Ixempra

Other Cytotoxic Antibiotics

Hazardous Drugs Classification
NIOSH 2016 List: Group 1
NIOSH (Draft) 2020 List: Table 1
Observe and exercise appropriate precautions for handling, preparation, administration, and disposal of hazardous drugs.
Use double chemotherapy gloves and a protective gown. Prepare in a biological safety cabinet or compounding aseptic containment isolator with a closed system drug transfer device. Eye/face and respiratory protection may be needed during preparation and administration.
Emetic Risk
Pediatrics: Doses 3 mg/m2 to 10 mg/m2: Moderate
Adults: Low
Administer routine antiemetic prophylaxis prior to treatment.
Extravasation Risk
Irritant

Injectable Administration

Visually inspect parenteral products for particular matter and discoloration prior to administration whenever solution and container permit.

Intravenous Administration

Administer as an intravenous infusion.
To help prevent hypersensitivity reactions, premedicate all patients an hour before ixabepilone administration with an H1 blocker (e.g., diphenhydramine 50 mg PO or equivalent) and an H2 blocker.
For patients who have experienced a hypersensitivity reaction to ixabepilone, additionally premedicate with a corticosteroid (e.g., dexamethasone 20 mg IV 30 minutes before administration, or orally, 60 minutes before administration). Consider extending the ixabepilone infusion time.
 
Reconstitution:
Ixabepilone is available in a kit that contains 1 vial of ixabepilone powder and 1 vial of diluent.
Remove the kit from the refrigerator and let stand at room temperature for 30 minutes. There may be a white precipitate seen in the diluent vial which should dissolve to form a clear solution once the vial reaches room temperature.
Withdraw all the diluent from its vial and slowly inject it into the vial with ixabepilone powder; do not use any diluent other than what is provided in the kit. Gently swirl and invert the vial until the powder is completely dissolved. The final concentration of the reconstituted solution is 2 mg/mL.
Storage after reconstitution: Dilute as soon as possible; reconstituted solution is stable in the vial (not the syringe) for up to 1 hour at room temperature and room light.
 
Dilution:
Compatible infusion fluids include Lactated Ringer's Injection, Plasma-Lyte A Injection pH 7.4, and pH-adjusted 0.9% Sodium Chloride Injection. If using a 250 mL or 500 mL bag of 0.9% Sodium Chloride Injection, add 2 mEq of Sodium Bicarbonate Injection (2 mL of an 8.4% w/v solution or 4 mL of a 4.2% w/v solution) prior to adding ixabepilone to achieve a pH between 6.0 and 9.0.
Use a DEHP-free bag to dilute the appropriate dose of reconstituted ixabepilone with either 250 mL or 500 mL of compatible fluid to a final concentration of 0.2 mg/mL to 0.6 mg/mL. Thoroughly mix the bag by manual rotation.
Storage after dilution: Diluted ixabepilone is stable at room temperature and room light for a maximum of 6 hours including infusion time.
 
Intravenous Infusion:
Infusion containers and administration sets must be DEHP-free.
Administer through an in-line filter of 0.2 to 1.2 micron pore size.
An ixabepilone dose of 40 mg/m2 should be infused over 3 hours.
An ixabepilone dose of 60 mg/m2 should be infused over 4 hours.

Severe

neutropenia / Delayed / 54.0-68.0
leukopenia / Delayed / 49.0-57.0
palmar-plantar erythrodysesthesia (hand and foot syndrome) / Delayed / 2.0-27.0
peripheral neuropathy / Delayed / 1.0-23.0
fatigue / Early / 12.0-16.0
asthenia / Delayed / 6.0-16.0
anemia / Delayed / 8.0-10.0
thrombocytopenia / Delayed / 7.0-8.0
myalgia / Early / 8.0-8.0
arthralgia / Delayed / 8.0-8.0
diarrhea / Early / 1.0-6.0
stomatitis / Delayed / 4.0-6.0
vomiting / Early / 1.0-4.0
anorexia / Delayed / 2.0-3.0
nausea / Early / 2.0-3.0
musculoskeletal pain / Early / 2.0-3.0
constipation / Delayed / 0-2.0
abdominal pain / Early / 2.0-2.0
rash / Early / 1.0-2.0
dehydration / Delayed / 1.0-2.0
headache / Early / 0-1.0
dizziness / Early / 0-1.0
gastroesophageal reflux / Delayed / 0-1.0
pruritus / Rapid / 0-1.0
edema / Delayed / 0-1.0
dyspnea / Early / 1.0-1.0
chest pain (unspecified) / Early / 1.0-1.0
insomnia / Early / 0-1.0
fever / Early / 1.0-1.0
anaphylactoid reactions / Rapid / 0-1.0
coagulopathy / Delayed / Incidence not known
ileus / Delayed / Incidence not known
enterocolitis / Delayed / Incidence not known
erythema multiforme / Delayed / Incidence not known
pulmonary edema / Early / Incidence not known
cardiomyopathy / Delayed / Incidence not known
myocardial infarction / Delayed / Incidence not known
atrial flutter / Early / Incidence not known
hepatic failure / Delayed / Incidence not known
thromboembolism / Delayed / Incidence not known
thrombosis / Delayed / Incidence not known
intracranial bleeding / Delayed / Incidence not known
stroke / Early / Incidence not known
GI bleeding / Delayed / Incidence not known
vasculitis / Delayed / Incidence not known
bronchospasm / Rapid / Incidence not known
renal failure / Delayed / Incidence not known

Moderate

hot flashes / Early / 5.0-6.0
neurotoxicity / Early / Incidence not known
lymphopenia / Delayed / Incidence not known
gastritis / Delayed / Incidence not known
dysphagia / Delayed / Incidence not known
colitis / Delayed / Incidence not known
esophagitis / Delayed / Incidence not known
dysphonia / Delayed / Incidence not known
pneumonitis / Delayed / Incidence not known
hypoxia / Early / Incidence not known
trismus / Delayed / Incidence not known
angina / Early / Incidence not known
hypotension / Rapid / Incidence not known
elevated hepatic enzymes / Delayed / Incidence not known
jaundice / Delayed / Incidence not known
radiation recall reaction / Delayed / Incidence not known
metabolic acidosis / Delayed / Incidence not known
hypokalemia / Delayed / Incidence not known
hyponatremia / Delayed / Incidence not known
hypovolemia / Early / Incidence not known
bleeding / Early / Incidence not known
nephrolithiasis / Delayed / Incidence not known

Mild

dysgeusia / Early / 6.0-12.0
weight loss / Delayed / 6.0-11.0
skin hyperpigmentation / Delayed / 2.0-11.0
infection / Delayed / 4.0-6.0
cough / Delayed / 2.0-6.0
lacrimation / Early / 4.0-5.0
syncope / Early / Incidence not known
laryngitis / Delayed / Incidence not known
weakness / Early / Incidence not known
chills / Rapid / Incidence not known
lethargy / Early / Incidence not known
flushing / Rapid / Incidence not known

Hepatic disease

Ixabepilone should be used with caution in patients with hepatic disease due to increased ixabepilone exposure resulting in increased neutropenia, febrile neutropenia, and serious adverse reactions; a dose reduction may be necessary based on the degree of hepatic impairment. Avoid use in patients with AST or ALT greater than 10 times the upper limit of normal (ULN) or bilirubin greater than 3 times ULN; combination therapy with capecitabine is contraindicated in patients with AST or ALT greater than 2.5 times ULN or bilirubin greater than the ULN due to an increased risk of toxicity and neutropenia-related death. Consider the alcohol content of ixabepilone when treating patients with hepatic impairment. Monitor liver function tests at baseline and periodically thereafter.

Ixempra

Rx

An epothilone microtubule inhibitor
Used for the treatment of metastatic or locally advanced breast cancer as monotherapy or in combination with capecitabine
Use is contraindicated in patients with neutrophil count less than 1,500 cells/mm3 or platelet count less than 100,000 cells/mm3; use in combination with capecitabine is contraindicated in patients with AST/ALT greater than 2.5 times ULN or bilirubin greater than 1 times ULN

For the treatment of breast cancer. For the treatment of metastatic or locally advanced breast cancer that is resistant to an anthracycline and a taxane, or that is taxane resistant and for patients whom further anthracycline therapy is contraindicated, in combination with capecitabine.
NOTE: Anthracycline resistance is defined as progression while on therapy or within 6 months in the adjuvant setting or 3 months in the metastatic setting. Taxane resistance is defined as progression while on therapy or within 12 months in the adjuvant setting or 4 months in the metastatic setting.
Intravenous dosage Adults

40 mg/m2 (maximum BSA, 2.2 m2) IV over 3 hours on day 1, in combination with capecitabine (1,000 mg/m2 PO twice daily on days 1 to 14, followed by 1 week of rest), every 3 weeks. One hour prior to ixabepilone administration, premedicate with an H1 antagonist (e.g., diphenhydramine 50 mg PO or equivalent) and an H2 antagonist; add dexamethasone 20 mg in patients who have previously had a reaction to ixabepilone. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. In a multicenter, randomized, open-label clinical trial of patients with anthracycline- and taxane-resistant locally advanced or metastatic breast cancer (n = 752), treatment with ixabepilone plus capecitabine significantly improved the median progression-free survival (5.7 months vs. 4.1 months) and objective response rate (34.7% vs. 14.3%) compared with capecitabine alone; the median duration of response was 6.4 months versus 5.6 months, respectively. There was no significant difference in overall survival.[33563]

For the treatment of metastatic or locally advanced breast cancer that is resistant or refractory to anthracyclines, taxanes, and capecitabine, as monotherapy. Intravenous dosage Adults

40 mg/m2 (maximum BSA, 2.2 m2) IV over 3 hours on day 1, every 3 weeks. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treatment with ixabepilone resulted in an objective response rate of 12.4% by independent review and 18.3% by investigator assessment, for a median duration of 6 months in a multicenter, single-arm study in women with progressive or recurrent locally advanced or metastatic breast cancer (n = 126); all responses were partial. The median time to response was 6.1 weeks.

Hepatic Impairment

Ixabepilone monotherapy:
NOTE: Recommendations exclude patients with elevated total bilirubin levels due to Gilbert's disease.
AST and ALT 2.5 times the upper limit of normal (ULN) or less and bilirubin at the ULN or less: No dose adjustment necessary.
AST and ALT 10 times ULN or less and bilirubin 1.5 times ULN or less: Reduce the dose of ixabepilone to 32 mg/m2. Base dose adjustments for subsequent cycles on patient tolerance.
AST and ALT 10 times ULN or less and bilirubin 1.6 to 3 times ULN: Reduce the dose of ixabepilone to 20 mg/m2 to 30 mg/m2. Base dose adjustments for subsequent cycles on patient tolerance; if a dose of 20 mg/m2 is tolerated, consider increasing the dose to 30 mg/m2 in subsequent cycles.
AST and ALT greater than 10 time ULN or bilirubin greater than 3 times ULN: Avoid the use of ixabepilone.
 
Ixabepilone plus capecitabine:
AST or ALT greater than 2.5 times ULN or bilirubin greater than ULN: The use of ixabepilone is contraindicated.

Renal Impairment

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

Adagrasib: (Major) Avoid concurrent use of ixabepilone and adagrasib due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and adagrasib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Amiodarone: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amiodarone is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amiodarone is a moderate CYP3A inhibitor.
Amlodipine: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Amlodipine; Atorvastatin: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Amlodipine; Benazepril: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Amlodipine; Celecoxib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Amlodipine; Olmesartan: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Amlodipine; Valsartan: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Amobarbital: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Amoxicillin; Clarithromycin; Omeprazole: (Major) Avoid concurrent use of ixabepilone and clarithromycin due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and clarithromycin is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Apalutamide: (Major) Avoid concurrent use of ixabepilone and apalutamide due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and apalutamide is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Aprepitant, Fosaprepitant: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of a 3-day oral regimen of aprepitant is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and aprepitant, administered orally over 3 days, is a moderate CYP3A4 inhibitor. Single oral doses of aprepitant and intravenous doses of fosaprepitant have not been shown to alter concentrations of CYP3A4 substrate.
Asciminib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of asciminib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and asciminib is a weak CYP3A inhibitor.
Aspirin, ASA; Butalbital; Caffeine: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Atazanavir: (Major) Avoid concurrent use of ixabepilone and atazanavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and atazanavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Atazanavir; Cobicistat: (Major) Avoid concurrent use of ixabepilone and atazanavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and atazanavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%. (Major) Avoid concurrent use of ixabepilone and cobicistat due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Avacopan: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of avacopan is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and avacopan is a weak CYP3A inhibitor.
Bacillus Calmette-Guerin Vaccine, BCG: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system.
Barbiturates: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Belumosudil: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of belumosudil is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and belumosudil is a weak CYP3A inhibitor.
Berotralstat: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of berotralstat is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and berotralstat is a moderate CYP3A inhibitor.
Bicalutamide: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of bicalutamide is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and bicalutamide is a weak CYP3A inhibitor.
Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: (Contraindicated) Medications with significant alcohol content should not be administered during therapy with metronidazole and should be avoided for 3 days after therapy is discontinued. The supplied diluent that must be used for reconstitution of ixabepilone has a high concentration of dehydrated alcohol (39.8% w/v). Administration of ixabepilone to patients receiving or who have recently received metronidazole may result in disulfiram-like reactions.
Bismuth Subsalicylate; Metronidazole; Tetracycline: (Contraindicated) Medications with significant alcohol content should not be administered during therapy with metronidazole and should be avoided for 3 days after therapy is discontinued. The supplied diluent that must be used for reconstitution of ixabepilone has a high concentration of dehydrated alcohol (39.8% w/v). Administration of ixabepilone to patients receiving or who have recently received metronidazole may result in disulfiram-like reactions.
Butabarbital: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Butalbital; Acetaminophen: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Butalbital; Acetaminophen; Caffeine: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Butalbital; Acetaminophen; Caffeine; Codeine: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Butalbital; Aspirin; Caffeine; Codeine: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Carbamazepine: (Major) Avoid concurrent use of ixabepilone and carbamazepine due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and carbamazepine is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Ceritinib: (Major) Avoid concurrent use of ixabepilone and ceritinib due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and ceritinib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Chloramphenicol: (Major) Avoid concurrent use of ixabepilone and chloramphenicol due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and chloramphenicol is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Cholera Vaccine: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the live cholera vaccine. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to cholera bacteria after receiving the vaccine.
Cimetidine: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of cimetidine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and cimetidine is a weak CYP3A inhibitor.
Ciprofloxacin: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of ciprofloxacin is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and ciprofloxacin is a moderate CYP3A inhibitor.
Clarithromycin: (Major) Avoid concurrent use of ixabepilone and clarithromycin due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and clarithromycin is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Cobicistat: (Major) Avoid concurrent use of ixabepilone and cobicistat due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Conivaptan: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of conivaptan is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and conivaptan is a moderate CYP3A inhibitor.
Crizotinib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of crizotinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and crizotinib is a moderate CYP3A inhibitor.
Cyclosporine: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of cyclosporine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and cyclosporine is a moderate CYP3A inhibitor.
Danazol: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of danazol is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and danazol is a moderate CYP3A inhibitor.
Darunavir: (Major) Avoid concurrent use of ixabepilone and darunavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and darunavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Darunavir; Cobicistat: (Major) Avoid concurrent use of ixabepilone and cobicistat due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%. (Major) Avoid concurrent use of ixabepilone and darunavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and darunavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Major) Avoid concurrent use of ixabepilone and cobicistat due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%. (Major) Avoid concurrent use of ixabepilone and darunavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and darunavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Delavirdine: (Major) Avoid concurrent use of ixabepilone and delavirdine due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and delavirdine is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Dichlorphenamide: (Moderate) Use dichlorphenamide and ixabepilone together with caution as both drugs can cause metabolic acidosis. Concurrent use may increase the severity of metabolic acidosis. Measure sodium bicarbonate concentrations at baseline and periodically during dichlorphenamide treatment. If metabolic acidosis occurs or persists, consider reducing the dose or discontinuing dichlorphenamide therapy.
Diltiazem: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of diltiazem is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and diltiazem is a moderate CYP3A inhibitor.
Disulfiram: (Contraindicated) The supplied diluent that must be used for reconstitution of ixabepilone has a high concentration of dehydrated alcohol (39.8% w/v). Administration of ixabepilone to patients receiving or who have recently received disulfiram may result in disulfiram-like reactions.
Dronedarone: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of dronedarone is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and dronedarone is a moderate CYP3A inhibitor.
Duvelisib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of duvelisib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and duvelisib is a moderate CYP3A inhibitor.
Elbasvir; Grazoprevir: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of grazoprevir is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and grazoprevir is a weak CYP3A inhibitor.
Elexacaftor; tezacaftor; ivacaftor: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of ivacaftor is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and ivacaftor a weak CYP3A inhibitor.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Major) Avoid concurrent use of ixabepilone and cobicistat due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Major) Avoid concurrent use of ixabepilone and cobicistat due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Enzalutamide: (Major) Avoid concurrent use of ixabepilone and enzalutamide due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and enzalutamide is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Erythromycin: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of erythromycin is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and erythromycin is a moderate CYP3A inhibitor.
Everolimus: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of everolimus is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and everolimus is a weak CYP3A inhibitor.
Fedratinib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of fedratinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and fedratinib is a moderate CYP3A inhibitor.
Fluconazole: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of fluconazole is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and fluconazole is a moderate CYP3A inhibitor.
Fluvoxamine: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of fluvoxamine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and fluvoxamine is a moderate CYP3A inhibitor.
Fosamprenavir: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of fosamprenavir is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and fosamprenavir is a moderate CYP3A inhibitor.
Fosphenytoin: (Major) Avoid concurrent use of ixabepilone and fosphenytoin due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and fosphenytoin is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Fostamatinib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of fostamatinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and fostamatinib is a weak CYP3A inhibitor.
Grapefruit juice: (Major) Advise patients to avoid grapefruit and grapefruit juice during ixabepilone treatment due to the risk of increased ixabepilone exposure and adverse reactions. Ixabepilone is a CYP3A substrate and grapefruit juice is a strong CYP3A inhibitor.
Idelalisib: (Major) Avoid concurrent use of ixabepilone and idelalisib due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and idelalisib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Imatinib: (Major) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of imatinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and imatinib is a moderate CYP3A inhibitor.
Indinavir: (Major) Avoid concurrent use of ixabepilone and indinavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and indinavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Intranasal Influenza Vaccine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system.
Isavuconazonium: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of isavuconazonium is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and isavuconazonium is a moderate CYP3A inhibitor.
Isoniazid, INH: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of isoniazid is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and isoniazid is a weak CYP3A inhibitor.
Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Major) Avoid concurrent use of ixabepilone and rifampin due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and rifampin is a strong CYP3A inducer. Coadministration with rifampin decreased ixabepilone exposure by 43%. (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of isoniazid is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and isoniazid is a weak CYP3A inhibitor.
Isoniazid, INH; Rifampin: (Major) Avoid concurrent use of ixabepilone and rifampin due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and rifampin is a strong CYP3A inducer. Coadministration with rifampin decreased ixabepilone exposure by 43%. (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of isoniazid is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and isoniazid is a weak CYP3A inhibitor.
Istradefylline: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of istradefylline is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and istradefylline is a weak CYP3A inhibitor.
Itraconazole: (Major) Avoid concurrent use of ixabepilone and itraconazole due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and itraconazole is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Ivacaftor: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of ivacaftor is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and ivacaftor a weak CYP3A inhibitor.
Ketoconazole: (Major) Avoid coadministration of ixabepilone with strong CYP3A4 inhibitors like ketoconazole. If coadministration cannot be avoided, reduce the dose of ixabepilone to 20 mg per meters-squared. Monitor for neuropathy, GI symptoms, and myelosuppression. If the strong inhibitor is discontinued, increase the ixabepilone dose (at 1 week after discontinuing the inhibitor) to that was used before starting the strong inhibitor. Ixabepilone is a CYP3A substrate and ketoconazole is a strong CYP3A inhibitor. Coadministration with ketoconazole increased ixabepilone exposure by 79%.
Lansoprazole; Amoxicillin; Clarithromycin: (Major) Avoid concurrent use of ixabepilone and clarithromycin due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and clarithromycin is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Lapatinib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of lapatinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and lapatinib is a weak CYP3A inhibitor.
Larotrectinib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of larotrectinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and larotrectinib a weak CYP3A inhibitor.
Lefamulin: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of oral lefamulin is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and oral lefamulin is a weak CYP3A inhibitor; an interaction is not expected with intravenous lefamulin.
Lenacapavir: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of lenacapavir is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and lenacapavir is a moderate CYP3A inhibitor.
Letermovir: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of letermovir WITHOUT concomitant cyclosporine is necessary. Avoid concurrent use of ixabepilone and letermovir WITH concomitant cyclosporine; if unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and letermovir is a moderate CYP3A inhibitor; however, the combined effect of letermovir and cyclosporine on CYP3A4 substrates may be similar to a strong CYP3A4 inhibitor.
Levamlodipine: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Levoketoconazole: (Major) Avoid coadministration of ixabepilone with strong CYP3A4 inhibitors like ketoconazole. If coadministration cannot be avoided, reduce the dose of ixabepilone to 20 mg per meters-squared. Monitor for neuropathy, GI symptoms, and myelosuppression. If the strong inhibitor is discontinued, increase the ixabepilone dose (at 1 week after discontinuing the inhibitor) to that was used before starting the strong inhibitor. Ixabepilone is a CYP3A substrate and ketoconazole is a strong CYP3A inhibitor. Coadministration with ketoconazole increased ixabepilone exposure by 79%.
Live Vaccines: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system.
Lonafarnib: (Major) Avoid concurrent use of ixabepilone and lonafarnib due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and lonafarnib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Lopinavir; Ritonavir: (Major) Avoid concurrent use of ixabepilone and ritonavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and ritonavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Lumacaftor; Ivacaftor: (Major) Avoid concurrent use of ixabepilone and lumacaftor; ivacaftor due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and lumacaftor; ivacaftor is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Lumacaftor; Ivacaftor: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of ivacaftor is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and ivacaftor a weak CYP3A inhibitor.
Maribavir: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of maribavir is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and maribavir is a weak CYP3A inhibitor.
Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system.
Measles/Mumps/Rubella Vaccines, MMR: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system.
Methohexital: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Metronidazole: (Contraindicated) Medications with significant alcohol content should not be administered during therapy with metronidazole and should be avoided for 3 days after therapy is discontinued. The supplied diluent that must be used for reconstitution of ixabepilone has a high concentration of dehydrated alcohol (39.8% w/v). Administration of ixabepilone to patients receiving or who have recently received metronidazole may result in disulfiram-like reactions.
Mifepristone: (Major) Avoid concurrent use of ixabepilone and mifepristone due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and mifepristone is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Mitotane: (Major) Avoid concurrent use of ixabepilone and mitotane due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and mitotane is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Nefazodone: (Major) Avoid concurrent use of ixabepilone and nefazodone due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and nefazodone is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Nelfinavir: (Major) Avoid concurrent use of ixabepilone and nelfinavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and nelfinavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Netupitant, Fosnetupitant; Palonosetron: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of netupitant is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and netupitant is a moderate CYP3A inhibitor.
Nicardipine: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of nicardipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and nicardipine is a weak CYP3A inhibitor.
Nilotinib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of nilotinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and nilotinib is a moderate CYP3A inhibitor.
Nirmatrelvir; Ritonavir: (Major) Avoid concurrent use of ixabepilone and ritonavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and ritonavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Osilodrostat: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of osilodrostat is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and osilodrostat is a weak CYP3A inhibitor.
Pacritinib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of pacritinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and pacritinib is a weak CYP3A inhibitor.
Palbociclib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of palbociclib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and palbociclib is a weak CYP3A inhibitor.
Pazopanib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of pazopanib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and pazopanib is a weak CYP3A inhibitor.
Pentobarbital: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Perindopril; Amlodipine: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Phenobarbital: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Phenytoin: (Major) Avoid concurrent use of ixabepilone and phenytoin due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and phenytoin is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Pirtobrutinib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of pirtobrutinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and pirtobrutinib is a weak CYP3A inhibitor.
Posaconazole: (Major) Avoid concurrent use of ixabepilone and posaconazole due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and posaconazole is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Primidone: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Ranolazine: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of ranolazine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and ranolazine is a weak CYP3A inhibitor.
Ribociclib: (Major) Avoid concurrent use of ixabepilone and ribociclib due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and ribociclib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Ribociclib; Letrozole: (Major) Avoid concurrent use of ixabepilone and ribociclib due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and ribociclib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Rifampin: (Major) Avoid concurrent use of ixabepilone and rifampin due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and rifampin is a strong CYP3A inducer. Coadministration with rifampin decreased ixabepilone exposure by 43%.
Rifapentine: (Major) Avoid concurrent use of ixabepilone and rifapentine due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and rifapentine is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Ritlecitinib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of ritlecitinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and ritlecitinib is a moderate CYP3A inhibitor.
Ritonavir: (Major) Avoid concurrent use of ixabepilone and ritonavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and ritonavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Rotavirus Vaccine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system.
Rucaparib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of rucaparib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and rucaparib is a weak CYP3A inhibitor.
Saquinavir: (Major) Avoid concurrent use of ixabepilone and saquinavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and saquinavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
SARS-CoV-2 (COVID-19) vaccines: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the SARS-CoV-2 virus vaccine. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine.
Secobarbital: (Major) Avoid concurrent use of ixabepilone and barbiturates due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and barbiturates are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Selpercatinib: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of selpercatinib is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and selpercatinib is a weak CYP3A inhibitor.
Smallpox and Monkeypox Vaccine, Live, Nonreplicating: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system.
Smallpox Vaccine, Vaccinia Vaccine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system.
Spironolactone: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of spironolactone is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and spironolactone is a weak CYP3A inhibitor.
Spironolactone; Hydrochlorothiazide, HCTZ: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of spironolactone is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and spironolactone is a weak CYP3A inhibitor.
St. John's Wort, Hypericum perforatum: (Major) Avoid concurrent use of ixabepilone and St. John's Wort due to decreased plasma concentrations of ixabepilone, which may reduce its efficacy. If concomitant use is unavoidable, gradually increase the dose of ixabepilone as tolerated from 40 mg/m2 to 60 mg/m2 and infuse over 4 hours; monitor carefully for ixabepilone-related toxicities. Ixabepilone is a CYP3A substrate and St. John's Wort is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased ixabepilone exposure by 43%.
Streptogramins: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of dalfopristin; quinupristin is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and dalfopristin; quinupristin is a weak CYP3A inhibitor.
Telmisartan; Amlodipine: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of amlodipine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor.
Tezacaftor; Ivacaftor: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of ivacaftor is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and ivacaftor a weak CYP3A inhibitor.
Ticagrelor: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of ticagrelor is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and ticagrelor is a weak CYP3A inhibitor.
Tipranavir: (Major) Avoid concurrent use of ixabepilone and tipranavir due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and tipranavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Trandolapril; Verapamil: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of verapamil is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and verapamil is a moderate CYP3A inhibitor.
Trofinetide: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of trofinetide is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and trofinetide is a weak CYP3A inhibitor.
Tuberculin Purified Protein Derivative, PPD: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Tucatinib: (Major) Avoid concurrent use of ixabepilone and tucatinib due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and tucatinib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Typhoid Vaccine: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regard

ing vaccination of patients who are receiving drugs that adversely affect the immune system.
Varicella-Zoster Virus Vaccine, Live: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system.
Verapamil: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of verapamil is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and verapamil is a moderate CYP3A inhibitor.
Viloxazine: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of viloxazine is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and viloxazine is a weak CYP3A inhibitor.
Vonoprazan; Amoxicillin: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of vonoprazan is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and vonoprazan is a weak CYP3A inhibitor.
Vonoprazan; Amoxicillin; Clarithromycin: (Major) Avoid concurrent use of ixabepilone and clarithromycin due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and clarithromycin is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%. (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of vonoprazan is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and vonoprazan is a weak CYP3A inhibitor.
Voriconazole: (Major) Avoid concurrent use of ixabepilone and voriconazole due to increased ixabepilone exposure, which may increase the risk of adverse reactions. If concomitant use is unavoidable, reduce the dose of ixabepilone to 20 mg/m2. Ixabepilone is a CYP3A substrate and voriconazole is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased ixabepilone exposure by 79%.
Voxelotor: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use voxelotor is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and voxelotor is a moderate CYP3A inhibitor.
Yellow Fever Vaccine, Live: (Contraindicated) Live virus vaccines should generally not be administered to an immunosuppressed patient. Live virus vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system.
Zafirlukast: (Major) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of zafirlukast is necessary. Concomitant use may increase ixabepilone exposure and the risk of adverse reactions. Ixabepilone is a CYP3A substrate and zafirlukast is a weak CYP3A inhibitor.

Ixabepilone/Ixempra Intravenous Inj Pwd F/Sol: 15mg, 45mg

Adults

40 mg/m2 (max BSA 2.2 m2).

Geriatric

40 mg/m2 (max BSA 2.2 m2).

Adolescents

Safety and efficacy have not been established.

Children

Safety and efficacy have not been established.

Ixabepilone is a microtubule inhibitor that is a semisynthetic analog of epothilone B. It binds directly to beta-tubulin subunits on the alpha-beta-II and alpha-beta-III microtubules, leading to dynamic instability and blocking cells in the mitotic phase of the cell division cycle, leading to cell death. Ixabepilone possesses low in vitro susceptibility to multiple tumor resistance mechanisms including efflux transporters (e.g., MRP-1 and P-glycoprotein).

Ixabepilone is administered intravenously. It is 67% to 77% protein bound; the blood to plasma concentration ratios range from 0.65 to 0.85. The mean volume of distribution of ixabepilone at steady-state was greater than 1,000 liters, and it has a terminal elimination half-life of approximately 52 hours. Ixabepilone is primarily eliminated as metabolites in the feces (65%) and the urine (21%); unchanged ixabepilone accounts for approximately 1.6% and 5.6% of a dose in the feces and urine, respectively.
 
Affected cytochrome P450 isoenzymes and drug transporters: CYP3A4
Ixabepilone is metabolized by CYP3A4. In vitro, it is a substrate and inhibitor of P-gp.

Intravenous Route

After administration of a single 40 mg/m2 dose of ixabepilone, the mean peak plasma concentration (Cmax) was 252 ng/mL (CV, 56%), and the mean AUC was 2,143 ng x hour/mL (CV, 48%). Ixabepilone exhibited linear pharmacokinetics at doses of 15 mg/m2 to 57 mg/m2 (0.375 to 1.425 times the approved recommended dose).

Pregnancy

Pregnancy should be avoided by females of reproductive potential during ixabepilone treatment and for at least 7 months after the last dose. Although there are no adequately controlled studies in pregnant women, ixabepilone can cause fetal harm or death when administered during pregnancy based on its mechanism of action and animal studies. Ixabepilone also contains alcohol which can interfere with neurobehavioral development. Women who are pregnant or who become pregnant while receiving ixabepilone should be apprised of the potential hazard to the fetus. In animal reproduction studies, IV administration of ixabepilone to pregnant rats and rabbits during organogenesis caused maternal toxicity (death), embryo-fetal lethality (e.g., post-implantation loss and decreased number of live fetuses), and fetal abnormalities (e.g., reduced ossification of caudal vertebrae, sternebrae, and metacarpals) at maternal exposures below the human clinical exposure based on AUC.

Counsel patients about the reproductive risk and contraception requirements during ixabepilone treatment. Ixabepilone can be teratogenic if taken by the mother during pregnancy. Females of reproductive potential should avoid pregnancy and use effective contraception during and for at least 7 months after treatment with ixabepilone. Due to the risk of male-mediated teratogenicity, males with female partners of reproductive potential should use effective contraception during and for at least 4 months after treatment with ixabepilone. Females of reproductive potential should undergo pregnancy testing prior to initiation of ixabepilone. Women who become pregnant while receiving ixabepilone should be apprised of the potential hazard to the fetus. Although there are no data regarding the effect of ixabepilone on human fertility, male and female infertility has been observed in animal studies.