Skip to main content

Table 3 Recommended dose adjustments in the setting of drug-drug interactions

From: Management of atrial fibrillation in patients taking targeted cancer therapies

TKI Interaction Dose Adjustments
Nilotinib * Should interrupt TKI therapy. If cannot interrupt TKI therapy, consider reducing TKI dose to:
300 mg QD (Resistant/intolerant Ph + CML)
200 mg QD (Newly diagnosed Chronic Phase Ph + CML, with careful monitoring, especially of QT interval)
If 3A4 inhibitor discontinued, allow washout period prior to uptitrating dose.
Pazopanib * Reduce TKI dose to 400 mg QD (careful monitoring). Further dose reductions may be necessary if toxicity occurs.
Ponatinib * Reduce TKI dose to 30 mg QD
Ruxolitinib * Dose of TKI:
-Platelets ≥ 100,000/mm3: 10 mg BID
-Platelets 50,000/mm3 - 100,000/mm3: 5 mg QD
Polycythemia Vera: 5 mg BID
Patients on already stable TKI doses of:
-5 mg QD: AVOID or interrupt TKI therapy
-5 mg BID: Reduce TKI dose to 5 mg QD
- ≥ 10 mg BID: Reduce TKI dose by 50% (rounded to closest available tablet strength)
(Canadian Labeling)
Reduce TKI dose by 50% (rounded to closest available tablet strength).
Monitor hematologic parameters more frequently (i.e. twice weekly).
-If platelets < 100,000/mm3: AVOID
-Titrate dose based on safety & efficacy
Sunitinib * Consider TKI dose reduction to minimum of:
GIST, RCC: 37.5 mg/day
PNET: 25 mg/day