Drug interactions
Bosutinib + Imatinib
Severity: Major
Bosutinib and Imatinib: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Imatinib inhibits CYP3A4, the main enzyme clearing bosutinib, and can raise bosutinib exposure substantially. This increases the risk of bosutinib toxicity such as diarrhea, hepatotoxicity and myelosuppression. Both drugs are also BCR-ABL kinase inhibitors, so combining them offers little therapeutic rationale.
What this interaction means in plain words
Bosutinib and Imatinib can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Bosutinib belongs to Oncology; Imatinib belongs to Oncology.
Why it happens
Imatinib inhibits CYP3A4-mediated metabolism of bosutinib, reducing its clearance.
What to do
Avoid the combination and choose a single BCR-ABL inhibitor appropriate to the disease. If unavoidable, monitor liver enzymes and gastrointestinal and hematologic toxicity closely and reduce the bosutinib dose.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Imatinib
- Imatinib + Lomitapide Contraindicated
- Imatinib + Lonafarnib Contraindicated
- Amobarbital + Imatinib Major
- Apalutamide + Imatinib Major
- Avapritinib + Imatinib Major
- Benzhydrocodone / acetaminophen + Imatinib Major
Other interactions of Bosutinib
- Amiodarone + Bosutinib Major
- Apalutamide + Bosutinib Major
- Aprepitant + Bosutinib Major
- Bosentan + Bosutinib Major
- Bosutinib + Carbamazepine Major
- Bosutinib + Chlorpromazine Major
Frequently asked questions
Can I take Bosutinib with Imatinib?
MediHelp rates the interaction as major. Bosutinib and Imatinib can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Imatinib inhibits CYP3A4, the main enzyme clearing bosutinib, and can raise bosutinib exposure substantially. This increases the risk of bosutinib toxicity such as diarrhea, hepatotoxicity and myelosuppression. Both drugs are also BCR-ABL kinase inhibitors, so combining them offers little therapeutic rationale.
How serious is the interaction between Bosutinib and Imatinib?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination and choose a single BCR-ABL inhibitor appropriate to the disease. If unavoidable, monitor liver enzymes and gastrointestinal and hematologic toxicity closely and reduce the bosutinib dose.
What other medicines interact with Imatinib?
MediHelp also lists interactions of Imatinib with, for example, Lomitapide, Lonafarnib, Amobarbital. The full list is on the Imatinib page.
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