HIGHLIGHT
Prevymis

Prevymis Drug Interactions

letermovir

Manufacturer:

Merck Sharp & Dohme

Distributor:

Zuellig Pharma
Full Prescribing Info
Drug Interactions
Effects of Other Drugs on PREVYMIS: Letermovir is a substrate of organic anion-transporting polypeptide 1B1/3 (OATP1B1/3) and P-glycoprotein (P-gp) transporters and UDP-glucuronosyltransferase 1A1/3 (UGT1A1/3) enzymes. Co-administration of PREVYMIS with drugs that are inhibitors of OATP1B1/3 transporters may result in increases in letermovir plasma concentrations. If PREVYMIS is co-administered with cyclosporine (a potent OATP1B1/3 inhibitor), the recommended dose of PREVYMIS is 240 mg once daily [see Dosage Adjustment in Adults under DOSAGE & ADMINISTRATION].
Co-administration of PREVYMIS with strong and moderate inducers of transporters (e.g., P-gp) and/or enzymes (e.g., UGTs) is not recommended due to the potential for a decrease in letermovir plasma concentrations (see Table 6).
Rifampin co-administration resulted in an initial increase in letermovir plasma concentrations (due to OATP1B1/3 inhibition) that is not clinically relevant, followed by clinically relevant decreases in letermovir plasma concentrations with continued rifampin co-administration [see Table 3 in PHARMACOLOGY: Drug Interaction Studies under ACTIONS].
Effects of PREVYMIS on Other Drugs: Co-administration of PREVYMIS with midazolam results in increased midazolam plasma concentrations, indicating that letermovir is a moderate inhibitor of CYP3A. Co-administration of PREVYMIS with drugs that are CYP3A substrates may result in clinically relevant increases in the plasma concentrations of co-administered CYP3A substrates [see CONTRAINDICATIONS, and Risk of Adverse Reactions or Reduced Therapeutic Effect Due to Drug Interactions under PRECAUTIONS] and Table 6.
Letermovir is an inhibitor of OATP1B1/3 transporters. Co-administration of PREVYMIS with drugs that are substrates of OATP1B1/3 transporters may result in a clinically relevant increase in plasma concentrations of co-administered OATP1B1/3 substrates (see Table 6).
Established and Other Potential Drug Interactions: If dose adjustments of concomitant medications are made due to treatment with PREVYMIS, doses should be readjusted after treatment with PREVYMIS is completed.
When PREVYMIS is co-administered with cyclosporine, the combined effect on CYP3A substrates may be similar to a strong CYP3A inhibitor. Refer to the prescribing information for dosing of the CYP3A substrate with a strong CYP3A inhibitor.
When PREVYMIS is co-administered with cyclosporine, the combined effect on agents that are both CYP3A and OATP1B1/3 substrates may be different than when they are administered with PREVYMIS alone. Refer to the prescribing information for both the co-administered drug and for cyclosporine.
Table 6 provides a listing of established or potentially clinically significant drug interactions. The drug interactions described are based on studies conducted with PREVYMIS or are predicted drug interactions that may occur with PREVYMIS [see Risk of Adverse Reactions or Reduced Therapeutic Effect Due to Drug Interactions under PRECAUTIONS]. (See Table 6.)

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Drugs without Clinically Significant Interactions with PREVYMIS: There was no clinically relevant interaction when PREVYMIS was co-administered with itraconazole, a P-gp/BCRP inhibitor.
There were no clinically relevant changes in plasma concentrations of digoxin, a P-gp substrate, and acyclovir, an OAT3 substrate, following co-administration with PREVYMIS in clinical studies.
The interaction between letermovir and the following drugs was evaluated in clinical studies: mycophenolate mofetil, fluconazole, posaconazole, and oral contraceptives. No dose adjustments are needed when PREVYMIS is used with these drugs.
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