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CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): The coadministration of ketoconazole, a strong CYP3A4 inhibitor, increased the exposure of bortezomib.
If concomitant administration of bortezomib with a strong CYP3A4 inhibitor is needed, patients should be monitored for signs of bortezomib toxicity. Reduction in bortezomib dose must also be considered.
CYP3A4 inducers [e.g., rifampicin, St. John's wort (Hypericum perforatum), carbamazepine, phenytoin, phenobarbital]: Since the exposure and efficacy of bortezomib may be decreased in an unpredictable manner, its coadministration with a strong CYP3A4 inducer is not recommended.
Oral antidiabetic agents: Due to the risk of hypoglycemia and/or hyperglycemia, patients concurrently administered with oral antidiabetic agents and bortezomib should be closely monitored for their blood glucose levels and adjustment of their antidiabetic medication dose.
Melphalan-prednisone: Melphalan-prednisone increased the bortezomib exposure. However, this interaction is considered to have no clinical relevance.
Drugs that are associated with peripheral neuropathy or decrease in blood pressure (e.g., amiodarone, anti-virals, isoniazid, nitrofurantoin, statins): Bortezomib should be used in caution with these drugs (See Precautions).
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