Orladeyo

Overview

berotralstat

kallikrein inhibitor

• P-gp substrate
• CYP2C9 inhibitor, weak
• CYP2D6 inhibitor, moderate
• CYP3A4 inhibitor, moderate
• P-gp inhibitor, weak
• prolongs QT interval (conditional)

Contraindicated

• colchicine
Orladeyo (berotralstat)

+

colchicine

1 interaction

Contraindicated

berotralstat + colchicine

CV RISK: avoid combo if renal or hepatic impairment; otherwise, monitor CK, myopathy s/sx; GOUT or FMF: contraindicated if renal or hepatic impairment; otherwise, use alternative or decr. colchicine dose during and x14 days after berotralstat use as follows: GOUT PROPHYLAXIS: give colchicine 0.3-0.6 mg/day divided qd-bid; ACUTE GOUT TX: avoid combo if receiving colchicine for gout prophylaxis; otherwise, give colchicine 1.2 mg x1 only; FMF: decr. max colchicine dose to 1.2 mg/day divided qd-bid: combo may incr. colchicine levels, risk of myopathy, rhabdomyolysis, other life-threatening toxicity (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• eliglustat
Orladeyo (berotralstat)

+

eliglustat

1 interaction

Contraindicated

berotralstat + eliglustat

CYP2D6 EM or IM: contraindicated; CYP2D6 PM: avoid combo: combo may incr. eliglustat levels, risk of PR or QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• flibanserin
Orladeyo (berotralstat)

+

flibanserin

1 interaction

Contraindicated

berotralstat + flibanserin

contraindicated w/in 14 days prior to, during, and x2 days after flibanserin tx: combo may incr. flibanserin levels, risk of CNS depression, psychomotor impairment, severe hypotension (including syncope), other adverse effects (hepatic metabolism inhibited)

• lomitapide
Orladeyo (berotralstat)

+

lomitapide

1 interaction

Contraindicated

berotralstat + lomitapide

contraindicated: combo may incr. lomitapide levels, risk of hepatotoxicity, other adverse effects (hepatic metabolism inhibited)

• pimozide
Orladeyo (berotralstat)

+

pimozide

1 interaction

Contraindicated

berotralstat + pimozide

contraindicated: combo may incr. pimozide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• thioridazine
Orladeyo (berotralstat)

+

thioridazine

1 interaction

Contraindicated

berotralstat + thioridazine

contraindicated: combo may incr. thioridazine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

Avoid/Use Alternative

• alfentanil
Orladeyo (berotralstat)

+

alfentanil

1 interaction

Avoid/Use Alternative

berotralstat + alfentanil

use alternative or monitor respiratory rate; consider decr. alfentanil dose: combo may incr. alfentanil levels, risk of CNS and respiratory depression, psychomotor impairment, delayed recovery from anesthesia, other adverse effects (hepatic metabolism inhibited)

• alprazolam
Orladeyo (berotralstat)

+

alprazolam

1 interaction

Avoid/Use Alternative

berotralstat + alprazolam

use alternative or monitor respiratory rate; consider decr. alprazolam dose: combo may incr. alprazolam levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• amiodarone
Orladeyo (berotralstat)

+

amiodarone

1 interaction

Avoid/Use Alternative

berotralstat + amiodarone

use alternative or monitor ECG: combo may incr. amiodarone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• amphetamine
Orladeyo (berotralstat)

+

amphetamine

1 interaction

Avoid/Use Alternative

berotralstat + amphetamine

consider alternative or monitor serotonin syndrome sx, especially during initiation/titration; decr. amphetamine start dose: combo may incr. amphetamine levels, risk of serotonin syndrome, other adverse effects (hepatic metabolism inhibited)

• apalutamide
Orladeyo (berotralstat)

+

apalutamide

1 interaction

Avoid/Use Alternative

berotralstat + apalutamide

avoid combo: combo may decr. berotralstat levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (P-gp-mediated transport induced; additive effects)

• aprepitant
Orladeyo (berotralstat)

+

aprepitant

1 interaction

Avoid/Use Alternative

berotralstat + aprepitant

avoid combo w/ oral aprepitant; IV aprepitant use OK: combo may incr. aprepitant levels, risk of adverse effects (hepatic metabolism inhibited)

• arsenic trioxide
Orladeyo (berotralstat)

+

arsenic trioxide

1 interaction

Avoid/Use Alternative

berotralstat + arsenic trioxide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• avapritinib
Orladeyo (berotralstat)

+

avapritinib

1 interaction

Avoid/Use Alternative

berotralstat + avapritinib

GIST: use alternative or monitor bleeding s/sx; decr. avapritinib start dose to 100 mg qd; ADVANCED SYSTEMIC MASTOCYTOSIS: use alternative or monitor bleeding s/sx; decr. avapritinib start dose to 50 mg qd; INDOLENT SYSTEMIC MASTOCYTOSIS: avoid combo: combo may incr. avapritinib levels, risk of bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited)

• bedaquiline
Orladeyo (berotralstat)

+

bedaquiline

1 interaction

Avoid/Use Alternative

berotralstat + bedaquiline

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• bosentan
Orladeyo (berotralstat)

+

bosentan

1 interaction

Avoid/Use Alternative

berotralstat + bosentan

avoid combo: combo may incr. bosentan levels, risk of adverse effects (hepatic metabolism inhibited)

• bosutinib
Orladeyo (berotralstat)

+

bosutinib

1 interaction

Avoid/Use Alternative

berotralstat + bosutinib

avoid combo: combo may incr. bosutinib levels, risk of myelosuppression, other adverse effects (hepatic metabolism inhibited)

• brigatinib
Orladeyo (berotralstat)

+

brigatinib

1 interaction

Avoid/Use Alternative

berotralstat + brigatinib

use alternative or monitor BP, HR; decr. brigatinib dose by approx. 40% as follows: if taking 180 mg, decr. to 120 mg, if taking 120 mg, decr. to 90 mg; if taking 90 mg, decr. to 60 mg: combo may incr. brigatinib levels, risk of HTN, bradycardia, other adverse effects (hepatic metabolism inhibited)

• buspirone
Orladeyo (berotralstat)

+

buspirone

1 interaction

Avoid/Use Alternative

berotralstat + buspirone

consider alternative or restart buspirone dose at 2.5 mg bid: combo may incr. buspirone levels, risk of adverse effects (hepatic metabolism inhibited)

• carbamazepine
Orladeyo (berotralstat)

+

carbamazepine

1 interaction

Avoid/Use Alternative

berotralstat + carbamazepine

avoid combo: combo may incr. carbamazepine levels, risk of adverse effects; may decr. berotralstat levels, efficacy (hepatic metabolism inhibited; P-gp-mediated transport induced)

• cariprazine
Orladeyo (berotralstat)

+

cariprazine

1 interaction

Avoid/Use Alternative

berotralstat + cariprazine

IF STARTING CARIPRAZINE TX: ADULT PTS: adjust dose as follows: SCHIZOPHRENIA/BIPOLAR MANIA: start cariprazine 0.75 mg qd, then may incr. to 1.5 mg qd; BIPOLAR DEPRESSION/DEPRESSION ADJUNCT: start cariprazine 0.75 mg qd; PEDS PTS: avoid combo; IF ON STABLE CARIPRAZINE TX AND STARTING BEROTRALSTAT: ADULT AND PEDS PTS, ALL INDICATIONS: adjust cariprazine dose as follows: if on cariprazine 1.5 mg or 3 mg qd, decr. dose to 0.75 mg qd; if on cariprazine 4.5 mg or 6 mg qd, decr. dose to 1.5 mg qd: combo may incr. cariprazine and active metabolite levels, risk of adverse effects (hepatic metabolism inhibited)

• cobimetinib
Orladeyo (berotralstat)

+

cobimetinib

1 interaction

Avoid/Use Alternative

berotralstat + cobimetinib

avoid combo or decr. cobimetinib dose to 20 mg/day and D/C berotralstat w/in 14 days: combo may incr. cobimetinib levels, risk of adverse effects (hepatic metabolism inhibited)

• codeine
Orladeyo (berotralstat)

+

codeine

1 interaction

Avoid/Use Alternative

berotralstat + codeine

use alternative or monitor respiratory rate, withdrawal sx; consider codeine dose adjustment: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and respiratory depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metabolism inhibited, conversion to morphine altered)

• conivaptan
Orladeyo (berotralstat)

+

conivaptan

1 interaction

Avoid/Use Alternative

berotralstat + conivaptan

consider alternative: combo may incr. conivaptan levels, risk of overly rapid serum sodium correction, neurologic sequelae, other adverse effects (hepatic metabolism inhibited)

• crizotinib
Orladeyo (berotralstat)

+

crizotinib

1 interaction

Avoid/Use Alternative

berotralstat + crizotinib

use alternative or monitor ECG, electrolytes, CBC: combo may incr. crizotinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited, additive effects)

• dabigatran
Orladeyo (berotralstat)

+

dabigatran

1 interaction

Avoid/Use Alternative

berotralstat + dabigatran

ATRIAL FIBRILLATION: avoid combo if CrCl <30 mL/min; OTHER INDICATIONS: avoid combo if CrCl <50 mL/min; if dabigatran use for DVT/PE prophylaxis post-hip replacement and CrCl >50 mL/min, consider separating admin. at least 2h apart: combo may incr. dabigatran levels, risk of bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited)

• danshen
Orladeyo (berotralstat)

+

danshen

1 interaction

Avoid/Use Alternative

berotralstat + danshen

avoid combo: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport induced)

• defactinib
Orladeyo (berotralstat)

+

defactinib

1 interaction

Avoid/Use Alternative

berotralstat + defactinib

avoid combo: combo may incr. defactinib levels, risk of adverse effects (hepatic metabolism inhibited)

• desogestrel (contraceptive)
Orladeyo (berotralstat)

+

desogestrel (contraceptive)

1 interaction

Avoid/Use Alternative

berotralstat + desogestrel (contraceptive)

use alternative: combo may incr. desogestrel active metabolite levels, risk of adverse effects (hepatic metabolism inhibited)

• dextroamphetamine
Orladeyo (berotralstat)

+

dextroamphetamine

1 interaction

Avoid/Use Alternative

berotralstat + dextroamphetamine

consider alternative or monitor serotonin syndrome sx, especially during initiation/titration; decr. dextroamphetamine start dose: combo may incr. dextroamphetamine levels, risk of serotonin syndrome, other adverse effects (hepatic metabolism inhibited)

• dicloxacillin
Orladeyo (berotralstat)

+

dicloxacillin

1 interaction

Avoid/Use Alternative

berotralstat + dicloxacillin

avoid combo: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport induced)

• dihydrocodeine
Orladeyo (berotralstat)

+

dihydrocodeine

1 interaction

Avoid/Use Alternative

berotralstat + dihydrocodeine

use alternative or monitor respiratory rate, withdrawal sx; consider dihydrocodeine dose adjustment: combo may incr. dihydrocodeine levels, alter active metabolite dihydromorphine levels, incr. risk of CNS and respiratory depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metabolism inhibited, conversion to dihydromorphine altered)

• dihydroergotamine
Orladeyo (berotralstat)

+

dihydroergotamine

1 interaction

Avoid/Use Alternative

berotralstat + dihydroergotamine

use alternative: combo may incr. dihydroergotamine levels, risk of ergot toxicity, severe vasospasm, other adverse effects (hepatic metabolism inhibited)

• disopyramide
Orladeyo (berotralstat)

+

disopyramide

1 interaction

Avoid/Use Alternative

berotralstat + disopyramide

use alternative or monitor disopyramide levels, ECG: combo may incr. disopyramide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• domperidone
Orladeyo (berotralstat)

+

domperidone

1 interaction

Avoid/Use Alternative

berotralstat + domperidone

avoid combo: combo may incr. domperidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• dordaviprone
Orladeyo (berotralstat)

+

dordaviprone

1 interaction

Avoid/Use Alternative

berotralstat + dordaviprone

use alternative or monitor ECG, electrolytes; for adult and pediatric pts weighing at least 52.5 kg, decr. dordaviprone dose to 500 mg once weekly; dose recommendation not established in pediatric pts weighing less than 52.5 kg: combo may incr. dordaviprone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• doxorubicin
Orladeyo (berotralstat)

+

doxorubicin

1 interaction

Avoid/Use Alternative

berotralstat + doxorubicin

avoid combo: combo may incr. doxorubicin levels, risk serious infection, myelosuppression, cardiotoxicity, other adverse effects (hepatic metabolism inhibited)

• dronedarone
Orladeyo (berotralstat)

+

dronedarone

1 interaction

Avoid/Use Alternative

berotralstat + dronedarone

use alternative or monitor ECG: combo may incr. dronedarone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• efavirenz
Orladeyo (berotralstat)

+

efavirenz

1 interaction

Avoid/Use Alternative

berotralstat + efavirenz

avoid combo: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport induced)

• elacestrant
Orladeyo (berotralstat)

+

elacestrant

1 interaction

Avoid/Use Alternative

berotralstat + elacestrant

avoid combo: combo may incr. elacestrant levels, risk of adverse effects (hepatic metabolism inhibited)

• encorafenib
Orladeyo (berotralstat)

+

encorafenib

1 interaction

Avoid/Use Alternative

berotralstat + encorafenib

use alternative or monitor ECG, electrolytes; decr. encorafenib 450 mg dose to 225 mg, decr. 300 mg dose to 150 mg, decr. 225 mg dose to 75 mg, and decr. 150 mg dose to 75 mg: combo may incr. encorafenib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• ensartinib
Orladeyo (berotralstat)

+

ensartinib

1 interaction

Avoid/Use Alternative

berotralstat + ensartinib

avoid combo: combo may incr. ensartinib levels, risk of bradycardia, hyperglycemia, other adverse effects (hepatic metabolism possibly inhibited, P-gp-mediated transport possibly inhibited)

• entrectinib
Orladeyo (berotralstat)

+

entrectinib

1 interaction

Avoid/Use Alternative

berotralstat + entrectinib

PEDS PTS w/ ENTRECTINIB START DOSE <200 mg/day: avoid combo; ADULT AND PEDS PTS >2yo: use alternative or monitor ECG, CBC, limit coadmin. to 14 days or less and decr. entrectinib dose as follows: if entrectinib start dose 200 mg qd, decr. to 50 mg qd; if entrectinib start dose 300 mg qd, decr. to 100 mg qd; if entrectinib start dose 400 or 600 mg qd, decr. to 200 mg qd: combo may incr. entrectinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• ephedra
Orladeyo (berotralstat)

+

ephedra

1 interaction

Avoid/Use Alternative

berotralstat + ephedra

avoid combo: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ergotamine
Orladeyo (berotralstat)

+

ergotamine

1 interaction

Avoid/Use Alternative

berotralstat + ergotamine

use alternative: combo may incr. ergotamine levels, risk of ergot toxicity, severe vasospasm, ischemia, other adverse effects (hepatic metabolism inhibited)

• etrasimod
Orladeyo (berotralstat)

+

etrasimod

1 interaction

Avoid/Use Alternative

berotralstat + etrasimod

if CYP2C9 poor metabolizer or if also combined w/ moderate or strong CYP2C9 inhibitor, avoid combo; otherwise, caution advised: combo may incr. etrasimod levels, risk of AV block, bradycardia, QT prolongation, cardiac arrhythmias, serious infection, other adverse effects (hepatic metabolism inhibited)

• fentanyl
Orladeyo (berotralstat)

+

fentanyl

1 interaction

Avoid/Use Alternative

berotralstat + fentanyl

use alternative or monitor respiratory rate, consider decr. fentanyl dose: combo may incr. fentanyl levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• fexinidazole
Orladeyo (berotralstat)

+

fexinidazole

1 interaction

Avoid/Use Alternative

berotralstat + fexinidazole

if possible, do not initiate fexinidazole until 5 half-lives after berotralstat D/C; use alternative or monitor ECG during and x7 days after fexinidazole tx: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. fexinidazole active metabolite levels, efficacy (additive effects; hepatic metabolism inhibited, decr. conversion to active metabolites)

• fosaprepitant
Orladeyo (berotralstat)

+

fosaprepitant

1 interaction

Avoid/Use Alternative

berotralstat + fosaprepitant

avoid combo: combo may incr. aprepitant levels, risk of adverse effects (hepatic metabolism inhibited)

• fosfomycin injection
Orladeyo (berotralstat)

+

fosfomycin injection

1 interaction

Avoid/Use Alternative

berotralstat + fosfomycin injection

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• fosphenytoin
Orladeyo (berotralstat)

+

fosphenytoin

1 interaction

Avoid/Use Alternative

berotralstat + fosphenytoin

avoid combo: combo may incr. phenytoin levels, risk of toxicity; may decr. berotralstat levels, efficacy (hepatic metabolism inhibited; P-gp-mediated transport induced)

• gepotidacin
Orladeyo (berotralstat)

+

gepotidacin

1 interaction

Avoid/Use Alternative

berotralstat + gepotidacin

UROGENITAL GONORRHEA: use alternative or monitor ECG, electrolytes; URINARY TRACT INFECTION: consider monitoring ECG, electrolytes: combo may incr. gepotidacin levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• hydrocodone
Orladeyo (berotralstat)

+

hydrocodone

1 interaction

Avoid/Use Alternative

berotralstat + hydrocodone

use alternative or monitor respiratory rate, ECG, consider decr. (benz)hydrocodone dose: combo may incr. hydrocodone levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• hydroxychloroquine
Orladeyo (berotralstat)

+

hydroxychloroquine

1 interaction

Avoid/Use Alternative

berotralstat + hydroxychloroquine

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ivabradine
Orladeyo (berotralstat)

+

ivabradine

1 interaction

Avoid/Use Alternative

berotralstat + ivabradine

avoid combo: combo may incr. ivabradine levels, risk of bradycardia, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• ivacaftor
Orladeyo (berotralstat)

+

ivacaftor

1 interaction

Avoid/Use Alternative

berotralstat + ivacaftor

pts <6 mo: avoid combo; pts >6 mo decr. ivacaftor dose as follows: 6 mo-5 yo and 5-6.9 kg: give 25 mg qd; 6 mo-5 yo and 7-13.9 kg: give 50 mg qd; 6 mo-5 yo and >14 kg: give 75 mg qd; 6 yo and older: give 150 mg qd: combo may incr. ivacaftor levels, risk of adverse effects (hepatic metabolism inhibited)

• ivosidenib
Orladeyo (berotralstat)

+

ivosidenib

1 interaction

Avoid/Use Alternative

berotralstat + ivosidenib

use alternative or monitor ECG, electrolytes: combo may incr. ivosidenib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• ixabepilone
Orladeyo (berotralstat)

+

ixabepilone

1 interaction

Avoid/Use Alternative

berotralstat + ixabepilone

consider alternatives or monitor CBC: combo may incr. ixabepilone levels, risk of serious infection, myelosuppression, other toxicity (hepatic metabolism inhibited)

• lefamulin
Orladeyo (berotralstat)

+

lefamulin

1 interaction

Avoid/Use Alternative

berotralstat + lefamulin

use alternative or monitor ECG: combo with oral lefamulin may incr. lefamulin levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; combo with IV lefamulin may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metabolism inhibited, additive effects)

• lemborexant
Orladeyo (berotralstat)

+

lemborexant

1 interaction

Avoid/Use Alternative

berotralstat + lemborexant

avoid combo: combo may incr. lemborexant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• levoketoconazole
Orladeyo (berotralstat)

+

levoketoconazole

1 interaction

Avoid/Use Alternative

berotralstat + levoketoconazole

consider alternative x2wk before and during levoketoconazole tx; otherwise, monitor ECG: combo may incr. levoketoconazole levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• lisdexamfetamine
Orladeyo (berotralstat)

+

lisdexamfetamine

1 interaction

Avoid/Use Alternative

berotralstat + lisdexamfetamine

use alternative or decr. lisdexamfetamine start dose; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. dextroamphetamine levels, risk of serotonin syndrome, other adverse effects (hepatic metabolism inhibited)

• lonafarnib
Orladeyo (berotralstat)

+

lonafarnib

1 interaction

Avoid/Use Alternative

berotralstat + lonafarnib

use alternative or monitor HR, ECG, electrolytes, especially during first week when adding lonafarnib to existing berotralstat tx: combo may incr. lonafarnib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• lorlatinib
Orladeyo (berotralstat)

+

lorlatinib

1 interaction

Avoid/Use Alternative

berotralstat + lorlatinib

avoid combo: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport induced)

• lovastatin
Orladeyo (berotralstat)

+

lovastatin

1 interaction

Avoid/Use Alternative

berotralstat + lovastatin

use alternative or monitor CK, myopathy sx; adjust lovastatin max dose to 20 mg/day: combo may incr. lovastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited)

• lumacaftor/ivacaftor
Orladeyo (berotralstat)

+

lumacaftor/ ivacaftor

1 interaction

Avoid/Use Alternative

berotralstat + lumacaftor/ ivacaftor

avoid combo: combo may incr. ivacaftor levels, risk of adverse effects; may decr. berotralstat levels, efficacy (hepatic metabolism inhibited; P-gp-mediated transport possibly induced)

• lurbinectedin
Orladeyo (berotralstat)

+

lurbinectedin

1 interaction

Avoid/Use Alternative

berotralstat + lurbinectedin

use alternative or monitor CBC; decr. lurbinectedin dose 50%: combo may incr. lurbinectedin levels, risk of myelosuppression, other adverse effects (hepatic metabolism inhibited)

• macitentan
Orladeyo (berotralstat)

+

macitentan

1 interaction

Avoid/Use Alternative

berotralstat + macitentan

if also combined w/ strong-mod CYP2C9 inhibitor, avoid combo; otherwise, caution advised: combo may incr. macitentan levels, risk of adverse effects (hepatic metabolism inhibited)

• meperidine
Orladeyo (berotralstat)

+

meperidine

1 interaction

Avoid/Use Alternative

berotralstat + meperidine

use alternative or monitor respiratory rate, ECG; consider decr. meperidine dose: combo may incr. meperidine levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• methadone
Orladeyo (berotralstat)

+

methadone

1 interaction

Avoid/Use Alternative

berotralstat + methadone

use alternative or monitor respiratory rate, ECG, consider decr. methadone dose: combo may incr. methadone levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• methylergonovine
Orladeyo (berotralstat)

+

methylergonovine

1 interaction

Avoid/Use Alternative

berotralstat + methylergonovine

avoid combo: combo may incr. methylergonovine levels, risk of ergot toxicity, severe vasospasm, ischemia, other adverse effects (hepatic metabolism inhibited)

• midazolam
Orladeyo (berotralstat)

+

midazolam

1 interaction

Avoid/Use Alternative

berotralstat + midazolam

avoid combo if midazolam nasal use; otherwise, monitor respiratory rate, consider decr. midazolam dose: combo may incr. midazolam and active metabolite levels, risk of profound CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• mitapivat
Orladeyo (berotralstat)

+

mitapivat

1 interaction

Avoid/Use Alternative

berotralstat + mitapivat

THALASSEMIA: avoid combo; HEMOLYTIC ANEMIA: monitor Hgb; adjust max mitapivat dose to 20 mg bid: combo may incr. mitapivat levels, risk of adverse effects (hepatic metabolism inhibited)

• mobocertinib
Orladeyo (berotralstat)

+

mobocertinib

1 interaction

Avoid/Use Alternative

berotralstat + mobocertinib

use alternative or monitor ECG, electrolytes; decr. mobocertinib dose as follows: if taking 160 mg, decr. dose to 80 mg; if taking 120 mg, decr. dose to 40 mg, if taking 80 mg, decr. dose to 40 mg: combo may incr. mobocertinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• naloxegol
Orladeyo (berotralstat)

+

naloxegol

1 interaction

Avoid/Use Alternative

berotralstat + naloxegol

use alternative or decr. naloxegol dose to 12.5 mg/day: combo may incr. naloxegol levels, risk of adverse effects (hepatic metabolism inhibited)

• neratinib
Orladeyo (berotralstat)

+

neratinib

1 interaction

Avoid/Use Alternative

berotralstat + neratinib

avoid combo: combo may incr. neratinib levels, risk of adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• nirogacestat
Orladeyo (berotralstat)

+

nirogacestat

1 interaction

Avoid/Use Alternative

berotralstat + nirogacestat

avoid combo: combo may incr. nirogacestat levels, risk of hypophosphatemia, other adverse effects (hepatic metabolism inhibited)

• nisoldipine
Orladeyo (berotralstat)

+

nisoldipine

1 interaction

Avoid/Use Alternative

berotralstat + nisoldipine

consider alternative or monitor BP: combo may incr. nisoldipine levels, risk of hypotension, other adverse effects (hepatic metabolism inhibited)

• olaparib
Orladeyo (berotralstat)

+

olaparib

1 interaction

Avoid/Use Alternative

berotralstat + olaparib

use alternative or monitor CBC; decr. olaparib dose to 150 mg bid: combo may incr. olaparib levels, risk of myelosuppression, other adverse effects (hepatic metabolism inhibited)

• oliceridine
Orladeyo (berotralstat)

+

oliceridine

1 interaction

Avoid/Use Alternative

berotralstat + oliceridine

use alternative or monitor respiratory rate, ECG; consider decr. oliceridine frequency: combo may incr. oliceridine levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• omaveloxolone
Orladeyo (berotralstat)

+

omaveloxolone

1 interaction

Avoid/Use Alternative

berotralstat + omaveloxolone

use alternative or decr. omaveloxolone dose to 100 mg/day: combo may incr. omaveloxolone levels, risk of adverse effects (hepatic metabolism inhibited)

• oxycodone
Orladeyo (berotralstat)

+

oxycodone

1 interaction

Avoid/Use Alternative

berotralstat + oxycodone

use alternative or monitor respiratory rate; consider decr. oxycodone dose: combo may incr. oxycodone levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• palovarotene
Orladeyo (berotralstat)

+

palovarotene

1 interaction

Avoid/Use Alternative

berotralstat + palovarotene

use alternative or decr. palovarotene dose as follows: wt 10-19.9 kg maint. dose 1 mg daily, flare dose 5 mg daily wk 1-4, then 2.5 mg daily wk 5-12; wt 20-39.9 kg maint. dose 1.5 mg daily, flare dose 6 mg daily wk 1-4, then 3 mg daily wk 5-12; wt 40-59.9 kg maint. dose 2 mg daily, flare dose 7.5 mg daily wk 1-4, then 4 mg daily wk 5-12; wt 60 kg and greater or 14 yo and older maint. dose 2.5 mg daily, flare dose 10 mg daily wk 1-4, then 5 mg daily wk 5-12: combo may incr. palovarotene levels, risk of adverse effects (hepatic metabolism inhibited)

• pemigatinib
Orladeyo (berotralstat)

+

pemigatinib

1 interaction

Avoid/Use Alternative

berotralstat + pemigatinib

use alternative or monitor phosphate and decr. pemigatinib dose as follows: if on pemigatinib 13.5 mg qd, decr. to 9 mg qd; if on pemigatinib 9 mg qd, decr. to 4.5 mg qd: combo may incr. pemigatinib levels, risk of hyperphosphatemia, other adverse effects (hepatic metabolism inhibited)

• pexidartinib
Orladeyo (berotralstat)

+

pexidartinib

1 interaction

Avoid/Use Alternative

berotralstat + pexidartinib

use alternative or monitor LFTs, decr. pexidartinib dose as follows: if on pexidartinib 500 mg/day or 375 mg/day, decr. to 125 mg bid; if on pexidartinib 250 mg/day, decr. to 125 mg qd: combo may incr. pexidartinib levels, risk of hepatotoxicity, other adverse effects (hepatic metabolism inhibited)

• phenobarbital
Orladeyo (berotralstat)

+

phenobarbital

1 interaction

Avoid/Use Alternative

berotralstat + phenobarbital

avoid combo: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport possibly induced)

• phenytoin
Orladeyo (berotralstat)

+

phenytoin

1 interaction

Avoid/Use Alternative

berotralstat + phenytoin

avoid combo: combo may incr. phenytoin levels, risk of toxicity; may decr. berotralstat levels, efficacy (hepatic metabolism inhibited; P-gp-mediated transport induced)

• pirfenidone
Orladeyo (berotralstat)

+

pirfenidone

1 interaction

Avoid/Use Alternative

berotralstat + pirfenidone

avoid combo if also combined w/ mod-strong CYP1A2 inhibitor; otherwise, caution advised: combo may incr. pirfenidone levels, risk of adverse effects (hepatic metabolism inhibited)

• pralsetinib
Orladeyo (berotralstat)

+

pralsetinib

1 interaction

Avoid/Use Alternative

berotralstat + pralsetinib

use alternative or consider monitoring ECG, electrolytes and decr. pralsetinib dose as follows: if on pralsetinib 400 mg qd, decr. to 300 mg qd; if on pralsetinib 300 mg qd, decr. to 200 mg qd; if on pralsetinib 200 mg qd, decr. to 100 mg qd: combo may incr. pralsetinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• primidone
Orladeyo (berotralstat)

+

primidone

1 interaction

Avoid/Use Alternative

berotralstat + primidone

consider alternative: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport possibly induced)

• propafenone
Orladeyo (berotralstat)

+

propafenone

1 interaction

Avoid/Use Alternative

berotralstat + propafenone

avoid combo: combo may incr. propafenone levels, risk of QT prolongation, cardiac arrhythmias, hypotension, other adverse effects (hepatic metabolism inhibited, additive effects)

• quizartinib
Orladeyo (berotralstat)

+

quizartinib

1 interaction

Avoid/Use Alternative

berotralstat + quizartinib

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• relugolix
Orladeyo (berotralstat)

+

relugolix

1 interaction

Avoid/Use Alternative

berotralstat + relugolix

PROSTATE CANCER: may hold relugolix if berotralstat tx up to 2wk; otherwise, use alternative or monitor ECG, electrolytes and admin. relugolix at least 6h before berotralstat; FIBROID-ASSOC. BLEEDING: use alternative or admin. relugolix at least 6h before berotralstat: combo may incr. relugolix levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (gut P-gp-mediated transport inhibited)

• remibrutinib
Orladeyo (berotralstat)

+

remibrutinib

1 interaction

Avoid/Use Alternative

berotralstat + remibrutinib

avoid combo: combo may incr. remibrutinib levels, risk of adverse effects (hepatic metabolism inhibited)

• repotrectinib
Orladeyo (berotralstat)

+

repotrectinib

1 interaction

Avoid/Use Alternative

berotralstat + repotrectinib

avoid combo; D/C berotralstat 3-5 half-lives prior to repotrectinib tx: combo may incr. repotrectinib levels, risk of adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• rifabutin
Orladeyo (berotralstat)

+

rifabutin

1 interaction

Avoid/Use Alternative

berotralstat + rifabutin

use alternative or monitor CBC, uveitis s/sx: combo may incr. rifabutin levels, risk of myelosuppression, uveitis, other adverse effects; may decr. berotralstat levels, efficacy (hepatic metabolism inhibited; P-gp-mediated transport possibly induced)

• rifampin
Orladeyo (berotralstat)

+

rifampin

1 interaction

Avoid/Use Alternative

berotralstat + rifampin

avoid combo: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport induced)

• rifapentine
Orladeyo (berotralstat)

+

rifapentine

1 interaction

Avoid/Use Alternative

berotralstat + rifapentine

avoid combo: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport possibly induced)

• rilzabrutinib
Orladeyo (berotralstat)

+

rilzabrutinib

1 interaction

Avoid/Use Alternative

berotralstat + rilzabrutinib

avoid combo if berotralstat use greater than 7 days; use alternative or hold rilzabrutinib if berotralstat use less than 7 days: combo may incr. rilzabrutinib levels, risk of adverse effects (hepatic metabolism inhibited)

• rivaroxaban
Orladeyo (berotralstat)

+

rivaroxaban

1 interaction

Avoid/Use Alternative

berotralstat + rivaroxaban

use alternative if CrCl <80; otherwise, monitor bleeding s/sx: combo may incr. rivaroxaban levels, risk of bleeding, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• selpercatinib
Orladeyo (berotralstat)

+

selpercatinib

1 interaction

Avoid/Use Alternative

berotralstat + selpercatinib

use alternative or monitor ECG, electrolytes; decr. selpercatinib dose as follows: if on selpercatinib 40 mg tid, decr. to 40 mg qd; if on selpercatinib 80 mg bid, decr. to 40 mg bid; if on selpercatinib 120 mg bid, decr. to 80 mg bid; if on selpercatinib 160 mg bid, decr. to 120 mg bid: combo may incr. selpercatinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• selumetinib
Orladeyo (berotralstat)

+

selumetinib

1 interaction

Avoid/Use Alternative

berotralstat + selumetinib

use alternative or monitor LVEF, CK, myopathy sx; decr. selumetinib dose as follows: if on selumetinib 25 mg/m^2 bid, decr. to 20 mg/m^2 bid; if on selumetinib 20 mg/m^2 bid, decr. to 15 mg/m^2 bid; see selumetinib pkg insert for specific dose adjustments: combo may incr. selumetinib levels, risk of cardiotoxicity, myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited)

• simvastatin
Orladeyo (berotralstat)

+

simvastatin

1 interaction

Avoid/Use Alternative

berotralstat + simvastatin

use alternative or monitor CK, myopathy sx; adjust max simvastatin dose to 10 mg/day: combo may incr. simvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited)

• siponimod
Orladeyo (berotralstat)

+

siponimod

1 interaction

Avoid/Use Alternative

berotralstat + siponimod

if also combined w/ strong CYP2C9 inhibitor, avoid combo; if also combined w/ moderate CYP2C9 inhibitor, monitor HR, ECG: combo may incr. siponimod levels, risk of PR interval prolongation, AV block, bradycardia, serious infection, other adverse effects (hepatic metabolism inhibited)

• sirolimus albumin-bound
Orladeyo (berotralstat)

+

sirolimus albumin-bound

1 interaction

Avoid/Use Alternative

berotralstat + sirolimus albumin-bound

avoid combo: combo may incr. sirolimus albumin-bound levels, risk of serious infection, myelosuppression, bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• sonidegib
Orladeyo (berotralstat)

+

sonidegib

1 interaction

Avoid/Use Alternative

berotralstat + sonidegib

use alternative or monitor closely: combo may incr. sonidegib levels, risk of adverse effects (hepatic metabolism inhibited)

• sotalol
Orladeyo (berotralstat)

+

sotalol

1 interaction

Avoid/Use Alternative

berotralstat + sotalol

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• St. John's wort
Orladeyo (berotralstat)

+

St. John's wort

1 interaction

Avoid/Use Alternative

berotralstat + St. John's wort

avoid combo: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport induced)

• sufentanil
Orladeyo (berotralstat)

+

sufentanil

1 interaction

Avoid/Use Alternative

berotralstat + sufentanil

consider alternative or monitor respiratory rate, consider decr. sufentanil dose or frequency: combo may incr. sufentanil levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• taletrectinib
Orladeyo (berotralstat)

+

taletrectinib

1 interaction

Avoid/Use Alternative

berotralstat + taletrectinib

avoid combo: combo may incr. taletrectinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• tazemetostat
Orladeyo (berotralstat)

+

tazemetostat

1 interaction

Avoid/Use Alternative

berotralstat + tazemetostat

use alternative or monitor ECG, CBC; decr. tazemetostat dose as follows: if taking 800 mg bid, decr. tazemetostat dose to 400 mg bid; if taking 600 mg bid, decr. tazemetostat dose to 400 mg qam plus 200 mg qpm; if taking 400 mg bid, decr. tazemetostat dose to 200 mg bid: combo may incr. tazemetostat levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• tipranavir
Orladeyo (berotralstat)

+

tipranavir

1 interaction

Avoid/Use Alternative

berotralstat + tipranavir

avoid combo: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport induced)

• tolvaptan
Orladeyo (berotralstat)

+

tolvaptan

1 interaction

Avoid/Use Alternative

berotralstat + tolvaptan

HYPONATREMIA USE: avoid combo; AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DZ USE: decr. tolvaptan total daily dose by 50% as follows: if taking 60 mg/day, decr. to 15 mg qam and 15 mg qpm; if taking 90 mg/day, decr. to 30 mg qam and 15 mg qpm; if taking 120 mg/day, decr. to 45 mg qam and 15 mg qpm: combo may incr. tolvaptan levels, risk of adverse effects (hepatic metabolism inhibited)

• topotecan
Orladeyo (berotralstat)

+

topotecan

1 interaction

Avoid/Use Alternative

berotralstat + topotecan

avoid combo w/ oral topotecan: combo may incr. topotecan levels, risk of serious infection, myelosuppression, other adverse effects (gut P-gp-mediated transport inhibited)

• toremifene
Orladeyo (berotralstat)

+

toremifene

1 interaction

Avoid/Use Alternative

berotralstat + toremifene

use alternative or monitor ECG: combo may incr. toremifene levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• tramadol
Orladeyo (berotralstat)

+

tramadol

1 interaction

Avoid/Use Alternative

berotralstat + tramadol

use alternative or monitor respiratory rate, ECG, withdrawal sx; consider tramadol dose adjustment: combo may incr. tramadol, alter active metabolite levels, incr. risk of CNS and respiratory depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metabolism inhibited, may alter production of active metabolite, additive effects)

• turmeric
Orladeyo (berotralstat)

+

turmeric

1 interaction

Avoid/Use Alternative

berotralstat + turmeric

avoid combo w/ oral turmeric: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport induced)

• vandetanib
Orladeyo (berotralstat)

+

vandetanib

1 interaction

Avoid/Use Alternative

berotralstat + vandetanib

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• vardenafil
Orladeyo (berotralstat)

+

vardenafil

1 interaction

Avoid/Use Alternative

berotralstat + vardenafil

max vardenafil dose 5 mg/24h; avoid combo w/ ODT form: combo may incr. vardenafil levels, risk of QT prolongation, cardiac arrhythmias, hypotension, priapism, other adverse effects (hepatic metabolism inhibited)

• venetoclax
Orladeyo (berotralstat)

+

venetoclax

1 interaction

Avoid/Use Alternative

berotralstat + venetoclax

monitor CBC, tumor lysis syndrome s/sx; CLL/SLL: consider alternative or decr. venetoclax dose by at least 50%; AML: decr. venetoclax dose by at least 50%: combo may incr. venetoclax levels, risk of serious infection, myelosuppression, tumor lysis syndrome, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• ziprasidone
Orladeyo (berotralstat)

+

ziprasidone

1 interaction

Avoid/Use Alternative

berotralstat + ziprasidone

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

Monitor/Modify Tx

• abemaciclib
Orladeyo (berotralstat)

+

abemaciclib

1 interaction

Monitor/Modify Tx

berotralstat + abemaciclib

consider decr. abemaciclib 200 mg bid dose to 150 mg bid, abemaciclib 150 mg bid dose to 100 mg bid, abemaciclib 100 mg bid dose to 50 mg bid; monitor CBC: combo may incr. abemaciclib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• acalabrutinib
Orladeyo (berotralstat)

+

acalabrutinib

1 interaction

Monitor/Modify Tx

berotralstat + acalabrutinib

decr. acalabrutinib dose to 100 mg qd; monitor CBC: combo may incr. acalabrutinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• adagrasib
Orladeyo (berotralstat)

+

adagrasib

1 interaction

Monitor/Modify Tx

berotralstat + adagrasib

monitor ECG, electrolytes: combo may incr. adagrasib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• afatinib
Orladeyo (berotralstat)

+

afatinib

1 interaction

Monitor/Modify Tx

berotralstat + afatinib

decr. afatinib dose by 10 mg/day if not tolerated: combo may incr. afatinib levels, risk of adverse effects (P-gp-mediated transport inhibited)

• aficamten
Orladeyo (berotralstat)

+

aficamten

1 interaction

Monitor/Modify Tx

berotralstat + aficamten

monitor cardiac fxn, incl. LVEF: combo may incr. aficamten levels, risk of cardiotoxicity, other adverse effects (hepatic metabolism inhibited)

• alfuzosin
Orladeyo (berotralstat)

+

alfuzosin

1 interaction

Monitor/Modify Tx

berotralstat + alfuzosin

monitor BP, ECG: combo may incr. alfuzosin levels, risk of QT prolongation, cardiac arrhythmias, hypotension (including orthostasis, syncope), other adverse effects (hepatic metabolism inhibited)

• anagrelide
Orladeyo (berotralstat)

+

anagrelide

1 interaction

Monitor/Modify Tx

berotralstat + anagrelide

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• apixaban
Orladeyo (berotralstat)

+

apixaban

1 interaction

Monitor/Modify Tx

berotralstat + apixaban

monitor bleeding s/sx: combo may incr. apixaban levels, risk of bleeding, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• apomorphine
Orladeyo (berotralstat)

+

apomorphine

1 interaction

Monitor/Modify Tx

berotralstat + apomorphine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• aripiprazole oral
Orladeyo (berotralstat)

+

aripiprazole oral

1 interaction

Monitor/Modify Tx

berotralstat + aripiprazole oral

consider decr. PO aripiprazole dose; no dose adjustment if depression adjunct tx use: combo may incr. aripiprazole levels, risk of adverse effects (hepatic metabolism inhibited)

• artemether/lumefantrine
Orladeyo (berotralstat)

+

artemether/ lumefantrine

1 interaction

Monitor/Modify Tx

berotralstat + artemether/ lumefantrine

monitor ECG: combo may incr. artemether/lumefantrine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• asenapine
Orladeyo (berotralstat)

+

asenapine

1 interaction

Monitor/Modify Tx

berotralstat + asenapine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• atorvastatin
Orladeyo (berotralstat)

+

atorvastatin

1 interaction

Monitor/Modify Tx

berotralstat + atorvastatin

monitor CK, myopathy sx: combo may incr. atorvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• avanafil
Orladeyo (berotralstat)

+

avanafil

1 interaction

Monitor/Modify Tx

berotralstat + avanafil

monitor BP; adjust max avanafil dose to 50 mg/24h: combo may incr. avanafil levels, risk of hypotension, priapism, other adverse effects (hepatic metabolism inhibited)

• avatrombopag
Orladeyo (berotralstat)

+

avatrombopag

1 interaction

Monitor/Modify Tx

berotralstat + avatrombopag

CHRONIC IMMUNE THROMBOCYTOPENIA: monitor platelets, thrombosis s/sx; if avatrombopag tablet also combined w/ a moderate or strong CYP2C9 inhibitor, decr. start dose to 20 mg 3x/wk; if avatrombopag sprinkle also combined w/ a moderate or strong CYP2C9 inhibitor, decr. start dose to 10 mg 3x/wk; CHRONIC LIVER DZ: monitor platelets, thrombosis s/sx: combo may incr. avatrombopag levels, risk of thromboembolism, other adverse effects (hepatic metabolism inhibited)

• axitinib
Orladeyo (berotralstat)

+

axitinib

1 interaction

Monitor/Modify Tx

berotralstat + axitinib

consider decr. axitinib dose: combo may incr. axitinib levels, risk of adverse effects (hepatic metabolism inhibited)

• azithromycin
Orladeyo (berotralstat)

+

azithromycin

1 interaction

Monitor/Modify Tx

berotralstat + azithromycin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• brexpiprazole
Orladeyo (berotralstat)

+

brexpiprazole

1 interaction

Monitor/Modify Tx

berotralstat + brexpiprazole

decr. brexpiprazole dose 75%: combo may incr. brexpiprazole levels, risk of adverse effects (hepatic metabolism inhibited)

• bromocriptine
Orladeyo (berotralstat)

+

bromocriptine

1 interaction

Monitor/Modify Tx

berotralstat + bromocriptine

limit bromocriptine max dose to 1.6 mg/day if diabetes tx; otherwise, caution advised: combo may incr. bromocriptine levels, risk of hypotension, other adverse effects (hepatic metabolism inhibited)

• budesonide
Orladeyo (berotralstat)

+

budesonide

1 interaction

Monitor/Modify Tx

berotralstat + budesonide

monitor hypercorticism s/sx: combo may incr. budesonide levels, risk of systemic corticosteroid effects, including Cushing syndrome, adrenal suppression, serious infection, other adverse effects (hepatic metabolism inhibited)

• butorphanol
Orladeyo (berotralstat)

+

butorphanol

1 interaction

Monitor/Modify Tx

berotralstat + butorphanol

monitor respiratory rate, consider decr. butorphanol dose: combo may incr. butorphanol levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• cabozantinib
Orladeyo (berotralstat)

+

cabozantinib

1 interaction

Monitor/Modify Tx

berotralstat + cabozantinib

monitor ECG, BP, bleeding s/sx: combo may incr. cabozantinib levels, risk of QT prolongation, cardiac arrhythmias, HTN, GI or other bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• capivasertib
Orladeyo (berotralstat)

+

capivasertib

1 interaction

Monitor/Modify Tx

berotralstat + capivasertib

monitor glucose; decr. capivasertib dose to 320 mg bid x4 days followed by 3 days off: combo may incr. capivasertib levels, risk of severe hyperglycemia, other adverse effects (hepatic metabolism inhibited)

• celecoxib
Orladeyo (berotralstat)

+

celecoxib

1 interaction

Monitor/Modify Tx

berotralstat + celecoxib

monitor bleeding s/sx: combo may incr. celecoxib levels, risk of GI or other bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited)

• ceritinib
Orladeyo (berotralstat)

+

ceritinib

1 interaction

Monitor/Modify Tx

berotralstat + ceritinib

monitor ECG, electrolytes: combo may incr. ceritinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• chloroquine
Orladeyo (berotralstat)

+

chloroquine

1 interaction

Monitor/Modify Tx

berotralstat + chloroquine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• cilostazol
Orladeyo (berotralstat)

+

cilostazol

1 interaction

Monitor/Modify Tx

berotralstat + cilostazol

decr. cilostazol dose to 50 mg bid: combo may incr. cilostazol levels, risk of adverse effects (hepatic metabolism inhibited)

• citalopram
Orladeyo (berotralstat)

+

citalopram

1 interaction

Monitor/Modify Tx

berotralstat + citalopram

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• clarithromycin
Orladeyo (berotralstat)

+

clarithromycin

1 interaction

Monitor/Modify Tx

berotralstat + clarithromycin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• clofazimine
Orladeyo (berotralstat)

+

clofazimine

1 interaction

Monitor/Modify Tx

berotralstat + clofazimine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• clonazepam
Orladeyo (berotralstat)

+

clonazepam

1 interaction

Monitor/Modify Tx

berotralstat + clonazepam

monitor respiratory rate: combo may incr. clonazepam levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• clozapine
Orladeyo (berotralstat)

+

clozapine

1 interaction

Monitor/Modify Tx

berotralstat + clozapine

monitor ECG, BP, HR; consider decr. clozapine dose: combo may incr. clozapine levels, risk of QT prolongation, cardiac arrhythmias, hypotension, bradycardia, other adverse effects (hepatic metabolism inhibited)

• copanlisib
Orladeyo (berotralstat)

+

copanlisib

1 interaction

Monitor/Modify Tx

berotralstat + copanlisib

monitor CBC: combo may incr. copanlisib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• cyclosporine
Orladeyo (berotralstat)

+

cyclosporine

1 interaction

Monitor/Modify Tx

berotralstat + cyclosporine

monitor cyclosporine levels, renal fxn: combo may incr. cyclosporine levels, risk of serious infection, nephrotoxicity, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• daridorexant
Orladeyo (berotralstat)

+

daridorexant

1 interaction

Monitor/Modify Tx

berotralstat + daridorexant

adjust max daridorexant dose to 25 mg/day: combo may incr. daridorexant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• dasatinib
Orladeyo (berotralstat)

+

dasatinib

1 interaction

Monitor/Modify Tx

berotralstat + dasatinib

monitor ECG, CBC: combo may incr. dasatinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• deflazacort
Orladeyo (berotralstat)

+

deflazacort

1 interaction

Monitor/Modify Tx

berotralstat + deflazacort

decr. deflazacort to 1/3 usual dose: combo may incr. deflazacort active metabolite levels, risk of systemic corticosteroid effects including Cushing syndrome and adrenal suppression (hepatic metabolism inhibited)

• degarelix
Orladeyo (berotralstat)

+

degarelix

1 interaction

Monitor/Modify Tx

berotralstat + degarelix

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• desflurane
Orladeyo (berotralstat)

+

desflurane

1 interaction

Monitor/Modify Tx

berotralstat + desflurane

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• desipramine
Orladeyo (berotralstat)

+

desipramine

1 interaction

Monitor/Modify Tx

berotralstat + desipramine

monitor ECG; consider monitoring desipramine levels: combo may incr. desipramine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• deuruxolitinib
Orladeyo (berotralstat)

+

deuruxolitinib

1 interaction

Monitor/Modify Tx

berotralstat + deuruxolitinib

monitor CBC, thrombosis s/sx: combo may incr. deuruxolitinib levels, risk of serious infection, thromboembolism, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• deutetrabenazine
Orladeyo (berotralstat)

+

deutetrabenazine

1 interaction

Monitor/Modify Tx

berotralstat + deutetrabenazine

monitor ECG: combo may incr. deutetrabenazine active metabolite levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• dexmedetomidine
Orladeyo (berotralstat)

+

dexmedetomidine

1 interaction

Monitor/Modify Tx

berotralstat + dexmedetomidine

monitor HR, ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• dexmedetomidine injection
Orladeyo (berotralstat)

+

dexmedetomidine injection

1 interaction

Monitor/Modify Tx

berotralstat + dexmedetomidine injection

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• diclofenac
Orladeyo (berotralstat)

+

diclofenac

1 interaction

Monitor/Modify Tx

berotralstat + diclofenac

monitor bleeding s/sx; use lowest effective diclofenac dose, shortest duration of concomitant tx: combo may incr. diclofenac levels, risk of GI or other bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited)

• digoxin
Orladeyo (berotralstat)

+

digoxin

1 interaction

Monitor/Modify Tx

berotralstat + digoxin

monitor digoxin levels, HR; consider decr. digoxin frequency or dose by 15-30%: combo may incr. digoxin levels, risk of bradycardia, AV block, other adverse effects (P-gp-mediated transport inhibited)

• docetaxel
Orladeyo (berotralstat)

+

docetaxel

1 interaction

Monitor/Modify Tx

berotralstat + docetaxel

monitor CBC; consider decr. docetaxel dose: combo may incr. docetaxel levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• dofetilide
Orladeyo (berotralstat)

+

dofetilide

1 interaction

Monitor/Modify Tx

berotralstat + dofetilide

monitor ECG: combo may incr. dofetilide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• donepezil
Orladeyo (berotralstat)

+

donepezil

1 interaction

Monitor/Modify Tx

berotralstat + donepezil

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• droperidol
Orladeyo (berotralstat)

+

droperidol

1 interaction

Monitor/Modify Tx

berotralstat + droperidol

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• edoxaban
Orladeyo (berotralstat)

+

edoxaban

1 interaction

Monitor/Modify Tx

berotralstat + edoxaban

monitor bleeding s/sx: combo may incr. edoxaban levels, risk of bleeding, other adverse effects (P-gp-mediated transport inhibited)

• elexacaftor/tezacaftor/ivacaftor
Orladeyo (berotralstat)

+

elexacaftor/ tezacaftor/ ivacaftor

1 interaction

Monitor/Modify Tx

berotralstat + elexacaftor/ tezacaftor/ ivacaftor

2-5 YO: decr. usual morning dose by alternating between one elexacaftor/tezacaftor/ivacaftor packet (Day 1) and one ivacaftor packet (Day 2), no evening doses; 6 YO AND OLDER: decr. usual morning dose by alternating between two elexacaftor/tezacaftor/ivacaftor tablets (Day 1) and one ivacaftor tablet (Day 2), no evening doses: combo may incr. elexacaftor/tezacaftor/ivacaftor levels, risk of adverse effects (hepatic metabolism inhibited)

• elinzanetant
Orladeyo (berotralstat)

+

elinzanetant

1 interaction

Monitor/Modify Tx

berotralstat + elinzanetant

decr. elinzanetant dose to 60 mg daily: combo may incr. elinzanetant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• enfortumab vedotin
Orladeyo (berotralstat)

+

enfortumab vedotin

1 interaction

Monitor/Modify Tx

berotralstat + enfortumab vedotin

if also combined w/ strong CYP3A4 inhibitor, monitor CBC, glucose: combo may incr. enfortumab vedotin levels, risk of myelosuppression, neuropathy, hyperglycemia, other adverse effects (P-gp-mediated transport inhibited)

• epirubicin
Orladeyo (berotralstat)

+

epirubicin

1 interaction

Monitor/Modify Tx

berotralstat + epirubicin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• eplerenone
Orladeyo (berotralstat)

+

eplerenone

1 interaction

Monitor/Modify Tx

berotralstat + eplerenone

ALL INDICATIONS: monitor potassium, renal fxn; POST-MI HFrEF: adjust max eplerenone dose to 25 mg/day; HTN: start eplerenone 25 mg qd, adjust max eplerenone dose to 50 mg/day: combo may incr. eplerenone levels, risk of hyperkalemia, other adverse effects (hepatic metabolism inhibited)

• erdafitinib
Orladeyo (berotralstat)

+

erdafitinib

1 interaction

Monitor/Modify Tx

berotralstat + erdafitinib

monitor phosphate: combo may incr. erdafitinib levels, risk of hyperphosphatemia, other adverse effects (hepatic metabolism inhibited)

• eribulin
Orladeyo (berotralstat)

+

eribulin

1 interaction

Monitor/Modify Tx

berotralstat + eribulin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• erythromycin
Orladeyo (berotralstat)

+

erythromycin

1 interaction

Monitor/Modify Tx

berotralstat + erythromycin

monitor ECG: combo may incr. erythromycin levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• estazolam
Orladeyo (berotralstat)

+

estazolam

1 interaction

Monitor/Modify Tx

berotralstat + estazolam

monitor respiratory rate; consider decr. estazolam dose: combo may incr. estazolam levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• estradiol (contraceptive)
Orladeyo (berotralstat)

+

estradiol (contraceptive)

1 interaction

Monitor/Modify Tx

berotralstat + estradiol (contraceptive)

monitor thrombosis s/sx: combo may incr. estradiol levels, risk of thromboembolism, other adverse effects (hepatic metabolism inhibited)

• eszopiclone
Orladeyo (berotralstat)

+

eszopiclone

1 interaction

Monitor/Modify Tx

berotralstat + eszopiclone

consider decr. eszopiclone dose: combo may incr. eszopiclone levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• ethinyl estradiol (contraceptive)
Orladeyo (berotralstat)

+

ethinyl estradiol (contraceptive)

1 interaction

Monitor/Modify Tx

berotralstat + ethinyl estradiol (contraceptive)

monitor thrombosis s/sx, especially if oral ethinyl estradiol dose >35 mcg/day: combo may incr. ethinyl estradiol levels, risk of thromboembolism, other adverse effects (hepatic metabolism inhibited)

• everolimus
Orladeyo (berotralstat)

+

everolimus

1 interaction

Monitor/Modify Tx

berotralstat + everolimus

BREAST CA, PNET, RENAL CELL CA, or RENAL ANGIOMYOLIPOMA w/ TSC: decr. everolimus dose to 2.5 mg/day, may then incr. to 5 mg/day if tolerated, monitor CBC; TSC-ASSOC. SEGA or TSC-ASSOC. PARTIAL-ONSET SEIZURES: monitor everolimus levels, CBC and decr. everolimus dose 50%; give every other day if already on lowest available dose; TRANSPLANT: monitor everolimus levels, CBC: combo may incr. everolimus levels, risk of myelosuppression, serious infection, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• fedratinib
Orladeyo (berotralstat)

+

fedratinib

1 interaction

Monitor/Modify Tx

berotralstat + fedratinib

if fedratinib also combined w/ CYP2C19 inhibitor, monitor CBC, LFTs: combo may incr. fedratinib levels, risk of myelosuppression, hepatotoxicity, other adverse effects (hepatic metabolism inhibited)

• felodipine
Orladeyo (berotralstat)

+

felodipine

1 interaction

Monitor/Modify Tx

berotralstat + felodipine

monitor BP, HR: combo may incr. felodipine levels, risk of hypotension, reflex tachycardia, other adverse effects (hepatic metabolism inhibited)

• finerenone
Orladeyo (berotralstat)

+

finerenone

1 interaction

Monitor/Modify Tx

berotralstat + finerenone

monitor potassium: combo may incr. finerenone levels, risk of hyperkalemia, other adverse effects (hepatic metabolism inhibited)

• flecainide
Orladeyo (berotralstat)

+

flecainide

1 interaction

Monitor/Modify Tx

berotralstat + flecainide

monitor flecainide levels, ECG: combo may incr. flecainide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• fluorouracil
Orladeyo (berotralstat)

+

fluorouracil

1 interaction

Monitor/Modify Tx

berotralstat + fluorouracil

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• fluvastatin
Orladeyo (berotralstat)

+

fluvastatin

1 interaction

Monitor/Modify Tx

berotralstat + fluvastatin

monitor CK, myopathy sx: combo may incr. fluvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited)

• futibatinib
Orladeyo (berotralstat)

+

futibatinib

1 interaction

Monitor/Modify Tx

berotralstat + futibatinib

monitor phosphate: combo may incr. futibatinib levels, risk of hyperphosphatemia, other adverse effects (hepatic metabolism inhibited)

• gepirone
Orladeyo (berotralstat)

+

gepirone

1 interaction

Monitor/Modify Tx

berotralstat + gepirone

monitor ECG, electrolytes; decr. gepirone dose 50%: combo may incr. gepirone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

monitor ECG, electrolytes; decr. gepirone dose 50%: combo may incr. gepirone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• gilteritinib
Orladeyo (berotralstat)

+

gilteritinib

1 interaction

Monitor/Modify Tx

berotralstat + gilteritinib

monitor ECG, electrolytes: combo may incr. gilteritinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• glasdegib
Orladeyo (berotralstat)

+

glasdegib

1 interaction

Monitor/Modify Tx

berotralstat + glasdegib

monitor CBC, ECG: combo may incr. glasdegib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited, additive effects)

• glimepiride
Orladeyo (berotralstat)

+

glimepiride

1 interaction

Monitor/Modify Tx

berotralstat + glimepiride

monitor glucose: combo may incr. glimepiride levels, risk of hypoglycemia, other adverse effects (hepatic metabolism inhibited)

• goserelin
Orladeyo (berotralstat)

+

goserelin

1 interaction

Monitor/Modify Tx

berotralstat + goserelin

PROSTATE CANCER: monitor ECG, electrolytes; ALL OTHER INDICATIONS: consider monitoring ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• guanfacine
Orladeyo (berotralstat)

+

guanfacine

1 interaction

Monitor/Modify Tx

berotralstat + guanfacine

decr. guanfacine ER dose 50%, consider decr. dose for immed.-release form: combo may incr. guanfacine levels, risk of adverse effects (hepatic metabolism inhibited)

• haloperidol
Orladeyo (berotralstat)

+

haloperidol

1 interaction

Monitor/Modify Tx

berotralstat + haloperidol

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• histrelin
Orladeyo (berotralstat)

+

histrelin

1 interaction

Monitor/Modify Tx

berotralstat + histrelin

consider monitoring ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• hydrocortisone
Orladeyo (berotralstat)

+

hydrocortisone

1 interaction

Monitor/Modify Tx

berotralstat + hydrocortisone

consider decr. hydrocortisone dose: combo may incr. hydrocortisone levels, risk of systemic corticosteroid effects, including Cushing syndrome and adrenal suppression, other adverse effects (hepatic metabolism inhibited)

• hydroxyzine
Orladeyo (berotralstat)

+

hydroxyzine

1 interaction

Monitor/Modify Tx

berotralstat + hydroxyzine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ibrutinib
Orladeyo (berotralstat)

+

ibrutinib

1 interaction

Monitor/Modify Tx

berotralstat + ibrutinib

B-CELL MALIGNANCIES: decr. ibrutinib dose to 280 mg qd; CHRONIC GVHD: consider decr. ibrutinib dose,: combo may incr. ibrutinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• ibutilide
Orladeyo (berotralstat)

+

ibutilide

1 interaction

Monitor/Modify Tx

berotralstat + ibutilide

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• iloperidone
Orladeyo (berotralstat)

+

iloperidone

1 interaction

Monitor/Modify Tx

berotralstat + iloperidone

monitor ECG: combo may incr. iloperidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• imipramine
Orladeyo (berotralstat)

+

imipramine

1 interaction

Monitor/Modify Tx

berotralstat + imipramine

monitor imipramine levels: combo may incr. imipramine levels, risk of adverse effects (hepatic metabolism inhibited)

• inotuzumab ozogamicin
Orladeyo (berotralstat)

+

inotuzumab ozogamicin

1 interaction

Monitor/Modify Tx

berotralstat + inotuzumab ozogamicin

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• irinotecan
Orladeyo (berotralstat)

+

irinotecan

1 interaction

Monitor/Modify Tx

berotralstat + irinotecan

monitor CBC: combo may incr. irinotecan and active metabolite levels, risk of serious infection, myelosuppression, other toxicities (hepatic metabolism inhibited)

• isoflurane
Orladeyo (berotralstat)

+

isoflurane

1 interaction

Monitor/Modify Tx

berotralstat + isoflurane

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• itraconazole
Orladeyo (berotralstat)

+

itraconazole

1 interaction

Monitor/Modify Tx

berotralstat + itraconazole

consider decr. itraconazole dose: combo may incr. itraconazole levels, risk of adverse effects (hepatic metabolism inhibited)

• lapatinib
Orladeyo (berotralstat)

+

lapatinib

1 interaction

Monitor/Modify Tx

berotralstat + lapatinib

monitor ECG; consider decr. lapatinib dose: combo may incr. lapatinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• leuprolide
Orladeyo (berotralstat)

+

leuprolide

1 interaction

Monitor/Modify Tx

berotralstat + leuprolide

PROSTATE CANCER: monitor ECG, electrolytes; ALL OTHER INDICATIONS: consider monitoring ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• levofloxacin
Orladeyo (berotralstat)

+

levofloxacin

1 interaction

Monitor/Modify Tx

berotralstat + levofloxacin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• lidocaine
Orladeyo (berotralstat)

+

lidocaine

1 interaction

Monitor/Modify Tx

berotralstat + lidocaine

monitor lidocaine levels if lidocaine antiarrhythmic use; otherwise, monitor BP, HR: combo may incr. lidocaine levels, risk of hypotension, bradycardia, other adverse effects; risk may be higher with continuous infusion or higher doses for local anesthesia (hepatic metabolism inhibited)

• lofexidine
Orladeyo (berotralstat)

+

lofexidine

1 interaction

Monitor/Modify Tx

berotralstat + lofexidine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• lumateperone
Orladeyo (berotralstat)

+

lumateperone

1 interaction

Monitor/Modify Tx

berotralstat + lumateperone

monitor ECG; decr. lumateperone dose to 21 mg qd: combo may incr. lumateperone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• lurasidone
Orladeyo (berotralstat)

+

lurasidone

1 interaction

Monitor/Modify Tx

berotralstat + lurasidone

monitor ECG; decr. lurasidone start dose to 20 mg or decr. usual lurasidone dose 50%, max 80 mg/day: combo may incr. lurasidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• macimorelin
Orladeyo (berotralstat)

+

macimorelin

1 interaction

Monitor/Modify Tx

berotralstat + macimorelin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• mavacamten
Orladeyo (berotralstat)

+

mavacamten

1 interaction

Monitor/Modify Tx

berotralstat + mavacamten

monitor cardiac fxn, incl. LVEF; if patient stable on berotralstat tx, initiate mavacamten at 5 mg qd; if adding short-term (<1wk) berotralstat tx to existing mavacamten tx, hold mavacamten until berotralstat D/C; if adding longer-term (>1wk) berotralstat tx, decr. mavacamten dose as follows for at least 12wk: decr. mavacamten 15 mg qd to 10 mg qd; decr. mavacamten 10 mg qd to 5 mg qd; decr. mavacamten 5 mg qd to 2.5 mg qd; do not start berotralstat tx if on mavacamten 2.5 mg qd: combo may incr. mavacamten levels, risk of heart failure, other adverse effects (hepatic metabolism inhibited)

• mavorixafor
Orladeyo (berotralstat)

+

mavorixafor

1 interaction

Monitor/Modify Tx

berotralstat + mavorixafor

monitor ECG: combo may incr. mavorixafor levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• mefloquine
Orladeyo (berotralstat)

+

mefloquine

1 interaction

Monitor/Modify Tx

berotralstat + mefloquine

monitor ECG: combo may incr. mefloquine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• metoprolol
Orladeyo (berotralstat)

+

metoprolol

1 interaction

Monitor/Modify Tx

berotralstat + metoprolol

monitor BP, HR; consider lower metoprolol dose: combo may incr. metoprolol levels, risk of hypotension, bradycardia, AV block, other adverse effects (hepatic metabolism inhibited)

• midostaurin
Orladeyo (berotralstat)

+

midostaurin

1 interaction

Monitor/Modify Tx

berotralstat + midostaurin

monitor ECG, CBC: combo may incr. midostaurin levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• milsaperidone
Orladeyo (berotralstat)

+

milsaperidone

1 interaction

Monitor/Modify Tx

berotralstat + milsaperidone

monitor ECG: combo may incr. milsaperidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• morphine
Orladeyo (berotralstat)

+

morphine

1 interaction

Monitor/Modify Tx

berotralstat + morphine

monitor respiratory rate, consider decr. dose of one or both drugs: combo may incr. morphine levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (P-gp-mediated transport inhibited)

• moxifloxacin
Orladeyo (berotralstat)

+

moxifloxacin

1 interaction

Monitor/Modify Tx

berotralstat + moxifloxacin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• nebivolol
Orladeyo (berotralstat)

+

nebivolol

1 interaction

Monitor/Modify Tx

berotralstat + nebivolol

monitor BP, HR: combo may incr. nebivolol levels, risk of hypotension, bradycardia, other adverse effects (hepatic metabolism inhibited)

• nifedipine
Orladeyo (berotralstat)

+

nifedipine

1 interaction

Monitor/Modify Tx

berotralstat + nifedipine

monitor BP, consider lowest nifedipine start dose: combo may incr. nifedipine levels, risk of hypotension, other adverse effects (hepatic metabolism inhibited)

• nilotinib
Orladeyo (berotralstat)

+

nilotinib

1 interaction

Monitor/Modify Tx

berotralstat + nilotinib

monitor ECG, electrolytes, CBC: combo may incr. nilotinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited, additive effects)

• nimodipine
Orladeyo (berotralstat)

+

nimodipine

1 interaction

Monitor/Modify Tx

berotralstat + nimodipine

monitor BP: combo may incr. nimodipine levels, risk of hypotension, other adverse effects (hepatic metabolism inhibited)

• nortriptyline
Orladeyo (berotralstat)

+

nortriptyline

1 interaction

Monitor/Modify Tx

berotralstat + nortriptyline

monitor nortriptyline levels: combo may incr. nortriptyline levels, risk of adverse effects (hepatic metabolism inhibited)

• ondansetron
Orladeyo (berotralstat)

+

ondansetron

1 interaction

Monitor/Modify Tx

berotralstat + ondansetron

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• osimertinib
Orladeyo (berotralstat)

+

osimertinib

1 interaction

Monitor/Modify Tx

berotralstat + osimertinib

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• pacritinib
Orladeyo (berotralstat)

+

pacritinib

1 interaction

Monitor/Modify Tx

berotralstat + pacritinib

monitor ECG, electrolytes, CBC, bleeding s/sx: combo may incr. pacritinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• palbociclib
Orladeyo (berotralstat)

+

palbociclib

1 interaction

Monitor/Modify Tx

berotralstat + palbociclib

monitor CBC: combo may incr. palbociclib levels, risk of myelosuppression, other adverse effects (hepatic metabolism inhibited)

• paliperidone
Orladeyo (berotralstat)

+

paliperidone

1 interaction

Monitor/Modify Tx

berotralstat + paliperidone

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• palonosetron
Orladeyo (berotralstat)

+

palonosetron

1 interaction

Monitor/Modify Tx

berotralstat + palonosetron

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• pasireotide
Orladeyo (berotralstat)

+

pasireotide

1 interaction

Monitor/Modify Tx

berotralstat + pasireotide

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• pazopanib
Orladeyo (berotralstat)

+

pazopanib

1 interaction

Monitor/Modify Tx

berotralstat + pazopanib

monitor ECG: combo may incr. pazopanib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• pentamidine
Orladeyo (berotralstat)

+

pentamidine

1 interaction

Monitor/Modify Tx

berotralstat + pentamidine

monitor ECG; risk may be lower w/ nebulized pentamidine: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• perphenazine
Orladeyo (berotralstat)

+

perphenazine

1 interaction

Monitor/Modify Tx

berotralstat + perphenazine

consider decr. perphenazine dose: combo may incr. perphenazine levels, risk of adverse effects (hepatic metabolism inhibited)

• pimavanserin
Orladeyo (berotralstat)

+

pimavanserin

1 interaction

Monitor/Modify Tx

berotralstat + pimavanserin

consider monitoring ECG: combo may incr. pimavanserin levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• pirtobrutinib
Orladeyo (berotralstat)

+

pirtobrutinib

1 interaction

Monitor/Modify Tx

berotralstat + pirtobrutinib

monitor CBC: combo may incr. pirtobrutinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• pitolisant
Orladeyo (berotralstat)

+

pitolisant

1 interaction

Monitor/Modify Tx

berotralstat + pitolisant

monitor ECG: combo may incr. pitolisant levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• ponatinib
Orladeyo (berotralstat)

+

ponatinib

1 interaction

Monitor/Modify Tx

berotralstat + ponatinib

monitor CBC: combo may incr. ponatinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• procainamide
Orladeyo (berotralstat)

+

procainamide

1 interaction

Monitor/Modify Tx

berotralstat + procainamide

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• propranolol
Orladeyo (berotralstat)

+

propranolol

1 interaction

Monitor/Modify Tx

berotralstat + propranolol

monitor BP, HR: combo may incr. propranolol levels, risk of hypotension, bradycardia, AV block, other adverse effects (hepatic metabolism inhibited)

• quetiapine
Orladeyo (berotralstat)

+

quetiapine

1 interaction

Monitor/Modify Tx

berotralstat + quetiapine

monitor ECG; consider decr. quetiapine dose: combo may incr. quetiapine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• quinidine (antiarrhythmic)
Orladeyo (berotralstat)

+

quinidine (antiarrhythmic)

1 interaction

Monitor/Modify Tx

berotralstat + quinidine (antiarrhythmic)

monitor quinidine levels, ECG: combo may incr. quinidine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited, additive effects)

• quinidine (CYP2D6 inhibitor)
Orladeyo (berotralstat)

+

quinidine (CYP2D6 inhibitor)

1 interaction

Monitor/Modify Tx

berotralstat + quinidine (CYP2D6 inhibitor)

monitor ECG: combo may incr. quinidine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• quinine
Orladeyo (berotralstat)

+

quinine

1 interaction

Monitor/Modify Tx

berotralstat + quinine

monitor ECG: combo may incr. quinine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• ranolazine
Orladeyo (berotralstat)

+

ranolazine

1 interaction

Monitor/Modify Tx

berotralstat + ranolazine

monitor ECG; adjust ranolazine max dose to 1000 mg/day: combo may incr. ranolazine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• red yeast rice
Orladeyo (berotralstat)

+

red yeast rice

1 interaction

Monitor/Modify Tx

berotralstat + red yeast rice

monitor CK, myopathy sx w/ large amounts of red yeast rice: combo may incr. lovastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited, red yeast rice contains varying amounts of lovastatin)

• repaglinide
Orladeyo (berotralstat)

+

repaglinide

1 interaction

Monitor/Modify Tx

berotralstat + repaglinide

monitor glucose: combo may incr. repaglinide levels, risk of hypoglycemia, other adverse effects (hepatic metabolism inhibited)

• revumenib
Orladeyo (berotralstat)

+

revumenib

1 interaction

Monitor/Modify Tx

berotralstat + revumenib

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ribociclib
Orladeyo (berotralstat)

+

ribociclib

1 interaction

Monitor/Modify Tx

berotralstat + ribociclib

monitor ECG, electrolytes, CBC: combo may incr. ribociclib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited, additive effects)

• rimegepant
Orladeyo (berotralstat)

+

rimegepant

1 interaction

Monitor/Modify Tx

berotralstat + rimegepant

separate rimegepant doses by at least 48h: combo may incr. rimegepant levels, risk of adverse effects (hepatic metabolism inhibited)

• riociguat
Orladeyo (berotralstat)

+

riociguat

1 interaction

Monitor/Modify Tx

berotralstat + riociguat

monitor BP: combo may incr. riociguat levels, risk of severe hypotension, other adverse effects (hepatic metabolism inhibited)

• romidepsin
Orladeyo (berotralstat)

+

romidepsin

1 interaction

Monitor/Modify Tx

berotralstat + romidepsin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• rucaparib
Orladeyo (berotralstat)

+

rucaparib

1 interaction

Monitor/Modify Tx

berotralstat + rucaparib

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ruxolitinib
Orladeyo (berotralstat)

+

ruxolitinib

1 interaction

Monitor/Modify Tx

berotralstat + ruxolitinib

monitor CBC: combo may incr. ruxolitinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• ruxolitinib topical
Orladeyo (berotralstat)

+

ruxolitinib topical

1 interaction

Monitor/Modify Tx

berotralstat + ruxolitinib topical

monitor CBC: combo may incr. ruxolitinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• saxagliptin
Orladeyo (berotralstat)

+

saxagliptin

1 interaction

Monitor/Modify Tx

berotralstat + saxagliptin

monitor glucose: combo may incr. saxagliptin levels, risk of hypoglycemia, other adverse effects (hepatic metabolism inhibited)

• sebetralstat
Orladeyo (berotralstat)

+

sebetralstat

1 interaction

Monitor/Modify Tx

berotralstat + sebetralstat

decr. sebetralstat dose to 300 mg, may give second 300 mg dose at least 3h after first dose if needed: combo may incr. sebetralstat levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, duplicate therapy)

• sertraline
Orladeyo (berotralstat)

+

sertraline

1 interaction

Monitor/Modify Tx

berotralstat + sertraline

monitor ECG: combo may incr. sertraline levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• sevoflurane
Orladeyo (berotralstat)

+

sevoflurane

1 interaction

Monitor/Modify Tx

berotralstat + sevoflurane

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• sildenafil
Orladeyo (berotralstat)

+

sildenafil

1 interaction

Monitor/Modify Tx

berotralstat + sildenafil

monitor BP: combo may incr. sildenafil levels, risk of hypotension (including syncope), priapism, other adverse effects (hepatic metabolism inhibited)

• sirolimus
Orladeyo (berotralstat)

+

sirolimus

1 interaction

Monitor/Modify Tx

berotralstat + sirolimus

monitor sirolimus levels: combo may incr. sirolimus levels, risk of serious infection, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• sparsentan
Orladeyo (berotralstat)

+

sparsentan

1 interaction

Monitor/Modify Tx

berotralstat + sparsentan

monitor BP, potassium, renal fxn: combo may incr. sparsentan levels, risk of hypotension (including orthostasis, syncope), hyperkalemia, edema, nephrotoxicity, other adverse effects (hepatic metabolism inhibited)

• sunitinib
Orladeyo (berotralstat)

+

sunitinib

1 interaction

Monitor/Modify Tx

berotralstat + sunitinib

consider monitoring ECG, electrolytes: combo may incr. sunitinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• suvorexant
Orladeyo (berotralstat)

+

suvorexant

1 interaction

Monitor/Modify Tx

berotralstat + suvorexant

decr. suvorexant dose to 5 mg, max 10 mg/day: combo may incr. suvorexant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• suzetrigine
Orladeyo (berotralstat)

+

suzetrigine

1 interaction

Monitor/Modify Tx

berotralstat + suzetrigine

start suzetrigine 100 mg x1 at least 1h before or 2h after food, after 12h give 50 mg q12h x3 doses, then after 12h give 50mg q24h: combo may incr. suzetrigine and active metabolite levels, risk of adverse effects (hepatic metabolism inhibited)

• tacrolimus
Orladeyo (berotralstat)

+

tacrolimus

1 interaction

Monitor/Modify Tx

berotralstat + tacrolimus

monitor tacrolimus levels, ECG, renal fxn: combo may incr. tacrolimus levels, risk of QT prolongation, cardiac arrhythmias, nephrotoxicity, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• tadalafil
Orladeyo (berotralstat)

+

tadalafil

1 interaction

Monitor/Modify Tx

berotralstat + tadalafil

monitor BP: combo may incr. tadalafil levels, risk of hypotension, priapism, other adverse effects (hepatic metabolism inhibited)

• talazoparib
Orladeyo (berotralstat)

+

talazoparib

1 interaction

Monitor/Modify Tx

berotralstat + talazoparib

monitor CBC: combo may incr. talazoparib levels, risk of myelosuppression, other adverse effects (P-gp-mediated transport inhibited)

• tamsulosin
Orladeyo (berotralstat)

+

tamsulosin

1 interaction

Monitor/Modify Tx

berotralstat + tamsulosin

monitor BP, especially w/ tamsulosin dose >0.4 mg: combo may incr. tamsulosin levels, risk of hypotension (including orthostasis, syncope), other adverse effects (hepatic metabolism inhibited)

• telavancin
Orladeyo (berotralstat)

+

telavancin

1 interaction

Monitor/Modify Tx

berotralstat + telavancin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• temsirolimus
Orladeyo (berotralstat)

+

temsirolimus

1 interaction

Monitor/Modify Tx

berotralstat + temsirolimus

monitor CBC; consider decr. temsirolimus dose: combo may incr. temsirolimus and active metabolite sirolimus levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• tenofovir alafenamide
Orladeyo (berotralstat)

+

tenofovir alafenamide

1 interaction

Monitor/Modify Tx

berotralstat + tenofovir alafenamide

if tenofovir alafenamide not admin. w/ cobicistat, monitor renal fxn: combo may incr. tenofovir levels, risk of nephrotoxicity, other adverse effects (gut P-gp-mediated transport inhibited)

• tenofovir disoproxil
Orladeyo (berotralstat)

+

tenofovir disoproxil

1 interaction

Monitor/Modify Tx

berotralstat + tenofovir disoproxil

monitor renal fxn: combo may incr. tenofovir levels, risk of nephrotoxicity, other adverse effects (gut P-gp-mediated transport inhibited)

• tetrabenazine
Orladeyo (berotralstat)

+

tetrabenazine

1 interaction

Monitor/Modify Tx

berotralstat + tetrabenazine

monitor ECG; consider decr. tetrabenazine dose: combo may incr. tetrabenazine active metabolite levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• tezacaftor/ivacaftor
Orladeyo (berotralstat)

+

tezacaftor/ ivacaftor

1 interaction

Monitor/Modify Tx

berotralstat + tezacaftor/ ivacaftor

decr. dose by alternating tezacaftor/ivacaftor tab and ivacaftor tab at morning dose, no evening doses: combo may incr. tezacaftor/ivacaftor levels, risk of adverse effects (hepatic metabolism inhibited)

• tofacitinib
Orladeyo (berotralstat)

+

tofacitinib

1 interaction

Monitor/Modify Tx

berotralstat + tofacitinib

ALL USES: monitor CBC; if also combined w/ strong CYP2C19 inhibitor, adjust tofacitinib as follows: ADULT RHEUMATOID or PSORIATIC ARTHRITIS or ANKYLOSING SPONDYLITIS: decr. to 5 mg qd; ADULT ULCERATIVE COLITIS: decr. induction to 5 mg bid using tabs or 11 mg qd using XR tab for up to 16 wks, followed by 5 mg qd maintenance using tabs; do not use XR tabs for maintenance doses; PEDIATRIC PSORIATIC ARTHRITIS, POLYARTICULAR COURSE JUVENILE IDIOPATHIC ARTHRITIS: decr. usual bid dose to qd: combo may incr. tofacitinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• torsemide
Orladeyo (berotralstat)

+

torsemide

1 interaction

Monitor/Modify Tx

berotralstat + torsemide

monitor renal fxn, BP: combo may incr. torsemide levels, risk of nephrotoxicity, hypotension, other adverse effects (hepatic metabolism inhibited)

• trabectedin
Orladeyo (berotralstat)

+

trabectedin

1 interaction

Monitor/Modify Tx

berotralstat + trabectedin

monitor CBC, cardiac function (including LVEF), LFTs: combo may incr. trabectedin levels, risk of myelosuppression, cardiotoxicity, hepatotoxicity, other adverse effects (hepatic metabolism inhibited)

• trazodone
Orladeyo (berotralstat)

+

trazodone

1 interaction

Monitor/Modify Tx

berotralstat + trazodone

monitor ECG, BP: combo may incr. trazodone levels, risk of QT prolongation, cardiac arrhythmias, hypotension (including orthostasis, syncope), other adverse effects (hepatic metabolism inhibited)

• triazolam
Orladeyo (berotralstat)

+

triazolam

1 interaction

Monitor/Modify Tx

berotralstat + triazolam

monitor respiratory rate; consider decr. triazolam dose: combo may incr. triazolam levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• triclabendazole
Orladeyo (berotralstat)

+

triclabendazole

1 interaction

Monitor/Modify Tx

berotralstat + triclabendazole

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• trifluridine
Orladeyo (berotralstat)

+

trifluridine

1 interaction

Monitor/Modify Tx

berotralstat + trifluridine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• triptorelin
Orladeyo (berotralstat)

+

triptorelin

1 interaction

Monitor/Modify Tx

berotralstat + triptorelin

PROSTATE CANCER: monitor ECG, electrolytes; ALL OTHER INDICATIONS: consider monitoring ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• ubrogepant
Orladeyo (berotralstat)

+

ubrogepant

1 interaction

Monitor/Modify Tx

berotralstat + ubrogepant

limit ubrogepant dose to 50 mg, may give second 50 mg dose after 24h if needed: combo may incr. ubrogepant levels, risk of adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• vanzacaftor/tezacaftor/deutivacaftor
Orladeyo (berotralstat)

+

vanzacaftor/ tezacaftor/ deutivacaftor

1 interaction

Monitor/Modify Tx

berotralstat + vanzacaftor/ tezacaftor/ deutivacaftor

6-11 YO AND WT <40 KG: decr. vanzacaftor/tezacaftor/deutivacaftor dose to two tablets (4 mg/20 mg/50 mg each) qod; 6-11 YO AND WT 40 KG AND ABOVE: decr. vanzacaftor/tezacaftor/deutivacaftor dose to one tablet (10 mg/50 mg/125 mg) qod; 12 YO AND OLDER: decr. vanzacaftor/tezacaftor/deutivacaftor dose to one tablet (10 mg/50 mg/125 mg) qod: combo may incr. vanzacaftor/tezacaftor/deutivacaftor levels, risk of adverse effects (hepatic metabolism inhibited)

• vemurafenib
Orladeyo (berotralstat)

+

vemurafenib

1 interaction

Monitor/Modify Tx

berotralstat + vemurafenib

monitor ECG, electrolytes: combo may incr. vemurafenib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• vepdegestrant
Orladeyo (berotralstat)

+

vepdegestrant

1 interaction

Monitor/Modify Tx

berotralstat + vepdegestrant

monitor ECG, electrolytes: combo may incr. vepdegestrant levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• vinblastine
Orladeyo (berotralstat)

+

vinblastine

1 interaction

Monitor/Modify Tx

berotralstat + vinblastine

monitor CBC: combo may incr. vinblastine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects (hepatic metabolism inhibited)

• vincristine
Orladeyo (berotralstat)

+

vincristine

1 interaction

Monitor/Modify Tx

berotralstat + vincristine

monitor CBC: combo may incr. vincristine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects (hepatic metabolism inhibited)

• vinorelbine
Orladeyo (berotralstat)

+

vinorelbine

1 interaction

Monitor/Modify Tx

berotralstat + vinorelbine

monitor CBC: combo may incr. vinorelbine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects (hepatic metabolism inhibited)

• voclosporin
Orladeyo (berotralstat)

+

voclosporin

1 interaction

Monitor/Modify Tx

berotralstat + voclosporin

monitor ECG, renal fxn; decr. voclosporin morning dose to 15.8 mg and evening dose to 7.9 mg: combo may incr. voclosporin levels, risk of QT prolongation, cardiac arrhythmias, serious infection, nephrotoxicity, other adverse effects (hepatic metabolism inhibited)

• warfarin
Orladeyo (berotralstat)

+

warfarin

1 interaction

Monitor/Modify Tx

berotralstat + warfarin

monitor INR, bleeding s/sx, especially during initiation/titration: combo may incr. warfarin levels, risk of bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited)

• yohimbe
Orladeyo (berotralstat)

+

yohimbe

1 interaction

Monitor/Modify Tx

berotralstat + yohimbe

monitor BP, HR: combo may incr. yohimbe levels, risk of HTN, tachycardia, other adverse effects (hepatic metabolism inhibited)

• zanubrutinib
Orladeyo (berotralstat)

+

zanubrutinib

1 interaction

Monitor/Modify Tx

berotralstat + zanubrutinib

decr. zanubrutinib dose to 80 mg bid; monitor CBC: combo may incr. zanubrutinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• ziftomenib
Orladeyo (berotralstat)

+

ziftomenib

1 interaction

Monitor/Modify Tx

berotralstat + ziftomenib

monitor ECG, electrolytes: combo may incr. ziftomenib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

Caution Advised

• aliskiren
Orladeyo (berotralstat)

+

aliskiren

1 interaction

Caution Advised

berotralstat + aliskiren

caution advised: combo may incr. aliskiren levels, risk of adverse effects (hepatic metabolism inhibited)

• avacopan
Orladeyo (berotralstat)

+

avacopan

1 interaction

Caution Advised

berotralstat + avacopan

caution advised: combo may incr. avacopan levels, risk of adverse effects (hepatic metabolism inhibited)

• budesonide rectal
Orladeyo (berotralstat)

+

budesonide rectal

1 interaction

Caution Advised

berotralstat + budesonide rectal

caution advised: combo may incr. budesonide levels, risk of systemic corticosteroid effects including Cushing syndrome and adrenal suppression, serious infection, other adverse effects (hepatic metabolism inhibited)

• cyclophosphamide
Orladeyo (berotralstat)

+

cyclophosphamide

1 interaction

Caution Advised

berotralstat + cyclophosphamide

caution advised: combo may decr. cyclophosphamide active metabolite levels, efficacy (hepatic metabolism possibly inhibited, decr. conversion to active metabolite)

• darifenacin
Orladeyo (berotralstat)

+

darifenacin

1 interaction

Caution Advised

berotralstat + darifenacin

caution advised: combo may incr. darifenacin levels, risk of adverse effects (hepatic metabolism inhibited)

• darolutamide
Orladeyo (berotralstat)

+

darolutamide

1 interaction

Caution Advised

berotralstat + darolutamide

if also combined w/ strong CYP3A4 inhibitor, caution advised: combo may incr. darolutamide levels, risk of adverse effects (P-gp-mediated transport inhibited)

• dexamethasone
Orladeyo (berotralstat)

+

dexamethasone

1 interaction

Caution Advised

berotralstat + dexamethasone

caution advised: combo may incr. dexamethasone levels, risk of systemic corticosteroid effects including Cushing syndrome and adrenal suppression, serious infection, other adverse effects (hepatic metabolism inhibited)

• duvelisib
Orladeyo (berotralstat)

+

duvelisib

1 interaction

Caution Advised

berotralstat + duvelisib

caution advised: combo may incr. duvelisib levels, risk of adverse effects (hepatic metabolism inhibited)

• eletriptan
Orladeyo (berotralstat)

+

eletriptan

1 interaction

Caution Advised

berotralstat + eletriptan

caution advised: combo may incr. eletriptan levels, risk of adverse effects (hepatic metabolism inhibited)

• erlotinib
Orladeyo (berotralstat)

+

erlotinib

1 interaction

Caution Advised

berotralstat + erlotinib

caution advised: combo may incr. erlotinib levels, risk of adverse effects (hepatic metabolism inhibited)

• glecaprevir
Orladeyo (berotralstat)

+

glecaprevir

1 interaction

Caution Advised

berotralstat + glecaprevir

caution advised: combo may incr. glecaprevir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• grazoprevir
Orladeyo (berotralstat)

+

grazoprevir

1 interaction

Caution Advised

berotralstat + grazoprevir

caution advised: combo may incr. grazoprevir levels, risk of adverse effects (hepatic metabolism inhibited)

• ifosfamide
Orladeyo (berotralstat)

+

ifosfamide

1 interaction

Caution Advised

berotralstat + ifosfamide

caution advised: combo may decr. ifosfamide active metabolite levels, efficacy (hepatic metabolism inhibited, decr. active metabolite formation)

• imlunestrant
Orladeyo (berotralstat)

+

imlunestrant

1 interaction

Caution Advised

berotralstat + imlunestrant

caution advised: combo may incr. imlunestrant levels, risk of adverse effects (hepatic metabolism inhibited)

• isavuconazonium
Orladeyo (berotralstat)

+

isavuconazonium

1 interaction

Caution Advised

berotralstat + isavuconazonium

caution advised: combo may incr. isavuconazole levels, risk of adverse effects (hepatic metabolism inhibited)

• istradefylline
Orladeyo (berotralstat)

+

istradefylline

1 interaction

Caution Advised

berotralstat + istradefylline

caution advised: combo may incr. istradefylline levels, risk of adverse effects (hepatic metabolism inhibited)

• larotrectinib
Orladeyo (berotralstat)

+

larotrectinib

1 interaction

Caution Advised

berotralstat + larotrectinib

caution advised: combo may incr. larotrectinib levels, risk of adverse effects (hepatic metabolism inhibited)

• maraviroc
Orladeyo (berotralstat)

+

maraviroc

1 interaction

Caution Advised

berotralstat + maraviroc

caution advised: combo may incr. maraviroc levels, risk of adverse effects (hepatic metabolism inhibited)

• meropenem
Orladeyo (berotralstat)

+

meropenem

1 interaction

Caution Advised

berotralstat + meropenem

caution advised: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport possibly induced)

• methylprednisolone
Orladeyo (berotralstat)

+

methylprednisolone

1 interaction

Caution Advised

berotralstat + methylprednisolone

caution advised: combo may incr. methylprednisolone levels, risk of systemic corticosteroid effects including Cushing syndrome and adrenal suppression (hepatic metabolism inhibited)

• mifepristone
Orladeyo (berotralstat)

+

mifepristone

1 interaction

Caution Advised

berotralstat + mifepristone

caution advised if daily mifepristone use: combo may incr. mifepristone levels, risk of adverse effects (hepatic metabolism inhibited)

• naldemedine
Orladeyo (berotralstat)

+

naldemedine

1 interaction

Caution Advised

berotralstat + naldemedine

caution advised: combo may incr. naldemedine levels, risk of adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• ospemifene
Orladeyo (berotralstat)

+

ospemifene

1 interaction

Caution Advised

berotralstat + ospemifene

caution advised: combo may incr. ospemifene levels, risk of adverse effects (hepatic metabolism inhibited)

• oxcarbazepine
Orladeyo (berotralstat)

+

oxcarbazepine

1 interaction

Caution Advised

berotralstat + oxcarbazepine

caution advised: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport possibly induced)

• pibrentasvir
Orladeyo (berotralstat)

+

pibrentasvir

1 interaction

Caution Advised

berotralstat + pibrentasvir

caution advised: combo may incr. pibrentasvir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• roflumilast
Orladeyo (berotralstat)

+

roflumilast

1 interaction

Caution Advised

berotralstat + roflumilast

caution advised: combo may incr. roflumilast levels, risk of adverse effects (hepatic metabolism inhibited)

• roflumilast topical
Orladeyo (berotralstat)

+

roflumilast topical

1 interaction

Caution Advised

berotralstat + roflumilast topical

caution advised: combo may incr. roflumilast levels, risk of adverse effects (hepatic metabolism inhibited)

• seladelpar
Orladeyo (berotralstat)

+

seladelpar

1 interaction

Caution Advised

berotralstat + seladelpar

caution advised if CYP2C9 poor metabolizer or if also combined w/ moderate CYP2C9 inhibitor: combo may incr. seladelpar levels, risk of adverse effects (hepatic metabolism inhibited)

• sevabertinib
Orladeyo (berotralstat)

+

sevabertinib

1 interaction

Caution Advised

berotralstat + sevabertinib

caution advised: combo may incr. sevabertinib levels, risk of adverse effects (hepatic metabolism inhibited)

• silodosin
Orladeyo (berotralstat)

+

silodosin

1 interaction

Caution Advised

berotralstat + silodosin

caution advised: combo may incr. silodosin levels, risk of adverse effects (hepatic metabolism inhibited)

• sirolimus topical
Orladeyo (berotralstat)

+

sirolimus topical

1 interaction

Caution Advised

berotralstat + sirolimus topical

caution advised: combo may incr. sirolimus levels, risk of adverse effects (hepatic metabolism inhibited)

• tamoxifen
Orladeyo (berotralstat)

+

tamoxifen

1 interaction

Caution Advised

berotralstat + tamoxifen

caution advised: combo may decr. active tamoxifen metabolite levels, efficacy (hepatic metabolism inhibited, decr. conversion to active metabolite)

• ticagrelor
Orladeyo (berotralstat)

+

ticagrelor

1 interaction

Caution Advised

berotralstat + ticagrelor

caution advised: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• tretinoin
Orladeyo (berotralstat)

+

tretinoin

1 interaction

Caution Advised

berotralstat + tretinoin

caution advised: combo may incr. tretinoin levels, risk of adverse effects (hepatic metabolism inhibited)

• upadacitinib
Orladeyo (berotralstat)

+

upadacitinib

1 interaction

Caution Advised

berotralstat + upadacitinib

caution advised: combo may incr. upadacitinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• vaborbactam
Orladeyo (berotralstat)

+

vaborbactam

1 interaction

Caution Advised

berotralstat + vaborbactam

caution advised: combo may decr. berotralstat levels, efficacy (P-gp-mediated transport possibly induced)

• verapamil
Orladeyo (berotralstat)

+

verapamil

1 interaction

Caution Advised

berotralstat + verapamil

caution advised: combo may incr. verapamil levels, risk of hypotension, bradycardia, AV block, other adverse effects (hepatic metabolism inhibited)

• vilazodone
Orladeyo (berotralstat)

+

vilazodone

1 interaction

Caution Advised

berotralstat + vilazodone

caution advised: combo may incr. vilazodone levels, risk of adverse effects (hepatic metabolism inhibited)

• vortioxetine
Orladeyo (berotralstat)

+

vortioxetine

1 interaction

Caution Advised

berotralstat + vortioxetine

caution advised: combo may incr. vortioxetine levels, risk of adverse effects (hepatic metabolism inhibited)