Management: Avoid coadministration of siponimod with drugs that may cause bradycardia.Sirolimus: P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Sirolimus. Initiate amiodarone in a clinical setting where continuous ECGs and cardiac resuscitation are available.• Bradycardia/hypotension: May cause hypotension, which may be refractory and fatal, and bradycardia (infusion-rate related). Erythromycin (Systemic) may increase the serum concentration of Amiodarone. Lefamulin: May enhance the QTc-prolonging effect of QT-prolonging CYP3A4 Substrates. Discard any unused portions of premixed solutions.Abametapir: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).Afatinib: P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Afatinib. PVC tubing is recommended for administration regardless of infusion duration. This has been demonstrated in seventeen randomized controlled trials, of which five included a placebo arm. Use of amiodarone post-MI was not associated with an increase in mortality in two post-MI trials. If signs or symptoms of thyroid disease or arrhythmia breakthrough/exacerbation occur then immediate re-evaluation is necessary. Management: Consider alternatives to this combination. Management: Consider alternatives to cimetidine. Amiodarone is a potential source of large amounts of inorganic iodine; ~3 mg of inorganic iodine per 100 mg of amiodarone is released into the systemic circulation. Patients with additional risk factors for QTc prolongation may be at even higher risk.Haloperidol: Amiodarone may enhance the QTc-prolonging effect of Haloperidol. Management: Colchicine is contraindicated in patients with impaired renal or hepatic function who are also receiving a P-gp inhibitor. Management: Consider alternatives to this combination. Patients with additional risk factors for QTc prolongation may be at even higher risk.QT-prolonging Class IA Antiarrhythmics (Highest Risk): May enhance the QTc-prolonging effect of Amiodarone. Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Management: If combined, administer the P-gp inhibitor simultaneously with, or after, the dose of afatinib. Aprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).Atazanavir: May increase the serum concentration of Amiodarone.AtorvaSTATin: Amiodarone may increase the serum concentration of AtorvaSTATin.
Tablets: Store at 20°C to 25°C (68°F to 77°F); protect from light.Injection: Store undiluted vials and premixed solutions (Nexterone) at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F). Commercially-prepared premixed solutions do not contain polysorbate 80 and may have a lower incidence of hypotension.• Dermatologic toxicity: May cause life-threatening or fatal cutaneous reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Generic drugs usually cost less than brand-name versions. Infusions >2 hours must be administered in a non-PVC container (eg, glass or polyolefin). Patients with additional risk factors for QTc prolongation may be at even higher risk.Midodrine: May enhance the bradycardic effect of Bradycardia-Causing Agents.Midostaurin: QT-prolonging Agents (Highest Risk) may enhance the QTc-prolonging effect of Midostaurin. Amiodarone may increase the serum concentration of Beta-Blockers. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities.Venetoclax: P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Venetoclax. Use only volumetric infusion pump; use of drop counting may lead to underdosage. Management: Consider alternatives to this drug combination.
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