Drug interactions
Indinavir + Siponimod
Severity: Major
Indinavir and Siponimod: 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
Indinavir is a strong CYP3A4 inhibitor and may increase siponimod concentrations. The effect is larger in patients with reduced CYP2C9 activity. Higher exposure raises the risk of bradycardia and immunosuppression.
What this interaction means in plain words
Indinavir and Siponimod 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.
Why it happens
Strong CYP3A4 inhibition reduces siponimod metabolism.
What to do
Avoid in patients with CYP2C9*2/*3 or *3/*3 genotypes or those on CYP2C9 inhibitors. Otherwise monitor heart rate, lymphocyte counts and signs of infection.
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 Siponimod
- Cladribine + Siponimod Contraindicated
- Fingolimod + Siponimod Contraindicated
- Fluconazole + Siponimod Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Siponimod Contraindicated
- Ponesimod + Siponimod Contraindicated
- Siponimod + Thioridazine Contraindicated
Frequently asked questions
Can I take Indinavir with Siponimod?
MediHelp rates the interaction as major. Indinavir and Siponimod 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. Indinavir is a strong CYP3A4 inhibitor and may increase siponimod concentrations. The effect is larger in patients with reduced CYP2C9 activity. Higher exposure raises the risk of bradycardia and immunosuppression.
How serious is the interaction between Indinavir and Siponimod?
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 in patients with CYP2C9*2/*3 or *3/*3 genotypes or those on CYP2C9 inhibitors. Otherwise monitor heart rate, lymphocyte counts and signs of infection.
What other medicines interact with Siponimod?
MediHelp also lists interactions of Siponimod with, for example, Cladribine, Fingolimod, Fluconazole. The full list is on the Siponimod page.
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