Table 3.

Recommendations for concomitant medications to be avoided.

Class	Examples of medications/substances to avoid	Potential effect
QT-prolonging medications	Azithromycin, chlorpromazine, ciprofloxacin, citalopram, clarithromycin, erythromycin, escitalopram, fluconazole, gatifloxacin, levofloxacin, loperamidea, moxifloxacin, ondansetronb	Effect of co-administering medicinal products known to prolong the QTc interval with adagrasib is unknown When not feasible to avoid concomitant administration of such drugs, conduct periodic ECG monitoring
CYP3A substrates with narrow therapeutic index	Alprazolam, cyclosporine, fentanyl, lovastatin, naloxegol, rivaroxaban, simvastatin	Increased exposure of CYP3A substrates, potentially increasing risk of SAEs associated with concomitant medication
Strong inducers of CYP3A	Carbamazepine, enzalutamide, rifampin, St. John’s wort	Decreased exposure to adagrasib, potentially reducing efficacy
CYP2D6 substrates with narrow therapeutic indexc	Thioridazine, pimozide	Increased exposure of CYP2D6 substrate, potentially increasing risk of toxicities associated with concomitant medication
CYP2C9 substrates with narrow therapeutic indexc	Warfarind	Increased exposure of CYP2C9 substrate, potentially increasing risk of toxicities associated with concomitant medication
Substrates of P-gp	Digoxin	Increased exposure of P-gp substrate, potentially increasing risk of toxicities associated with concomitant medication

Note: this is not a comprehensive list of medications to avoid.

^aOral administration of loperamide at 0.5-1 mg per dose, up to 3 mg daily in patients without underlying bradycardia, congestive heart failure, or congenital long QT syndrome.

^bOral administration of ondansetron at doses up to 4 mg every 6 hours, with a maximum total daily dose of 16 mg, in patients without underlying bradycardia, congestive heart failure, or congenital long QT syndrome.

^cIf alternative treatments cannot be used, consider a dose reduction of the concomitant drug.

^dIf warfarin is co-administered, conduct additional international normalized ratio monitoring.

Abbreviations: BCRP, breast cancer resistance protein; CYP, cytochrome P450 enzyme; P-gp, P-glycoprotein 1; QT, QT interval; SAE, serious adverse event.