Supratherapeutic INR resulting from the initiation of warfarin in a patient receiving axitinib

Primeaux, Brian; Burton, Bradley; Shuey, Stephanie

doi:10.1177/1078155216677853

Cited by 2 publications

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“…8 The elevated INRs associated with the concurrent use of sorafenib/axitinib/regorafenib and warfarin were also observed. [24][25][26] It was also reported that the coadministration of warfarin and statins could lead to clinically significant DDIs caused by CYP450 inhibition. 27 In the current study, the concomitant apatinib administration increased the exposure of S-warfarin by 92%, nearly two times.…”

Section: Safety Summarymentioning

confidence: 99%

<p>Effects of Apatinib on the Pharmacokinetics of Nifedipine and Warfarin in Patients with Advanced Solid Tumors</p>

Zhu¹,

Zhang²,

Zhang³

et al. 2020

DDDT

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Background and Purpose: Apatinib is a small-molecule tyrosine kinase inhibitor for the treatment of recurrent or progressive advanced-stage gastric adenocarcinoma or gastroesophageal junction cancer. The in vitro inhibition studies suggested that apatinib exerted potent inhibition on CYP3A4 and CYP2C9. To evaluate the potential of apatinib as a perpetrator in CYP450-based drug-drug interactions in vivo, nifedipine and warfarin were, respectively, selected in the present study as the probe substrates of CYP3A4 and CYP2C9 for clinical drug-drug interaction studies. Since hypertension and thrombus are common adverse effects of vascular targeting anticancer agents, nifedipine and warfarin are usually coadministered with apatinib in clinical practice. Methods: A single-center, open-label, single-arm, and self-controlled trial was conducted in patients with advanced solid tumors. The patients received a single dose of 30 mg nifedipine on Day 1/14 and a single dose of 3 mg warfarin on Day 3/16. On Day 9-21, the subjects received a daily dose of 750 mg apatinib, respectively. The pharmacokinetics of nifedipine and warfarin in the absence or presence of apatinib was, respectively, investigated. Results: Compared with the single oral administration, coadministration with apatinib contributed to the significant increases of AUC 0-48h and C max of nifedipine by 83% (90% confidence interval [CI] 1.46-2.31) and 64% (90% CI 1.34-2.01), respectively. Similarly, coadministration with apatinib contributed to the significant increases of AUC 0-t and C max of S-warfarin by 92% (90% CI 1.68-2.18) and 24% (90% CI 1.10-1.39), respectively. Conclusion: Concomitant apatinib administration resulted in significant increases in systemic exposure to nifedipine and S-warfarin. Owing to the risk of pharmacokinetic drug-drug interactions based on CYP3A4/CYP2C9 inhibition by apatinib, caution is advised in the concurrent use of apatinib with either CYP2C9 or CYP3A4 substrates.

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