Drug Interactions of Lomitapide

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Lomitapide may interact majorly with drugs such as CYP3A4 Inhibitors (Azole antifungals – Ketoconazole, Macrolide antibiotics – Clarithromycin, etc), Simvastatin or Lovastatin and Warfarin and Grapefruit Juice and Alcohol.

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Drug Interactions of Antihyperlipidemics Part 6 (Drug Interactions of Lomitapide):

Drug Interactions of Antihyperlipidemics Part 6 ( Drug Interactions of Lomitapide ) D r . P.Naina Mohamed P h D P harmacologist

Introduction:

Introduction An adverse drug interaction is defined as an interaction between one or more coadministered medications which leads to decreased therapeutic efficacy or elevated risk of toxicity of any of the coadministered medications. Drug interactions can be caused by P rescription and Over-the-counter (OTC) medications, herbal products or vitamins, foods, diseases, and genetics (family history). It is estimated that people over 65 take an average of seven drugs at any one time to treat a variety of illnesses including higher cholesterol, diabetes, hypertension, etc. With this amount of medicine use, the probability that a person will take two prescribed drugs that may interact with one another is very high.

Antihyperlipidemics:

Antihyperlipidemics Statins (HMG CoA Reductase Inhibitors) Fibrates Bile acid S equestrants Niacin Ezetimibe Lomitapide Orlistat

Lomitapide:

Lomitapide Lomitapide is an Orphan drug approved to reduce LDL cholesterol, total cholesterol, apolipoprotein B, and non-high-density lipoprotein (non-HDL) cholesterol in patients with Homozygous familial hypercholesterolemia ( HoFH ).

Lomitapide & CYP3A4 Inhibitors :

Lomitapide & CYP3A4 Inhibitors The concomitant use of L omitapide and a CYP3A4 inhibitor is contraindicated . If treatment with a CYP3A4 inhibitor is unavoidable, discontinue lomitapide during the course of treatment.

Lomitapide & Simvastatin or Lovastatin :

Lomitapide & Simvastatin or Lovastatin Concomitant use of Lomitapide and Simvastatin or Lovastatin, warrants the monitoring of patients for the symptoms of myopathy. http :// link.springer.com/chapter/10.1007%2F978-3-319-20433-8_8

Lomitapide & Warfarin:

Lomitapide & Warfarin The INR of the patients receiving concurrent lomitapide and warfarin therapy, should be monitored regularly and adjust warfarin dose accordingly. http :// www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/UCM323841.pdf

Lomitapide + Grape Fruit Juice :

Lomitapide + Grape Fruit Juice Patients receiving lomitapide should avoid the ingestion of Grapefruit juice . http:// www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM428212.pdf

Lomitapide & Alcohol :

Lomitapide & Alcohol The patients taking lomitapide should be instructed about the elevated risk of liver injury associated to Alcohol. http:// circ.ahajournals.org/content/129/9/1022

Conclusion:

Conclusion The occurrence of significant morbidity and mortality can be reduced by minimizing the risk for drug interactions. The hyperlipidemic patients should bring a list of all the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist . The risk of adverse effects could be reduced and the quality of life for patients improved by healthcare professionals through the screening , education, and follow up on suspected drug interactions. If possible, the hyperlipidemic patients are recommended to fill all their prescriptions at one pharmacy.

References:

References Stockley’s Drug Interactions, 9e Karen Baxter Hurst's The Heart, 13e Valentin Fuster , Richard A. Walsh, Robert A. Harrington Basic & Clinical Pharmacology, 12e Bertram G. Katzung , Susan B. Masters, Anthony J. Trevor http :// www.micromedexsolutions.com

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