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Drug Interactions between Jemperli and ketoconazole

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

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Interactions between your drugs

Moderate

ketoconazole dostarlimab

Applies to: ketoconazole and Jemperli (dostarlimab)

Consumer information for this interaction is not currently available.

MONITOR: Concomitant use of immune checkpoint inhibitors (ICIs) such as anti-cytotoxic T-lymphocyte-associated protein (CTLA)-4 monoclonal antibodies and/or inhibitors of programmed cell death-1 (PD-1) or programmed death ligand-1 (PD-L1) with ketoconazole (and possibly with its enantiomer, levoketoconazole) may potentiate the risk of liver injury. The mechanism of this interaction is unknown. In one case series, 2 consecutive patients with different types of metastatic cancer (pituitary carcinoma and adrenal cortical carcinoma) received ketoconazole (800 mg/day) for Cushing syndrome and were later initiated on ICI therapy (nivolumab 3 mg/kg every 2 weeks for one and pembrolizumab 200 mg intravenous every 3 weeks for the other). Both patients exhibited normal liver function while on ketoconazole. However, after initiation of the ICI, the levels of each patient's alanine transaminase (ALT) and aspartate transaminase (AST) increased by 10- to 20-fold. Liver biopsies obtained for each patient were consistent with drug-induced hepatic injury. In both cases, the ICI and ketoconazole were discontinued, and treatment with methylprednisolone (62.5 mg/day) was initiated for hepatic injury. Liver function gradually improved and both patients recovered. Clinical data with levoketoconazole are not readily available.

MANAGEMENT: The risk of hepatic injury should be considered when immune checkpoint inhibitors (ICIs) are used in combination with ketoconazole and possibly levoketoconazole. Liver function tests should be monitored as clinically indicated and patients should be counseled to report any symptoms of liver damage such as fever, rash, right upper quadrant pain, dark urine, pale stools, and/or jaundice. Refer to the individual product labeling for the ICI in question as well as ketoconazole or levoketoconazole for more specific recommendations should signs or symptoms of hepatotoxicity occur.

Drug and food interactions

Moderate

ketoconazole food

Applies to: ketoconazole

You should avoid the use of alcohol while being treated with ketoconazole. Ketoconazole may cause liver damage and using it with alcohol or products containing alcohol may increase that risk. In addition, consumption of alcoholic beverages or products containing alcohol during treatment with ketoconazole may trigger a disulfiram-like reaction in some patients, with unpleasant symptoms such as flushing, palpitations, and nausea. Ketoconazole may be taken with or without food. You should avoid consumption of grapefruit, grapefruit juice, or any supplements that contain grapefruit extract during treatment with ketoconazole unless directed otherwise by your doctor. Grapefruit juice may increase the blood levels of ketoconazole. This may increase the risk and/or severity of side effects and liver problems. You should seek immediate medical attention if you develop signs and symptoms of liver damage during treatment with ketoconazole, such as joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, light colored stools, and yellowing of the skin or eyes. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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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.


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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.