hat dasatinib has the potential to prolong
cardiac ventricular repolarization (QT interval). Nine patients had QTc
prolongation as an adverse event. Three patients (<1%) experienced a QTcF
>500 msec. SPRYCEL should be administered with caution to patients who have
or may develop prolongation of QTc, including patients with hypokalemia,
hypomagnesemia, or congenital long QT syndrome and patients taking anti-
arrhythmic drugs, other medicinal products that lead to QT prolongation, or
cumulative high-dose anthracycline therapy. Hypokalemia or hypomagnesemia
should be corrected prior to SPRYCEL administration.
Drug Interactions:
Dasatinib is a CYP3A4 substrate. Drugs that may increase dasatinib
concentrations are: Strong CYP3A4 inhibitors (e.g., ketoconazole,
itraconazole, clarithromycin, atazanavir, indinavir, nefazodone,
nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole).
Concomitant use of dasatinib and drugs that inhibit CYP3A4 should be
avoided. If systemic administration of a potent CYP3A4 inhibitor cannot be
avoided, close monitoring for toxicity and a SPRYCEL dose reduction or
temporary discontinuation should be considered. Grapefruit juice may also
increase plasma concentrations of dasatinib and should be avoided. Drugs
that may decrease dasatinib concentrations are: Strong CYP3A4 inducers
(e.g., dexamethasone, phenytoin, carbamazepine, rifampin, rifabutin,
phenobarbital). Alternative agents with less enzyme induction potential
should be used or a dose increase of SPRYCEL should be considered. St
John's Wort may decrease dasatinib plasma concentrations unpredictably and
should be avoided.
Dasatinib is a time-dependent inhibitor of CYP3A4. Drugs that may have
their plasma concentration altered by dasatinib are: CYP3A4 substrates such
as simvastatin. Therefore, CYP3A4 substrates with a narrow therapeutic
index (e.g., alfentanil, astemizole, terfenadine, cisapride, cyclosporine,
fentanyl, pimozide, quinidine, sirolimus, tacrolimus, o
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