quizartinib (Rx)

Brand and Other Names:Vanflyta

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 17.7mg
  • 26.5mg

Acute Myeloid Leukemia

Indicated in combination with standard cytarabine and anthracycline induction and cytarabine consolidation, and as maintenance monotherapy following consolidation chemotherapy, for treatment of adult patients with newly diagnosed acute myeloid leukemia (AML) that is FLT3 internal tandem duplication (ITD)-positive as detected by an FDA-approved test

Each cycle is 28 days

If patient proceeds to hematopoietic stem cell transplantation (HSCT), stop quizartinib 7 days before starting conditioning regimen

Induction

May receive up to 2 cycles of induction

Quizartinib 35.4 mg PO qDay on Days 8-21, PLUS

7 + 3 regimen (cytarabine 100 or 200 mg/m2/day IV on Days 1-7 plus daunorubicin 60 mg/m2/day IV or idarubicin 12 mg/m2/day IV on Days 1-3)

  • Optional second induction
    • Quizartinib plus 7 + 3 or 5 + 2 regimen (5 days cytarabine plus 2 days daunorubicin or idarubicin)
    • If 5 + 2 regimen administered as second induction cycle, administer quizartinib on Days 6-19

Consolidation

  • Quizartinib 35.4 mg PO qDay on Days 6-19, PLUS
  • Cytarabine 1.5-3 g/m2 q12hr on Days 1, 3, and 5 for up to 4 cycles

Maintenance

  • Quizartinib 26.5 mg PO qDay on Days 1-14 of the first cycle if QTcF ≤450 ms
  • Increase dose to 53 mg once daily on Day 15 of first cycle if QTcF ≤450 ms
  • Maintain 26.5 mg PO qDay if QTcF >500 ms was observed during induction or consolidation
  • Duration is once daily with no break between cycles for up to 36 cycles

Dosage Modifications

Dosage adjustments for adverse reactions

  • Current dosage 53 mg qDay: Reduce to 35.4 mg qDay
  • Current dosage 35.4 mg qDay: Reduce to 26.5 mg qDay
  • Current dosage 26.5 mg qDay: Interrupt
  • Current dosage 17.7 mg qDay: Interrupt

QT prolongation

  • Grade 1 (QTcF 450-480 ms): Continue dose
  • Grade 2 (QTcF 481-500 ms)
    • Reduce dose without interruption
    • Resume at previous dose in the next cycle if QTcF has decreased to <450 ms
    • Closely monitor for QT prolongation during first cycle at increased dose
  • Grade 3 (QTcF >500 ms)
    • Interrupt therapy
    • Resume at a reduced when QTcF returns to <450 ms
    • Maintain the 26.5 mg/day-dose during maintenance if QTcF >500 ms during induction or consolidation
  • Recurrent Grade 3
    • Permanently discontinue if QTcF >500 ms recurs despite appropriate dose reduction and correction/elimination of other risk factors (eg, serum electrolyte abnormalities, concomitant QT prolonging medications)
  • Grade 4
    • Defined as torsades de pointes, polymorphic ventricular tachycardia, signs/symptoms of life-threatening arrhythmia
    • Permanently discontinue

Grade 3 or 4 nonhematologic adverse reactions

  • Interrupt therapy
  • Resume at the previous dose if reaction improves to Grade ≤1
  • Resume treatment at a reduced dose if reaction improves to Grade 2
  • Discontinue if Grade 3 or 4 adverse reaction persists beyond 28 days

Grade 3 or 4 hypokalemia or hypomagnesemia

  • Defined as hypokalemia (<3 mmol/L) or hypomagnesemia (<0.4 mmol/L or <0.9 mg/dL)
  • Interrupt therapy
  • Correct hypokalemia and hypomagnesemia according to institutional guidelines
  • May restart at previous dose when the adverse reaction improves to Grade ≤2 without symptoms

Grade 4 neutropenia or thrombocytopenia after achieving remission

  • Recommend bone marrow evaluation
  • Reduce dose

Dosage modifications for strong CYP3A inhibitors

  • Current quizartinib dose 53 mg qDay: Reduce quizartinib to 26.5 mg qDay
  • Current quizartinib dose 35.4 mg qDay: Reduce quizartinib to 17.7 mg qDay
  • Current quizartinib dose 26.5 mg qDay: Reduce quizartinib to 17.7 mg qDay
  • If current dosage is quizartinib 17.7 mg qDay, interrupt treatment for duration of strong CYP3A inhibitor use
  • After discontinuing of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating strong inhibitor

Renal impairment

  • Mild to moderate (CrCl 30-89 mL/min): No dosage adjustment necessary
  • Severe (CrCl <30 mL/min): Not studied

Hepatic impairment

  • Mild or moderate (Child-Pugh A or B): No dosage adjustment necessary
  • Severe (Child-Pugh C): Not studied

Dosing Considerations

Verify pregnancy status in females of reproductive potential within 7 days before starting treatment

Monitoring parameters

  • Initiate only if QTcF ≤450 ms
  • Perform electrocardiogram (ECGs)
    • During induction and consolidation: Before initiation and then once weekly during treatment or more frequently as clinically indicated
    • During maintenance: Before initiation, once weekly for at least first month following dose initiation and escalation, and thereafter as clinically indicated

  • Escalate dose only if QTcF ≤450 ms
  • Correct electrolyte abnormalities (hypokalemia and hypomagnesemia), and if possible, avoid coadministration of drugs that prolong the QT interval

Limitation of use

  • Not indicated as maintenance monotherapy following allogeneic hematopoietic stem cell transplantation (HSCT)
  • No improvement in overall survival in this setting demonstrated

Patient selection

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and quizartinib

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            Contraindicated (0)

              Serious - Use Alternative (40)

              • amobarbital

                amobarbital will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • apalutamide

                apalutamide will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • armodafinil

                armodafinil will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • belzutifan

                belzutifan will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • bexarotene

                bexarotene will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • bosentan

                bosentan will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • butabarbital

                butabarbital will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • butalbital

                butalbital will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • carbamazepine

                carbamazepine will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • cenobamate

                cenobamate will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • dabrafenib

                dabrafenib will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • duvelisib

                duvelisib will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • efavirenz

                efavirenz will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • elagolix

                elagolix will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • encorafenib

                encorafenib will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • enzalutamide

                enzalutamide will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • eslicarbazepine acetate

                eslicarbazepine acetate will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • etravirine

                etravirine will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • fosphenytoin

                fosphenytoin will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • ivosidenib

                ivosidenib will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • lorlatinib

                lorlatinib will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • lumacaftor/ivacaftor

                lumacaftor/ivacaftor will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • mavacamten

                mavacamten will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • mitapivat

                mitapivat will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • mitotane

                mitotane will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • modafinil

                modafinil will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • nafcillin

                nafcillin will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • olutasidenib

                olutasidenib will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • pentobarbital

                pentobarbital will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • pexidartinib

                pexidartinib will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • phenobarbital

                phenobarbital will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • phenytoin

                phenytoin will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • primidone

                primidone will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • rifabutin

                rifabutin will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • rifampin

                rifampin will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • rifapentine

                rifapentine will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • secobarbital

                secobarbital will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • sotorasib

                sotorasib will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • St John's Wort

                St John's Wort will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • telotristat ethyl

                telotristat ethyl will decrease the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              Monitor Closely (137)

              • adagrasib

                quizartinib, adagrasib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • alfuzosin

                quizartinib, alfuzosin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • amiodarone

                quizartinib, amiodarone. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • amitriptyline

                quizartinib, amitriptyline. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • apomorphine

                quizartinib, apomorphine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • arformoterol

                quizartinib, arformoterol. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • arsenic trioxide

                quizartinib, arsenic trioxide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • artemether/lumefantrine

                quizartinib, artemether/lumefantrine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • asenapine

                quizartinib, asenapine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • asenapine transdermal

                quizartinib, asenapine transdermal. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • atazanavir

                atazanavir will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • azithromycin

                quizartinib, azithromycin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • bedaquiline

                quizartinib, bedaquiline. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • chloramphenicol

                chloramphenicol will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • chlorpromazine

                quizartinib, chlorpromazine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • ciprofloxacin

                quizartinib, ciprofloxacin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • citalopram

                quizartinib, citalopram. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • clarithromycin

                clarithromycin will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

                quizartinib, clarithromycin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • clofazimine

                quizartinib, clofazimine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • clomipramine

                quizartinib, clomipramine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • clozapine

                quizartinib, clozapine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • cobicistat

                cobicistat will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • conivaptan

                conivaptan will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • crizotinib

                quizartinib, crizotinib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • darunavir

                darunavir will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • dasatinib

                quizartinib, dasatinib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • desipramine

                quizartinib, desipramine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • disopyramide

                quizartinib, disopyramide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • dofetilide

                quizartinib, dofetilide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • dolasetron

                quizartinib, dolasetron. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • dronedarone

                quizartinib, dronedarone. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • droperidol

                quizartinib, droperidol. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • elvitegravir

                elvitegravir will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • encorafenib

                quizartinib, encorafenib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • entrectinib

                quizartinib, entrectinib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • eribulin

                quizartinib, eribulin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • erythromycin base

                quizartinib, erythromycin base. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • erythromycin ethylsuccinate

                quizartinib, erythromycin ethylsuccinate. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • erythromycin lactobionate

                quizartinib, erythromycin lactobionate. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • erythromycin stearate

                quizartinib, erythromycin stearate. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • escitalopram

                quizartinib, escitalopram. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • flecainide

                quizartinib, flecainide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • fluconazole

                quizartinib, fluconazole. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • fluoxetine

                quizartinib, fluoxetine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • fluphenazine

                quizartinib, fluphenazine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • formoterol

                quizartinib, formoterol. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • foscarnet

                quizartinib, foscarnet. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • fostemsavir

                quizartinib, fostemsavir. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • gemifloxacin

                quizartinib, gemifloxacin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • gemtuzumab

                quizartinib, gemtuzumab. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • glasdegib

                quizartinib, glasdegib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • grapefruit

                grapefruit will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • haloperidol

                quizartinib, haloperidol. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • hydroxychloroquine sulfate

                quizartinib, hydroxychloroquine sulfate. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • ibutilide

                quizartinib, ibutilide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • idelalisib

                idelalisib will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • iloperidone

                quizartinib, iloperidone. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • indacaterol, inhaled

                quizartinib, indacaterol, inhaled. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • indapamide

                quizartinib, indapamide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • inotuzumab

                quizartinib, inotuzumab. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • isradipine

                quizartinib, isradipine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • itraconazole

                itraconazole will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • ketoconazole

                ketoconazole will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • lapatinib

                quizartinib, lapatinib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • lefamulin

                quizartinib, lefamulin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • levofloxacin

                quizartinib, levofloxacin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • levoketoconazole

                levoketoconazole will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • lofexidine

                quizartinib, lofexidine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • lonafarnib

                lonafarnib will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • lopinavir

                lopinavir will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

                quizartinib, lopinavir. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • maprotiline

                quizartinib, maprotiline. Either decreases toxicity of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • mefloquine

                quizartinib, mefloquine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • methadone

                quizartinib, methadone. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • mifepristone

                mifepristone will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

                quizartinib, mifepristone. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • mobocertinib

                quizartinib, mobocertinib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • moxifloxacin

                quizartinib, moxifloxacin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • nefazodone

                nefazodone will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • nelfinavir

                nelfinavir will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • nilotinib

                quizartinib, nilotinib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • nirmatrelvir/ritonavir

                nirmatrelvir/ritonavir will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • nortriptyline

                quizartinib, nortriptyline. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • octreotide

                quizartinib, octreotide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • ofloxacin

                quizartinib, ofloxacin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • olanzapine

                quizartinib, olanzapine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • ondansetron

                quizartinib, ondansetron. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • osilodrostat

                quizartinib, osilodrostat. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • osimertinib

                quizartinib, osimertinib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • ozanimod

                quizartinib, ozanimod. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • paliperidone

                quizartinib, paliperidone. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • panobinostat

                quizartinib, panobinostat. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • pasireotide

                quizartinib, pasireotide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • pazopanib

                quizartinib, pazopanib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • pentamidine

                quizartinib, pentamidine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • perphenazine

                quizartinib, perphenazine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • pimavanserin

                quizartinib, pimavanserin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • pimozide

                quizartinib, pimozide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • pitolisant

                quizartinib, pitolisant. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • ponesimod

                quizartinib, ponesimod. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • posaconazole

                posaconazole will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

                quizartinib, posaconazole. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • procainamide

                quizartinib, procainamide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • propafenone

                quizartinib, propafenone. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • protriptyline

                quizartinib, protriptyline. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • quetiapine

                quizartinib, quetiapine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • quinidine

                quizartinib, quinidine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • quinine

                quizartinib, quinine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • ranolazine

                quizartinib, ranolazine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • ribociclib

                quizartinib, ribociclib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • rilpivirine

                quizartinib, rilpivirine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • risperidone

                quizartinib, risperidone. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • ritonavir

                ritonavir will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • romidepsin

                quizartinib, romidepsin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • rucaparib

                rucaparib will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • saquinavir

                saquinavir will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

                quizartinib, saquinavir. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • selpercatinib

                quizartinib, selpercatinib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • sertraline

                quizartinib, sertraline. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • siponimod

                siponimod and quizartinib both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • solifenacin

                quizartinib, solifenacin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • sorafenib

                quizartinib, sorafenib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • sotalol

                quizartinib, sotalol. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • stiripentol

                stiripentol will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • sunitinib

                quizartinib, sunitinib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • tacrolimus

                quizartinib, tacrolimus. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • telavancin

                quizartinib, telavancin. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • tetrabenazine

                quizartinib, tetrabenazine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • thioridazine

                quizartinib, thioridazine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • thiothixene

                quizartinib, thiothixene. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • toremifene

                quizartinib, toremifene. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • trimipramine

                quizartinib, trimipramine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • tucatinib

                tucatinib will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

              • vandetanib

                quizartinib, vandetanib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • vardenafil

                quizartinib, vardenafil. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • vemurafenib

                quizartinib, vemurafenib. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • vilanterol/fluticasone furoate inhaled

                quizartinib, vilanterol/fluticasone furoate inhaled. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • voriconazole

                voriconazole will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

                quizartinib, voriconazole. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • vorinostat

                quizartinib, vorinostat. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • ziprasidone

                quizartinib, ziprasidone. Either decreases toxicity of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              Minor (2)

              • ezogabine

                quizartinib, ezogabine. Either increases effects of the other by QTc interval. Minor/Significance Unknown. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

              • indinavir

                indinavir will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.

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              Adverse Effects

              All listed adverse reactions for quizartinib and chemoherapy

              >10%

              All grades

              • Lymphocytes decreased (60%)
              • Potassium decreased (59%)
              • Albumin decreased (53%)
              • Phosphorus decreased (52%)
              • Alkaline phosphatase increased (51%)
              • Febrile neutropenia (44%)
              • Magnesium decreased (44%)
              • Diarrhea (42%)
              • Mucositis (38%)
              • Nausea (34%)
              • Calcium decreased (33%)
              • Abdominal pain (30%)
              • Sepsis (30%)
              • Neutropenia (29%)
              • Headache (28%)
              • Creatine phosphokinase increased (26%)
              • Vomiting (25%)
              • Upper respiratory tract infection (21%)
              • Hypertransaminasemia (19%)
              • Thrombocytopenia (18%)
              • Decreased appetite (17%)
              • Fungal infection (16%)
              • Epistaxis (15%)
              • Potassium increased (15%)
              • Herpesvirus infection (14%)
              • Insomnia (14%)
              • QT prolonged (14%)
              • Magnesium increased (14%)
              • Sodium increased (13%)
              • Anemia (11%)
              • Eye irritation (11%)

              Grade 3 or 4

              • Lymphocytes decreased (57%)
              • Febrile neutropenia (43%)
              • Neutropenia (26%)
              • Potassium decreased (22%)
              • Phosphorus decreased (22%)
              • Thrombocytopenia (13%)
              • Dyspepsia (11%)

              1-10%

              All grades

              • Differentiation syndrome (5%)
              • Acute febrile neutrophilic dermatosis (3%)

              Grade 3 or 4

              • Diarrhea (8%)
              • Hypertransaminasemia (7%)
              • Anemia (6%)
              • Fungal infection (6%)
              • Mucositis (5%)
              • Decreased appetite (4.9%)
              • Prolonged QT (3%)
              • Magnesium increased (2.8%)
              • Upper respiratory tract infection (2.6%)
              • Herpesvirus infection (2.6%)
              • Creatine phosphokinase increased (2.5%)
              • Calcium decreased (2.4%)
              • Abdominal pain (2.3%)
              • Magnesium decreased (2%)
              • Albumin decreased (1.6%)
              • Alkaline phosphatase increased (1.6%)
              • Nausea (1.5%)
              • Potassium increased (1.2%)
              • Epistaxis (1.1%)

              <1%

              Grade 3 or 4

              • Dyspepsia (0.4%)
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              Warnings

              Black Box Warnings

              QT prolongation

              • Prolongs QT interval in a dose- and concentration-related manner
              • Before administration and periodically, monitor for hypokalemia or hypomagnesemia, and correct deficiencies
              • Perform ECGs to monitor QTc at baseline, weekly during induction and consolidation therapy, weekly for at least the first month of maintenance, and periodically thereafter
              • Torsades de pointes and cardiac arrest
                • Torsades de pointes and cardiac arrest have occurred
                • Do not administer to patients with severe hypokalemia, severe hypomagnesemia, or long QT syndrome
                • Do not initiate treatment or escalate dose if QT interval corrected by Fridericia’s formula (QTcF) >450 ms
                • Monitor ECGs more frequently if concomitant use of QT prolonging drugs
                • Reduce dose when used concomitantly with strong CYP3A inhibitors, as they may increase quizartinib exposure
                • Owing to risk of QT prolongation, quizartinib is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called VANFLYTA REMS

              Contraindications

              Severe hypokalemia, severe hypomagnesemia, long QT syndrome, or history of ventricular arrhythmias or torsades de pointes

              Cautions

              Based on findings in animals and its mechanism of action, fetal harm may occur when administered to pregnant females

              QT prolongation, torsades de pointes, and cardiac arrest

              • QT interval prolongation in a dose- and concentration-dependent manner
              • Torsades de pointes, ventricular fibrillation, cardiac arrest, and sudden death have occurred
              • These severe cardiac arrhythmias occurred predominantly during the induction phase
              • Avoid use in patients who are at significant risk of developing torsades de pointes, including uncontrolled or significant cardiac disease, recent myocardial infarction, heart failure, unstable angina, bradyarrhythmias, tachyarrhythmias, uncontrolled hypertension, high-degree atrioventricular block, severe aortic stenosis, or uncontrolled hypothyroidism
              • Do not initiate treatment if QTcF interval >450 ms
              • Do not use in patients with severe hypokalemia, severe hypomagnesemia, long QT syndrome, or in patients with a history of ventricular arrhythmias or torsades de pointes
              • Perform an ECG and correct electrolyte abnormalities before initiating
              • During induction and consolidation, perform an ECG before initiation and then once weekly during treatment or more frequently as clinically indicated
              • During maintenance, perform ECGs before initiation, once weekly for at least the first month following dose initiation and escalation, and as clinically indicated thereafter
              • Do not escalate the dose if QTcF >450 ms
              • Perform ECG monitoring of the QT interval more frequently in patients who are at significant risk of developing QT interval prolongation and torsades de pointes, or following dose escalation
              • Monitor and correct hypokalemia and hypomagnesemia before and during treatment
              • Maintain electrolytes in normal range
              • Monitor electrolytes and ECGs more frequently in patients who experience diarrhea or vomiting
              • Monitor more frequently with ECGs if coadministration of quizartinib with drugs known to prolong the QT interval

              Risk Evaluation and Mitigation Strategy (REMS) program

              • Quizartinib is available only through a restricted distribution program under a REMS called the VANFLYTA REMS
              • Notable requirements include:
                • Prescribers must be certified by enrolling and completing training
                • Prescribers must counsel patients about risk of QT prolongation, torsades de pointes, and cardiac arrest, and provide patients with a Patient Wallet Card
                • Pharmacies that dispense quizartinib must be certified with the VANFLYTA REMS and must verify prescribers are certified through VANFLYTA REMS
                • Further information is available at www.VANFLYTAREMS.com or by telephone at 1-855-212-6670

              Drug interaction overview

              • CYP3A4 substrate
              • Strong CYP3A inhibitors
                • Reduce dose
                • Strong CYP3A inhibitor increases quizartinib systemic exposure
              • Strong or moderate CYP3A inducers
                • Avoid coadministration
                • Strong or moderate CYP3A inducers decreases quizartinib systemic exposure
              • QT interval prolonging drugs
                • Monitor more frequently with ECG
                • Coadministration with other drugs that prolong QT interval may further increase QT prolongation incidence
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              Pregnancy & Lactation

              Pregnancy

              Based on findings from animal studies and its mechanism of action, embryofetal harm may occur when administered to pregnant females

              There are no available data on use in pregnant females to evaluate for a drug-associated risk

              Pregnancy testing

              • Verify pregnancy status in females of reproductive potential within 7 days before initiating

              Contraception

              • Females of reproductive potential: Use effective contraception during treatment and for 7 months after last dose
              • Males with female partners of reproductive potential: Use effective contraception during treatment and for 4 months after last dose

              Infertility

              • May impair female and male fertility
              • These effects on fertility were reversible

              Animal data

              • Oral administration to pregnant rats during organogenesis resulted in adverse developmental outcomes including structural abnormalities and alterations to growth at maternal exposures ~3x those in patients at the maximum recommended human dose of 53 mg/day
              • Advise pregnant women of the potential risk to a fetus

              Lactation

              There are no data on presence of quizartinib or its metabolites in human milk, or effects on breastfed children or milk production

              Advise females not to breastfeed during treatment and for 1 month after last dose

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Quizartinib and its active metabolite (AC886) bind to the adenosine triphosphate (ATP) binding domain of FLT3 with comparable affinity, and both had 10-fold lower affinity towards FLT3-ITD mutation compared to FLT3 in a binding assay

              Quizartinib and AC886 inhibited FLT3 kinase activity, preventing autophosphorylation of the receptor, thereby inhibiting downstream FLT3 receptor signaling and blocking FLT3-ITD-dependent cell proliferation

              Absorption

              Bioavailability: 71%

              Peak plasma time

              • Quizartinib: 4 hr
              • AC886 (metabolite): 5-6 hr

              Peak plasma concentration

              • Induction therapy (steady-state following 35.4-mg/day): 140 ng/mL (quizartinib); 163 ng/mL (AC886)
              • Consolidation therapy (steady-state following 35.4-mg/day): 204 ng/mL (quizartinib); 172 ng/mL (AC886)
              • Maintenance therapy (steady-state following 53-mg/day): 529 ng/mL (quizartinib); 172 ng/mL (AC886)

              Area under the curve

              • Induction therapy (steady-state following 35.4-mg/day): 2,680 ng⋅hr/mL (quizartinib); 3,590 ng⋅hr/mL (AC886)
              • Consolidation therapy (steady-state following 35.4-mg/day): 3,930 ng⋅hr/mL (quizartinib); 3,800 ng⋅hr/mL (AC886)
              • Maintenance therapy (steady-state following 53-mg/day): 10,200 ng⋅hr/mL (quizartinib); 5,790 ng⋅hr/mL (AC886)

              Accumulation ratio

              • Quizartinib: 5.4
              • AC886: 8.7

              Distribution

              Vd: 275 L

              Protein bound: 99%

              • Quizartinib: 0.79-1.30
              • AC886: 1.36-3.19

              Metabolism

              Primarily metabolized via oxidation by CYP3A4/5 and forms AC886, which is metabolized by CYP3A4/5

              Elimination

              Clearance: 2.23 L/hr

              Half-life

              • Quizartinib: 81 hr
              • AC886: 136 hr

              Excretion

              • Feces: 76.3% (4% unchanged)
              • Urine: 1.64%
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              Administration

              Oral Administration

              Administer orally with or without food at approximately same time each day

              Swallow tablets whole; do not cut, crush, or chew

              Vomited dose

              • Do not administer a replacement dose; wait until next scheduled dose

              Missed dose

              • Missed or not taken at usual time: Administer dose as soon as possible on same day and return to usual schedule the following day
              • Do not take 2 doses on same day

              Storage

              Store at room temperature from 20-25ºC (68-77ºF)

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              Images

              No images available for this drug.
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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.