Potentiated & prolonged myelosuppressive toxicity w/ other anticancer medicinal products. Closely monitor patients co-administered w/ vaccines or immunosuppressants. Increased mean Cmax
& AUC w/ strong (eg, itraconazole, telithromycin, clarithromycin, PIs boosted w/ ritonavir or cobicistat, boceprevir, telaprevir) or moderate (eg, erythromycin, diltiazem, fluconazole, verapamil) CYP3A inhibitors; grapefruit juice. Decreased mean Cmax
& AUC w/ strong CYP3A inducers eg, phenytoin, rifampicin, rifapentine, carbamazepine, nevirapine, phenobarb, St. John's wort. Not recommended w/ moderate to strong CYP3A inducers eg, efavirenz, rifabutin. Clinical monitoring w/ CYP3A substrates or substrates w/ narrow therapeutic margin (eg, simvastatin, cisapride, cyclosporine, ergot alkaloids, fentanyl, pimozide, sirolimus, tacrolimus, quetiapine) & P-gp substrates (eg, pravastatin, dabigatran, digoxin, colchicine). Reduced exposure to CYP1A2, 2B6 & 3A4, CYP2C9, CYP2C19 & P-gp substrates. Increased exposure to BRCP, OATP1B1, OCT1, OCT2, OAT3, MATE1 & MATE2K substrates.