Drug General Information (ID: DDI2MYIOQC)
Drug Name			Bicalutamide		Drug Info		Ribociclib		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antineoplastics				Antineoplastics/Cdk 4/6 Inhibitors
Structure

Mechanism of Bicalutamide-Ribociclib Interaction (Severity Level: Major)
Increased risk of prolong QT interval Click to Show/Hide Mechanism Graph
Drug Name		Bicalutamide				Ribociclib
Mechanism		Prolong QT interval				Prolong QT interval
Key Mechanism Factor 1
		Factor Name		QT interval
		Factor Description		Long QT syndrome is a heart signaling disorder that can cause a fast, chaotic heartbeat (arrhythmia). Many people may not exhibit symptoms, and usually the condition is detected during routine medical tests. In others, the most common symptoms include: sudden fainting, palpitations, dizziness, seizures, sudden death.
Mechanism Description		Increased risk of prolong QT interval by the combination of Bicalutamide and Ribociclib

Recommended Action
Management		Coadministration of ribociclib with other drugs that can prolong the QT interval should generally be avoided. However, if concomitant use is required, caution and clinical and laboratory monitoring are recommended. ECGs should be assessed prior to initiation of treatment, during treatment when clinically necessary, and more frequently if QTcF prolongation occurs at any time during treatment. Ribociclib should be permanently discontinued if the QTcF interval prolongation is either greater than 500 msec or there is a greater than 60 msec change from baseline and associated with any of the following: Torsades de Pointes, polymorphic ventricular tachycardia, unexplained syncope, or signs/symptoms of serious arrhythmia. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

References
1	Canadian Pharmacists Association.
2	Cerner Multum, Inc. "Australian Product Information.".
3	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
4	Glassman AH, Bigger JT Jr "Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death." Am J Psychiatry 158 (2001): 1774-82. [PMID: 11691681]
5	Iannini PB "Cardiotoxicity of macrolides, ketolides and fluoroquinolones that prolong the QTc interval." Expert Opin Drug Saf 1 (2002): 121-8. [PMID: 12904146]
6	Product Information. Kisqali (ribociclib). Novartis Pharmaceuticals, East Hanover, NJ.
7	Witchel HJ, Hancox JC, Nutt DJ "Psychotropic drugs, cardiac arrhythmia, and sudden death." J Clin Psychopharmacol 23 (2003): 58-77. [PMID: 12544377]
8	EMA. European Medicines Agency. European Union "EMA - List of medicines under additional monitoring.".