Aqneursa

Overview

levacetylleucine

leucine analog

• P-gp inhibitor, weak

• avoid combo w/ N-acetyl-DL-leucine or N-acetyl-D-leucine; competition for transporter uptake may decr. levacetylleucine efficacy

Contraindicated

• colchicine
Aqneursa (levacetylleucine)

+

colchicine

1 interaction

Contraindicated

levacetylleucine + colchicine

CV RISK REDUCTION: consider monitoring CK, myopathy s/sx; GOUT OR FMF: contraindicated in pts w/ renal or hepatic impairment; otherwise, consider decr. colchicine dose during and x14 days after levacetylleucine use: combo may incr. colchicine levels, risk of myopathy, rhabdomyolysis, other life-threatening toxicity (P-gp-mediated transport possibly inhibited)

Avoid/Use Alternative

• apixaban
Aqneursa (levacetylleucine)

+

apixaban

1 interaction

Avoid/Use Alternative

levacetylleucine + apixaban

ADULT PTS: monitor bleeding s/sx; if also combined w/ strong CYP3A4 inhibitor, decr. apixaban 5mg bid or 10 mg bid dose by 50% or avoid combo if already on 2.5 mg bid; PEDS PTS: monitor bleeding s/sx; if also combined w/ strong CYP3A4 inhibitor, consider decr. apixaban dose: combo may incr. apixaban levels, risk of bleeding, other adverse effects (P-gp-mediated transport possibly inhibited)

• dabigatran
Aqneursa (levacetylleucine)

+

dabigatran

1 interaction

Avoid/Use Alternative

levacetylleucine + 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 (incl. life-threatening), other adverse effects (P-gp-mediated transport possibly inhibited)

• ensartinib
Aqneursa (levacetylleucine)

+

ensartinib

1 interaction

Avoid/Use Alternative

levacetylleucine + ensartinib

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

• futibatinib
Aqneursa (levacetylleucine)

+

futibatinib

1 interaction

Avoid/Use Alternative

levacetylleucine + futibatinib

avoid combo if also combined w/ strong CYP3A4 inhibitor; otherwise, monitor phosphate: combo may incr. futibatinib levels, risk of hyperphosphatemia, other adverse effects (P-gp-mediated transport possibly inhibited)

• neratinib
Aqneursa (levacetylleucine)

+

neratinib

1 interaction

Avoid/Use Alternative

levacetylleucine + neratinib

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

• pralsetinib
Aqneursa (levacetylleucine)

+

pralsetinib

1 interaction

Avoid/Use Alternative

levacetylleucine + 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 400 mg qd and also combined w/ strong CYP3A4 inhibitor: decr. to 200 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 (P-gp-mediated transport possibly inhibited)

• relugolix
Aqneursa (levacetylleucine)

+

relugolix

1 interaction

Avoid/Use Alternative

levacetylleucine + relugolix

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

• repotrectinib
Aqneursa (levacetylleucine)

+

repotrectinib

1 interaction

Avoid/Use Alternative

levacetylleucine + repotrectinib

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

• rivaroxaban
Aqneursa (levacetylleucine)

+

rivaroxaban

1 interaction

Avoid/Use Alternative

levacetylleucine + rivaroxaban

avoid combo if also combined w/ strong CYP3A4 inhibitor; use alternative if CrCl <80 and combined w/ moderate CYP3A4 inhibitor; otherwise, monitor bleeding s/sx: combo may incr. rivaroxaban levels, risk of bleeding, other adverse effects (P-gp-mediated transport possibly inhibited)

• sirolimus albumin-bound
Aqneursa (levacetylleucine)

+

sirolimus albumin-bound

1 interaction

Avoid/Use Alternative

levacetylleucine + sirolimus albumin-bound

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

• topotecan
Aqneursa (levacetylleucine)

+

topotecan

1 interaction

Avoid/Use Alternative

levacetylleucine + topotecan

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

• venetoclax
Aqneursa (levacetylleucine)

+

venetoclax

1 interaction

Avoid/Use Alternative

levacetylleucine + 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 (P-gp-mediated transport possibly inhibited)

Monitor/Modify Tx

• afatinib
Aqneursa (levacetylleucine)

+

afatinib

1 interaction

Monitor/Modify Tx

levacetylleucine + afatinib

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

• atorvastatin
Aqneursa (levacetylleucine)

+

atorvastatin

1 interaction

Monitor/Modify Tx

levacetylleucine + atorvastatin

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

• cyclosporine
Aqneursa (levacetylleucine)

+

cyclosporine

1 interaction

Monitor/Modify Tx

levacetylleucine + cyclosporine

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

• digoxin
Aqneursa (levacetylleucine)

+

digoxin

1 interaction

Monitor/Modify Tx

levacetylleucine + digoxin

monitor digoxin levels, HR; 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 possibly inhibited)

• edoxaban
Aqneursa (levacetylleucine)

+

edoxaban

1 interaction

Monitor/Modify Tx

levacetylleucine + edoxaban

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

• enfortumab vedotin
Aqneursa (levacetylleucine)

+

enfortumab vedotin

1 interaction

Monitor/Modify Tx

levacetylleucine + 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 possibly inhibited)

• everolimus
Aqneursa (levacetylleucine)

+

everolimus

1 interaction

Monitor/Modify Tx

levacetylleucine + everolimus

TSC-ASSOC. SEGA, TSC-ASSOC. PARTIAL ONSET SEIZURES, TRANSPLANT: monitor everolimus levels, CBC; OTHER INDICATIONS: monitor CBC: combo may incr. everolimus levels, risk of myelosuppression, other adverse effects (P-gp-mediated transport possibly inhibited)

• mavorixafor
Aqneursa (levacetylleucine)

+

mavorixafor

1 interaction

Monitor/Modify Tx

levacetylleucine + mavorixafor

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

• morphine
Aqneursa (levacetylleucine)

+

morphine

1 interaction

Monitor/Modify Tx

levacetylleucine + morphine

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

• quinidine (antiarrhythmic)
Aqneursa (levacetylleucine)

+

quinidine (antiarrhythmic)

1 interaction

Monitor/Modify Tx

levacetylleucine + quinidine (antiarrhythmic)

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

• ranolazine
Aqneursa (levacetylleucine)

+

ranolazine

1 interaction

Monitor/Modify Tx

levacetylleucine + ranolazine

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

• sirolimus
Aqneursa (levacetylleucine)

+

sirolimus

1 interaction

Monitor/Modify Tx

levacetylleucine + sirolimus

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

• tacrolimus
Aqneursa (levacetylleucine)

+

tacrolimus

1 interaction

Monitor/Modify Tx

levacetylleucine + tacrolimus

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

• talazoparib
Aqneursa (levacetylleucine)

+

talazoparib

1 interaction

Monitor/Modify Tx

levacetylleucine + talazoparib

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

• tenofovir alafenamide
Aqneursa (levacetylleucine)

+

tenofovir alafenamide

1 interaction

Monitor/Modify Tx

levacetylleucine + 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 possibly inhibited)

• tenofovir disoproxil
Aqneursa (levacetylleucine)

+

tenofovir disoproxil

1 interaction

Monitor/Modify Tx

levacetylleucine + tenofovir disoproxil

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

• ubrogepant
Aqneursa (levacetylleucine)

+

ubrogepant

1 interaction

Monitor/Modify Tx

levacetylleucine + ubrogepant

limit ubrogepant dose to 50 mg, may give second 50 mg dose after 2h if needed: combo may incr. ubrogepant levels, risk of adverse effects (P-gp-mediated transport possibly inhibited)

Caution Advised

• darolutamide
Aqneursa (levacetylleucine)

+

darolutamide

1 interaction

Caution Advised

levacetylleucine + darolutamide

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

• glecaprevir
Aqneursa (levacetylleucine)

+

glecaprevir

1 interaction

Caution Advised

levacetylleucine + glecaprevir

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

• naldemedine
Aqneursa (levacetylleucine)

+

naldemedine

1 interaction

Caution Advised

levacetylleucine + naldemedine

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

• pibrentasvir
Aqneursa (levacetylleucine)

+

pibrentasvir

1 interaction

Caution Advised

levacetylleucine + pibrentasvir

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