Drug-drug interactions with venetoclax in acute myeloid leukemia

Background and Aims: Venetoclax is an important treatment option, especially in patients who are unfit for acute myeloid leukemia treatment. However, because venetoclax is metabolized by CYP3A4, it can lead to many drug-drug interactions (DDIs). DDIs may make a drug less effective, cause unexpected side effects, or increase the action of a particular drug. This study aims to examine venetoclax-related DDIs in this vulnerable patient population and to illuminate possible interventions for both patients and clinicians. Methods: This observational study was performed between November 2018-December 2022 in the Department of Hematology, Erciyes University Faculty of Medicine. The study involves 60 patients and uses Lexi-interact (R) to determine potential DDIs (pDDIs) in all patients and uses Lexi-interact (R) to take into account category D and category X interactions. Results: Forty-seven (78.4%) patients experienced drug interactions. The most common drug interactions were with azole antifungals, most commonly with posaconazole in category D (31.6%). Clarithromycin and diltiazem were found in more than 20% of patients. Carbamazepine, phenytoin and cladribine were found as contraindicated (category X) drugs. Conclusion: The study shows that at least 78.4% of the patients treated with venetoclax were at risk of DDIs. Dose reduction of venetoclax is necessary when used with azole antifungals. Due to the extremely high occurrence of DDIs, pharmacists have a significant role in drug interaction management in the multidisciplinary team.