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Fosnetupitant.

Fostamatinib

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Fostamatinib.

Gemigliptin

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Gemigliptin. CYP3A4 Inducers (Strong) may decrease the serum concentration of Gemigliptin.

Glasdegib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Glasdegib.

Grazoprevir

CYP3A4 Inducers (Strong) may decrease the serum concentration of Grazoprevir.

Ibrutinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ibrutinib.

Idelalisib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Idelalisib.

Irinotecan Products

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Irinotecan Products. Specifically, serum concentrations of SN-38 may be reduced. CYP3A4 Inducers (Strong) may decrease the serum concentration of Irinotecan Products.

Isavuconazonium Sulfate

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Isavuconazonium Sulfate. Specifically, CYP3A4 Inducers (Strong) may decrease isavuconazole serum concentrations.

Istradefylline

CYP3A4 Inducers (Strong) may decrease the serum concentration of Istradefylline.

Itraconazole

CYP3A4 Inducers (Strong) may decrease the serum concentration of Itraconazole.

Ivabradine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ivabradine.

Ivacaftor

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ivacaftor.

Ivosidenib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ivosidenib.

Ixazomib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ixazomib.

Lapatinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Lapatinib. Management: If therapy overlap cannot be avoided, consider titrating lapatinib gradually from 1,250 mg/day up to 4,500 mg/day (HER2 positive metastatic breast cancer) or 1,500 mg/day up to 5,500 mg/day (hormone receptor/HER2 positive breast cancer) as tolerated.

Lemborexant

CYP3A4 Inducers (Strong) may decrease the serum concentration of Lemborexant.

Lorlatinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Lorlatinib.

Lumateperone

CYP3A4 Inducers (Strong) may decrease the serum concentration of Lumateperone.

Lumefantrine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Lumefantrine.

Lurasidone

CYP3A4 Inducers (Strong) may decrease the serum concentration of Lurasidone.

Macimorelin

CYP3A4 Inducers (Strong) may decrease the serum concentration of Macimorelin.

Macitentan

CYP3A4 Inducers (Strong) may decrease the serum concentration of Macitentan.

Midostaurin

CYP3A4 Inducers (Strong) may decrease the serum concentration of Midostaurin.

MiFEPRIStone

CYP3A4 Inducers (Strong) may decrease the serum concentration of MiFEPRIStone.

Naldemedine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Naldemedine.

Naloxegol

CYP3A4 Inducers (Strong) may decrease the serum concentration of Naloxegol.

Neratinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Neratinib.

Netupitant

CYP3A4 Inducers (Strong) may decrease the serum concentration of Netupitant.

NIFEdipine

CYP3A4 Inducers (Strong) may decrease the serum concentration of NIFEdipine.

Nilotinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Nilotinib.

NiMODipine

CYP3A4 Inducers (Strong) may decrease the serum concentration of NiMODipine.

Nisoldipine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Nisoldipine.

Olaparib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Olaparib.

Palbociclib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Palbociclib.

Panobinostat

CYP3A4 Inducers (Strong) may decrease the serum concentration of Panobinostat.

PAZOPanib

CYP3A4 Inducers (Strong) may decrease the serum concentration of PAZOPanib.

Pexidartinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Pexidartinib.

Pimavanserin

CYP3A4 Inducers (Strong) may decrease the serum concentration of Pimavanserin.

Piperaquine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Piperaquine.

PONATinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of PONATinib.

Praziquantel

CYP3A4 Inducers (Strong) may decrease the serum concentration of Praziquantel. Management: Use of praziquantel with strong CYP3A4 inducers is contraindicated. Discontinue rifampin 4 weeks prior to initiation of praziquantel therapy. Rifampin may be resumed the day following praziquantel completion.

Pretomanid

CYP3A4 Inducers (Strong) may decrease the serum concentration of Pretomanid.

Ranolazine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ranolazine.

Regorafenib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Regorafenib.

Ribociclib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ribociclib.

Rivaroxaban

CYP3A4 Inducers (Strong) may decrease the serum concentration of Rivaroxaban.

Roflumilast

CYP3A4 Inducers (Strong) may decrease the serum concentration of Roflumilast. Management: Roflumilast U.S. prescribing information recommends against combining strong CYP3A4 inducers with roflumilast. The Canadian product monograph makes no such recommendation but notes that such agents may reduce roflumilast therapeutic effects.

RomiDEPsin

CYP3A4 Inducers (Strong) may decrease the serum concentration of RomiDEPsin.

Simeprevir

CYP3A4 Inducers (Strong) may decrease the serum concentration of Simeprevir.

Sonidegib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Sonidegib.

SORAfenib

CYP3A4 Inducers (Strong) may decrease the serum concentration of SORAfenib.

Tasimelteon

CYP3A4 Inducers (Strong) may decrease the serum concentration of Tasimelteon.

Ticagrelor

CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Ticagrelor. CYP3A4 Inducers (Strong) may decrease the serum concentration of Ticagrelor.

Tofacitinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Tofacitinib.

Tolvaptan

CYP3A4 Inducers (Strong) may decrease the serum concentration of Tolvaptan. Management: If concurrent use is necessary, increased doses of tolvaptan (with close monitoring for toxicity and clinical response) may be needed.

Toremifene

CYP3A4 Inducers (Strong) may decrease the serum concentration of Toremifene.

Trabectedin

CYP3A4 Inducers (Strong) may decrease the serum concentration of Trabectedin.

Ubrogepant

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ubrogepant.

Ulipristal

CYP3A4 Inducers (Strong) may decrease the serum concentration of Ulipristal.

Upadacitinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Upadacitinib.

Valbenazine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Valbenazine.

Vandetanib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Vandetanib.

Velpatasvir

CYP3A4 Inducers (Strong) may decrease the serum concentration of Velpatasvir.

Venetoclax

CYP3A4 Inducers (Strong) may decrease the serum concentration of Venetoclax.

VinCRIStine (Liposomal)

CYP3A4 Inducers (Strong) may decrease the serum concentration of VinCRIStine (Liposomal).

Vinflunine

CYP3A4 Inducers (Strong) may decrease the serum concentration of Vinflunine.

Vorapaxar

CYP3A4 Inducers (Strong) may decrease the serum concentration of Vorapaxar.

Voxilaprevir

CYP3A4 Inducers (Strong) may decrease the serum concentration of Voxilaprevir.

Zanubrutinib

CYP3A4 Inducers (Strong) may decrease the serum concentration of Zanubrutinib.