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Drug interactions with the tyrosine kinase inhibitors imatinib, dasatinib, and nilotinib

Amina Haouala1, Nicolas Widmer1, Michel A. Duchosal2, Michael Montemurro3, Thierry Buclin1, and Laurent A. Decosterd1


Several cancer treatments are shifting from traditional, time-limited, nonspecific cytotoxic chemotherapy cycles to continuous oral treatment with specific protein-targeted therapies. In this line, imatinib mesylate, a selective tyrosine kinases inhibitor (TKI), has excellent efficacy in the treatment of chronic myeloid leukemia. It has opened the way to the development of additional TKIs against chronic myeloid leukemia, including nilotinib and dasatinib. TKIs are prescribed for prolonged periods, often in patients with comorbidities. Therefore, they are regularly co-administered along with treatments at risk of drug-drug interactions. This aspect has been partially addressed so far, calling for a comprehensive review of the published data. We review here the available evidence and pharmacologic mechanisms of interactions between imatinib, dasatinib, and nilotinib and widely prescribed co-medications, including known inhibitors or inducers of cytochromes P450 or drug transporters. Information is mostly available for imatinib mesylate, well introduced in clinical practice. Several pharmacokinetic aspects yet remain insufficiently investigated for these drugs. Regular updates will be mandatory and so is the prospective reporting of unexpected clinical observations.

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I didn't know Liquorice was off the menu! I knew about Grapefruit but that's new. Liquorice Allsorts will have to wait.

Shame about liquorice! Also- and not included in this list- seville oranges are contraindicated with TKIs so marmalade is also off the menu!

Does the cooking of marmalade change whatever it is in the oranges that interacts with TKIs? I've been making - and eating - marmalade for all of the 5 years that I have been on imatinib, because I knew no better. I don't think I have suffered much from it!

I never heard of Liquorice on the list before.
Serveille or blood oranges are not allowed for Niltinib as is pomegranate and star fruit. Grapefruit is not allowed with any TKI's an lots of other drugs.,

Hi Olivia,
Yes... I think you may be right about the cooking process changing the ingredient of the seville orange in marmalade. I was talking with someone about this issue the other day and the same point was made. I think you just have to take a view on these things- fresh fruit/juice products from the list -grapefruit and seville orange in particular- should of course be avoided with all TKis.


Do you know if it's a bad idea to drink soy milk which has calcium at dinnertime? I usually take sprycel right after supper. My doctor had advised me not to take calcium supplements within 2 hrs of the sprycel. I didn't think twice until one day I found myself eating ice cream for a desert, right after supper!

I think to be on the safe side you might cut out the Soy milk.


Thanks Sandy. I did cut it out but thought I'd put it back in.
Now I won't.

New to this site! CML since 2009 and now on Destiny. Anyone else have problems on medication with onion, onion powder, mustard? Rules out a lot of recipes!!!!

I have been on Gleevec for 3 years now.. lots of foods I liked before don't like now & vice versa. no Yogurt.. of course no Grapefruit. didn't like Mayo.. better now. anyone else have this. also lots of side effects; sometimes cant walk for cramps in legs & feet.. also anywhere there is a muscle, hands, fingers, arms.. jaw. any ideas. I already take potassium, kphos & magnesium. nausea & restroom problems is just crazy.