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Drug Interactions between crizotinib and ginger / magnesium sulfate / pyridoxine

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

ginger crizotinib

Applies to: ginger / magnesium sulfate / pyridoxine and crizotinib

MONITOR: Limited data suggests that coadministration with ginger may increase the plasma concentrations and the risk of toxicity of crizotinib. The proposed mechanism, based on in vitro data, may be attributed to decreased clearance due to ginger-mediated inhibition of CYP450 3A4 and/or P-glycoprotein (P-gp). Ginger has previously been shown to inhibit CYP450 3A4, 2C9, and P-gp activities in vitro. In one case report, increased plasma levels and hepatotoxicity developed in a 48-year old woman receiving crizotinib (250 mg twice daily) following consumption of a drink containing grated ginger. Previously, the patient had tolerated crizotinib well. The concentration of crizotinib, two days after its discontinuation, was 1.8-fold higher than the previous level measured prior to the initiation of ginger.

MANAGEMENT: Until more information is available, caution is advised when ginger is used concomitantly with crizotinib. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for crizotinib whenever ginger is added to or withdrawn from therapy.

References (2)
  1. Kimura Y, Ito H, Hatano T (2010) "Effects of mace and nutmeg on human cytochrome P450 3A4 and 2C9 activity." Biol Pharm Bull, 33, p. 1977-82
  2. Revol B, Guitier-Veyret E, Arrive C, et al. (2019) "Pharmacokinetic herb-drug interaction between ginger and crizotinib." Br J Clin Pharmacol, [epub ahead of print]

Drug and food interactions

Major

crizotinib food

Applies to: crizotinib

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of crizotinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Because crizotinib is associated with concentration-dependent prolongation of the QT interval, increased levels may potentiate the risk of ventricular arrhythmias such as torsade de pointes and sudden death.

Food has no significant effect on the gastrointestinal absorption of crizotinib. According to the product labeling, a high-fat meal reduced crizotinib peak plasma concentration (Cmax) and systemic exposure (AUC) by approximately 14%.

MANAGEMENT: Patients treated with crizotinib should avoid consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract. Crizotinib may be taken without regards to food.

References (1)
  1. (2011) "Product Information. Xalkori (crizotinib)." Pfizer U.S. Pharmaceuticals Group

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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