Drug interactions
Fosphenytoin + Nilotinib
Severity: Major
Fosphenytoin and Nilotinib: major interaction.
Last updated Sources: UK SmPC
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
Phenytoin, released from fosphenytoin, strongly induces CYP3A4 and may markedly lower nilotinib exposure, compromising leukemia control. Nilotinib may also modestly alter phenytoin levels via CYP2C9 inhibition.
What this interaction means in plain words
Fosphenytoin and Nilotinib 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.
Fosphenytoin belongs to Central Nervous System; Nilotinib belongs to Oncology.
Why it happens
Phenytoin induces CYP3A4 and P-glycoprotein, increasing nilotinib clearance, while nilotinib may inhibit CYP2C9 metabolism of phenytoin.
What to do
Avoid the combination and use a non-inducing anticonvulsant if feasible. If unavoidable, monitor phenytoin concentrations and molecular response.
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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References
- Nilotinib 150 mg Hard Capsules - SmPC sections 4.3/4.5 (class statement: medicinal products that induce CYP3A4; "The concomitant administration of other medicinal products that induce CYP3A4 (e.g. phenytoin, carbamazepine, phenobarbital and St. John's Wort) is likewise lik") — electronic medicines compendium (UK SmPC)
Other interactions of Nilotinib
- Amiodarone + Nilotinib Contraindicated
- Arsenic trioxide + Nilotinib Contraindicated
- Disopyramide + Nilotinib Contraindicated
- Dofetilide + Nilotinib Contraindicated
- Dronedarone + Nilotinib Contraindicated
- Droperidol + Nilotinib Contraindicated
Other interactions of Fosphenytoin
- Dronedarone + Fosphenytoin Contraindicated
- Fosphenytoin + Ledipasvir-sofosbuvir Contraindicated
- Fosphenytoin + Lorlatinib Contraindicated
- Fosphenytoin + Lurasidone Contraindicated
- Fosphenytoin + Ranolazine Contraindicated
- Fosphenytoin + Sofosbuvir-velpatasvir-voxilaprevir Contraindicated
Frequently asked questions
Can I take Fosphenytoin with Nilotinib?
MediHelp rates the interaction as major. Fosphenytoin and Nilotinib 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. Phenytoin, released from fosphenytoin, strongly induces CYP3A4 and may markedly lower nilotinib exposure, compromising leukemia control. Nilotinib may also modestly alter phenytoin levels via CYP2C9 inhibition.
How serious is the interaction between Fosphenytoin and Nilotinib?
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 use a non-inducing anticonvulsant if feasible. If unavoidable, monitor phenytoin concentrations and molecular response.
What other medicines interact with Nilotinib?
MediHelp also lists interactions of Nilotinib with, for example, Amiodarone, Arsenic trioxide, Disopyramide. The full list is on the Nilotinib page.
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