Interactions : אינטראקציות

4.5   Interaction with other medicinal products and other forms of interaction

P-gp inhibitors
Concomitant use of avatrombopag with P-gp inhibitors resulted in alterations in exposure that were not clinically significant. No dose adjustment is recommended (see section 5.2).

CYP3A4/5 and CYP2C9 inhibitors

Concomitant use of avatrombopag with moderate or strong CYP3A4/5 and CYP2C9 dual inhibitors (e.g., fluconazole) increases avatrombopag exposure. Concomitant use of avatrombopag with moderate or strong CYP2C9 inhibitors is expected to increase avatrombopag exposure.

Chronic liver disease

The increase in avatrombopag exposure is not expected to have a clinically important effect on platelet counts due to the 5-day treatment duration, and no dose adjustment is recommended. However, these patients should be evaluated on the day of the procedure for an unexpectedly high increase in platelet count (see section 4.2 and 5.2).

Chronic immune thrombocytopenia

Reduce the starting dose of avatrombopag when used concomitantly with a moderate or strong dual inhibitor of CYP2C9 and CYP3A4/5 (see Table 4 and section 4.2). Reduction of the starting dose should also be considered for patients receiving a moderate or strong CYP2C9 inhibitor.
In patients starting moderate or strong dual inhibitors of CYP2C9 and CYP3A4/5, or moderate or strong inhibitors of CYP2C9, while receiving avatrombopag, monitor platelet counts and adjust the avatrombopag dose as necessary (see Table 2, Table 3 and section 4.2).

CYP3A4/5 and CYP2C9 inducers

Concomitant use of moderate or strong CYP3A4/5 and CYP2C9 dual inducers (e.g., rifampicin, enzalutamide) reduces avatrombopag exposure, and may result in a decreased effect on platelet counts.
Concomitant use of avatrombopag with moderate or strong CYP2C9 inducers is expected to reduce avatrombopag exposure.

Chronic liver disease

The decrease in avatrombopag exposure is not expected to have a clinically important effect on platelet counts due to the 5-day treatment duration. No dose adjustment is recommended (see section 5.2).


Chronic immune thrombocytopenia
Increase the recommended starting dose of Optzuro when used concomitantly with a moderate or strong dual inducer of CYP2C9 and CYP3A4/5 (see Table 4 and section 4.2). An increase in the starting dose should also be considered for patients receiving a moderate or strong CYP2C9 inducer.
In patients starting moderate or strong dual inducers of CYP2C9 and CYP3A4/5, or moderate or strong inducers of CYP2C9, while receiving avatrombopag, monitor platelet counts and adjust dose as necessary (see Table 2, Table 3 and section 4.2).

Medicinal products for treatment of ITP

Medicinal products used in the treatment of ITP in combination with avatrombopag in clinical trials included corticosteroids, danazol, dapsone, and intravenous immunoglobulin (IVIg). Platelet counts should be monitored when combining avatrombopag with other medicinal products for the treatment of ITP in order to avoid platelet counts outside of the recommended range.