Giotrif Drug Interactions

P-glycoprotein (P-gp) interactions: Based on in vitro data, afatinib is a substrate of P-gp. Based on clinical data, concomitant administration of strong P-gp inhibitors or inducers may alter exposure to afatinib.
If administered prior to GIOTRIF, strong P-gp inhibitors (including but not limited to ritonavir, cyclosporine A, ketoconazole, itraconazole, erythromycin, verapamil, quinidine, tacrolimus, nelfinavir, saquinavir, and amiodarone) may increase exposure to afatinib and should be used with caution. Therefore, it is recommended to administer strong P-gp inhibitors using staggered dosing, preferably 6 hours or 12 hours apart from GIOTRIF (see Dosage & Administration, Precautions and Pharmacology: Pharmacokinetics under Actions).
Strong P-gp inducers (including but not limited to rifampicin, carbamazepine, phenytoin, phenobarbital or St. John's Wort) may decrease exposure to afatinib (see Precautions and Pharmacology: Pharmacokinetics under Actions).
Interactions with BCRP: In vitro studies indicated that afatinib is a substrate and an inhibitor of the transporter BCRP. Afatinib may increase the bioavailability of orally administered BCRP substrates (including but not limited to rosuvastatin and sulfasalazine).
Food effect on afatinib: Co-administration of a high-fat meal with GIOTRIF resulted in a significant decrease of exposure to afatinib by about 50% in regard to C_max and 39% in regard to AUC_0-∞. GIOTRIF should be administered without food (see Dosage & Administration and Pharmacology: Pharmacokinetics under Actions).