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Fostamatinib is an orally available small-molecule inhibitor of spleen tyrosine kinase that is used to treat chronic immune thrombocytopenia. Fostamatinib is associated with transient and usually mild elevations in serum aminotransferase levels during therapy but has yet to be linked to instances of clinically apparent acute liver injury.
Fostamatinib is a small molecule Syk kinase inhibitor with potential anti-inflammatory and immunomodulating activities. Fostamatinib inhibits Syk kinase-mediated IgG Fc gamma receptor signaling, resulting in the inhibition of the activation of mast cells, macrophages, and B-cells and related inflammatory responses and tissue damage. Syk kinase, widely expressed in hematopoietic cells, is a nonreceptor tyrosine kinase that is involved in coupling activated immunoreceptors to signal downstream events that mediate diverse cellular responses, including proliferation, differentiation, and phagocytosis.
Fostamatinib Disodium is an orally available disodium salt of the Syk kinase inhibitor fostamatinib with potential anti-inflammatory and immunomodulating activities. Fostamatinib inhibits Syk kinase-mediated IgG Fc gamma receptor signaling, resulting in the inhibition of the activation of mast cells, macrophages, and B-cells and related inflammatory responses and tissue damage. Syk kinase, widely expressed in hematopoietic cells, is a nonreceptor tyrosine kinase that is involved in coupling activated immunoreceptors to signal downstream events that mediate diverse cellular responses, including proliferation, differentiation, and phagocytosis.
Fostamatinib has been investigated for the treatment and basic science of Rheumatoid Arthritis and Immune Thrombocytopenic Purpura (ITP). It was approved on April 17, 2018, under the trade name Tavalisse for use in ITP. Fostamatinib has also been granted orphan drug status by the FDA. Recently, fostamatinib has been identified as a potential therapeutic for controlling acute respiratory distress syndrome (ARDS) in patients with severe COVID-19 through its ability to modulate the SYK kinase.
Mechanism of Action
The active metabolite of fostamatinib, R406, is an inhibitor of spleen tyrosine kinase (Syk). It binds reversibly to the ATP binding pocket with high affinity (Ki = 30nM), inhibiting the kinase activity with an IC50 of 41nM. Syk is a cytosolic protein kinase and part of the signaling cascade which occurs with Fc receptors, TCRs, and BCRs. It contains two src homology 2 (SH2) domains separated by a linker domain. These SH2 domains bind to tyrosine residues on the immunoreceptor tyrosine-based activating motif phosphorylated by Lyn, another kinase in the cascade. This motif is located on the cytoplasmic regions of several immune receptors including Fc receptors, TCRs, BCRs, and natural killer cell receptors. The flexibility provided by the linker enables the protein to bind to many receptor types. Inhibition of Syk suppresses downstream signal transduction. While Syk plays a role in some pathways involved in the generation of the oxidative burst by neutrophils or phagocytosis by macrophages, R406 does not have a significant effect on these processes. This is likely due to redundant pathways which do not involve Syk. Similarly, Syk does not produce significant effects on platelet activation despite its involvement in glycoprotein IV and integrin-based signaling. Activation of antibody-dependent cell-mediated toxicity by natural killer cells is also unaffected despite the involvement of Syk in Fc receptor signaling. R406 binds to the adenosine A3 receptor as an antagonist as well as the adenosine and monoamine uptake transporters as an inhibitor. It has also been found to be an inhibitor of UDP glucuronosyltransferase UGT1A1, phosphodiesterase PDE5, fatty acid amide hydrolase, 5-lipoxygenase, cathepsin L, and cathepsin S. R406 appears to inhibit a wide range of kinases at higher concentrations. It is thought that inhibition of some of these targets may be responsible for the increase in blood pressure seen with fostamatinib.
The active metabolite of fostamatinib, R406, inhibits signal transduction by Fcγ receptors involved in the antibody-mediated destruction of platelets by immune cells in chronic ITP. This results in increased platelet counts in this population. R406 produces inhibition of T and B lymphocyte activation by T-cell receptors (TCRs) and B-cell receptors (BCRs) respectively. It can also inhibit signaling via Fcε receptors which could have applications in treating allergic symptoms through the prevention of mast cell degranulation. Inhibition of Fc receptor signaling system also affected by R406 suppresses both dendritic cell maturation and antigen presentation and may contribute to the effects of fostamatinib. As a knock-on effect of disabling signal transduction from Fc receptors, TCRs, and BCRs, the production of inflammatory mediators and cytokines like tumor necrosis factor α, leukotriene C4, interleukin-8, and granulocyte-macrophage colony-stimulating factor. Fostamatinib can produce hypertension through off-target effects
Indications
- Fostamatinib is indicated for use in the treatment of chronic immune thrombocytopenia (ITP) in patients who have had an insufficient response to previous therapy.
- Tables are indicated for the treatment of chronic immune thrombocytopenia (ITP) in adult patients who are refractory to other treatments.
- Fostamatinib is a spleen tyrosine kinase inhibitor used to treat chronic immune thrombocytopenia after attempting one other treatment.
- Treatment of idiopathic thrombocytopenic purpura as a model for immunomodulation
- Treatment of chronic idiopathic arthritis (including rheumatoid arthritis, ankylosing spondylarthritis, psoriatic arthritis,. and juvenile idiopathic arthritis )
- Fostamatinib is an orally available small-molecule inhibitor of spleen tyrosine kinase that is used to treat chronic immune thrombocytopenia.
- For the treatment of thrombocytopenia in adult patients with chronic immune thrombocytopenia (ITP) who have had an insufficient response to a previous treatment.
- Fostamatinib has been investigated for the treatment and basic science of Rheumatoid Arthritis and Immune Thrombocytopenic Purpura (ITP).
- Recently, fostamatinib has been identified as a potential therapeutic for controlling acute respiratory distress syndrome (ARDS) in patients with severe COVID-19 through its ability to modulate the SYK kinase.
- Chronic immune thrombocytopenia
Contraindications
- low levels of a type of white blood cell called neutrophils
- high blood pressure
- liver problems
- diarrhea
- pregnancy
- a patient who is producing milk and breastfeeding
- a significant drop in a certain type of white blood cell called a neutrophil
Dosage
Strengths: 100 mg; 150 mg
Thrombocytopenia
- 100 mg orally 2 times a day; after a month, if platelet count has not increased to at least 50 x 10(9)/L, increase to 150 mg orally 2 times a day
- This drug may be taken with or without food.
- In the case of a missed dose, instruct patients to take their next dose at its regularly scheduled time.
- Use the lowest dose to achieve and maintain a platelet count at least 50 x 10(9)/L to reduce the risk of bleeding.
Dose Adjustments
- Dose modification is recommended based on individual safety and tolerability. Management of some adverse reactions may require dose interruption, reduction, or discontinuation.
MANUFACTURER SUGGESTED DOSE REDUCTION SCHEDULE:
- 300 mg/day: Taken as 150 mg orally in the AM and 150 mg orally in the PM
- 200 mg/day: Taken as 100 mg orally in the AM and 100 mg orally in the PM
- 150 mg/day: Taken as 150 mg orally in the AM
- 100 mg/day: Taken as 100 mg orally in the AM
- If further dose reduction is needed, therapy should be discontinued.
RECOMMENDED DOSE MODIFICATIONS FOR SPECIFIC ADVERSE REACTIONS:
HYPERTENSION:
- Stage 1 (systolic between 130 and 139 or diastolic between 80 and 89 mmHg: Initiate or increase dose of antihypertensive medication for patients with increased cardiovascular risk, and adjust as needed until BP is controlled. If the BP target is not met after 8 weeks, reduce the dose to the next lower daily dose.
- Stage 2 (systolic at least 140 or diastolic at least 90 mmHg: Initiate or increase dose of antihypertensive medication, and adjust as needed until BP is controlled. If the BP remains 140/90 mmHg or higher for more than 8 weeks, reduce the dose to the next lower daily dose. If BP remains 160/100 mmHg or higher for more than 4 weeks despite aggressive antihypertensive therapy, interrupt or discontinue therapy.
HEPATOTOXICITY:
- AST/ALT is 3 x ULN or higher and less than 5 x ULN: If the patient is symptomatic (e.g., nausea, vomiting, abdominal pain), interrupt therapy; recheck LFTs every 72 hours until ALT/AST values are no longer elevated (below 1.5 x ULN) and total bilirubin (BL) remains less than 2 x ULN; resume therapy at next lower daily dose. If the patient is asymptomatic, recheck LFTs every 72 hours until ALT/AST are below 1.5 x ULN and total BL remains less than 2 x ULN; consider therapy interruption or dose reduction if ALT/AST and TBL remain in this category (AST/ALT is 3 to 5 x
- ULN; and total BL remains less than 2 x ULN); if therapy is interrupted, resume at the next lower daily dose when ALT/AST are no longer elevated (below 1.5 x
- ULN) and total BL remains less than 2 x ULN.
- AST/ALT is 5 x ULN or higher and total BL is less than 2 x ULN: Interrupt therapy and recheck LFTs every 72 hours; if AST and ALT decrease, recheck until ALT and AST are no longer elevated (below 1.5 x ULN) and total BL remains less than 2 x ULN; resume therapy at next lower daily dose; if AST/ALT persist at 5 x ULN or higher for 2 weeks or more, discontinue therapy.
- AST/ALT is 3 x ULN or higher and total BL is greater than 2 x ULN: Discontinue therapy.
- Elevated unconjugated (indirect) BL in absence of other LFT abnormalities: Continue therapy with frequent monitoring since the isolated increase in unconjugated (indirect) BL may be due to UGT1A1 inhibition.
DIARRHEA:
- Manage diarrhea using supportive measures (e.g., dietary changes, hydration, and/or antidiarrheal medication) early after the onset until symptoms have resolved.
- If symptom(s) become severe (Grade 3 or above), temporarily interrupt therapy.
- If diarrhea improves to mild (Grade 1), resume therapy at the next lower daily dose.
NEUTROPENIA:
- If absolute neutrophil count decreases (ANC less than 1 x 10(9)/L) and remains low after 72 hours, temporarily interrupt therapy until resolved (ANC greater than 1.5 x 10(9)/L).
- Resume therapy at the next lower daily dose.
DOSE MODIFICATION FOR DRUG INTERACTIONS
- Concomitant use with a strong CYP450 3A4 inhibitor increases exposure to R406 (the major active metabolite). Monitor for toxicities due to this drug that may require dose modifications when given concurrently with a strong CYP450 3A4 inhibitor.
DISCONTINUATION OF THERAPY:
- Discontinue therapy after 12 weeks if the platelet count does not increase to a level sufficient to avoid clinically important bleeding.
Administration advice:
- This drug may be taken with or without food.
- In case of a missed dose, the next dose should be taken at its regularly scheduled time.
Side Effects
The Most Common
- diarrhea
- nausea
- dizziness
- rash
- abdominal pain
- fatigue
- severe diarrhea
- headache, confusion, dizziness, chest pain, or shortness of breath
- pain in the upper right part of the stomach
- yellowing of the skin or eyes
- dark colored urine
- nausea
- vomiting
More common
- Black, tarry, stools
- blurred vision
- chest pain
- chills
- cough
- diarrhea
- dizziness
- fever
- headache
- lower back or side pain
- nervousness
- painful or difficult urination
- pale skin
- pounding in the ears
- slow or fast heartbeat
- sore throat
- stomach pain
- ulcers, sores, or white spots in the mouth
- unusual bleeding or bruising
- unusual tiredness or weakness
Rare
- severe diarrhea;
- stomach pain (upper right side);
- dark urine, jaundice (yellowing of the skin or eyes);
- headaches, chest pain, shortness of breath; or
- fever, sore throat, or other signs of infection.
- increased blood pressure;
- diarrhea, nausea, stomach pain;
- abnormal liver function tests;
- chest pain;
- dizziness, tiredness;
- rash; or
- cold symptoms such as stuffy nose, sneezing, and sore throat.
Drug Interactions
| DRUG | INTERACTION |
|---|---|
| Abacavir | The metabolism of Abacavir can be decreased when combined with Fostamatinib. |
| Abaloparatide | The therapeutic efficacy of Abaloparatide can be decreased when used in combination with Fostamatinib. |
| Abametapir | The serum concentration of Fostamatinib can be increased when it is combined with Abametapir. |
| Abemaciclib | The metabolism of Abemaciclib can be decreased when combined with Fostamatinib. |
| Acalabrutinib | The metabolism of Acalabrutinib can be decreased when combined with Fostamatinib. |
| Acebutolol | Fostamatinib may increase the antihypertensive activities of Acebutolol. |
| Acenocoumarol | The serum concentration of Acenocoumarol can be increased when it is combined with Fostamatinib. |
| Acetaminophen | The serum concentration of Acetaminophen can be increased when it is combined with Fostamatinib. |
| Afatinib | Fostamatinib may decrease the excretion rate of Afatinib which could result in a higher serum level. |
| Albendazole | The metabolism of Albendazole can be decreased when combined with Fostamatinib. |
| Aldesleukin | The risk or severity of hypotension can be increased when Fostamatinib is combined with Aldesleukin. |
| Alectinib | The metabolism of Alectinib can be decreased when combined with Fostamatinib. |
| Alfuzosin | The metabolism of Alfuzosin can be decreased when combined with Fostamatinib. |
| Aliskiren | Fostamatinib may increase the antihypertensive activities of Aliskiren. |
| Allopurinol | Fostamatinib may decrease the excretion rate of Allopurinol which could result in a higher serum level. |
| Alpelisib | The serum concentration of Alpelisib can be increased when it is combined with Fostamatinib. |
| Alprazolam | The metabolism of Alprazolam can be decreased when combined with Fostamatinib. |
| Alprostadil | The risk or severity of hypotension and priapism can be increased when Fostamatinib is combined with Alprostadil. |
| Ambrisentan | Fostamatinib may increase the antihypertensive activities of Ambrisentan. |
| Amifostine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Amifostine. |
| Amiloride | The risk or severity of hypotension can be increased when Fostamatinib is combined with Amiloride. |
| Aminophylline | The metabolism of Aminophylline can be decreased when combined with Fostamatinib. |
| Amiodarone | The metabolism of Fostamatinib can be decreased when combined with Amiodarone. |
| Amitriptyline | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Amitriptyline. |
| Amlodipine | Fostamatinib may increase the antihypertensive activities of Amlodipine. |
| Amoxapine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Amoxapine. |
| Amphotericin B | The risk or severity of hypotension can be increased when Fostamatinib is combined with Amphotericin B. |
| Amprenavir | The metabolism of Fostamatinib can be decreased when combined with Amprenavir. |
| Amyl Nitrite | The risk or severity of hypotension can be increased when Fostamatinib is combined with Amyl Nitrite. |
| Apalutamide | The metabolism of Fostamatinib can be increased when combined with Apalutamide. |
| Apixaban | Fostamatinib may decrease the excretion rate of Apixaban which could result in a higher serum level. |
| Apomorphine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Apomorphine. |
| Apraclonidine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Apraclonidine. |
| Aprepitant | The metabolism of Fostamatinib can be decreased when combined with Aprepitant. |
| Aripiprazole | The metabolism of Aripiprazole can be decreased when combined with Fostamatinib. |
| Aripiprazole lauroxil | The metabolism of Aripiprazole lauroxil can be decreased when combined with Fostamatinib. |
| Arsenic trioxide | The risk or severity of hypotension can be increased when Fostamatinib is combined with Arsenic trioxide. |
| Asenapine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Asenapine. |
| Astemizole | The metabolism of Astemizole can be decreased when combined with Fostamatinib. |
| Atazanavir | The metabolism of Fostamatinib can be decreased when combined with Atazanavir. |
| Atenolol | Fostamatinib may increase the antihypertensive activities of Atenolol. |
| Atorvastatin | The metabolism of Atorvastatin can be decreased when combined with Fostamatinib. |
| Avanafil | The serum concentration of Avanafil can be increased when it is combined with Fostamatinib. |
| Axitinib | The metabolism of Axitinib can be decreased when combined with Fostamatinib. |
| Azilsartan medoxomil | Fostamatinib may increase the antihypertensive activities of Azilsartan medoxomil. |
| Azithromycin | The metabolism of Azithromycin can be decreased when combined with Fostamatinib. |
| Bazedoxifene | The metabolism of Bazedoxifene can be decreased when combined with Fostamatinib. |
| Belinostat | The metabolism of Belinostat can be decreased when combined with Fostamatinib. |
| Benazepril | Fostamatinib may increase the antihypertensive activities of Benazepril. |
| Bendroflumethiazide | Fostamatinib may increase the antihypertensive activities of Bendroflumethiazide. |
| Bepridil | Fostamatinib may increase the antihypertensive activities of Bepridil. |
| Berotralstat | The serum concentration of Berotralstat can be increased when it is combined with Fostamatinib. |
| Betaxolol | Fostamatinib may increase the antihypertensive activities of Betaxolol. |
| Bethanidine | Fostamatinib may increase the antihypertensive activities of Bethanidine. |
| Bicalutamide | The metabolism of Bicalutamide can be decreased when combined with Fostamatinib. |
| Bictegravir | The metabolism of Bictegravir can be decreased when combined with Fostamatinib. |
| Binimetinib | The metabolism of Binimetinib can be decreased when combined with Fostamatinib. |
| Bisoprolol | Fostamatinib may increase the antihypertensive activities of Bisoprolol. |
| Boceprevir | The metabolism of Fostamatinib can be decreased when combined with Boceprevir. |
| Bortezomib | The metabolism of Bortezomib can be decreased when combined with Fostamatinib. |
| Bosentan | Fostamatinib may increase the antihypertensive activities of Bosentan. |
| Bosutinib | The metabolism of Bosutinib can be decreased when combined with Fostamatinib. |
| Brentuximab vedotin | The metabolism of Brentuximab vedotin can be decreased when combined with Fostamatinib. |
| Bretylium | Fostamatinib may increase the antihypertensive activities of Bretylium. |
| Brexpiprazole | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Brexpiprazole. |
| Brigatinib | The metabolism of Brigatinib can be decreased when combined with Fostamatinib. |
| Brimonidine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Brimonidine. |
| Bromocriptine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Bromocriptine. |
| Bumetanide | The risk or severity of hypotension can be increased when Fostamatinib is combined with Bumetanide. |
| Bupivacaine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Bupivacaine. |
| Buprenorphine | The metabolism of Buprenorphine can be decreased when combined with Fostamatinib. |
| Busulfan | The metabolism of Busulfan can be decreased when combined with Fostamatinib. |
| Cabazitaxel | The metabolism of Cabazitaxel can be decreased when combined with Fostamatinib. |
| Cabergoline | The metabolism of Cabergoline can be decreased when combined with Fostamatinib. |
| Cabotegravir | The metabolism of Cabotegravir can be decreased when combined with Fostamatinib. |
| Canagliflozin | The risk or severity of hypotension can be increased when Fostamatinib is combined with Canagliflozin. |
| Candesartan cilexetil | Fostamatinib may increase the antihypertensive activities of Candesartan cilexetil. |
| Cannabidiol | The metabolism of Fostamatinib can be decreased when combined with Cannabidiol. |
| Captopril | Fostamatinib may increase the antihypertensive activities of Captopril. |
| Carbamazepine | The metabolism of Carbamazepine can be decreased when combined with Fostamatinib. |
| Carbetocin | The risk or severity of hypotension can be increased when Fostamatinib is combined with Carbetocin. |
| Carbimazole | The therapeutic efficacy of Carbimazole can be decreased when used in combination with Fostamatinib. |
| Carteolol | The risk or severity of hypotension can be increased when Fostamatinib is combined with Carteolol. |
| Carvedilol | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Carvedilol. |
| Celecoxib | Fostamatinib may decrease the excretion rate of Celecoxib which could result in a higher serum level. |
| Celiprolol | Fostamatinib may increase the antihypertensive activities of Celiprolol. |
| Cenobamate | The serum concentration of Fostamatinib can be decreased when it is combined with Cenobamate. |
| Cephalexin | The metabolism of Cephalexin can be decreased when combined with Fostamatinib. |
| Ceritinib | The metabolism of Ceritinib can be decreased when combined with Fostamatinib. |
| Cerivastatin | Fostamatinib may decrease the excretion rate of Cerivastatin which could result in a higher serum level. |
| Chlorothiazide | Fostamatinib may increase the antihypertensive activities of Chlorothiazide. |
| Chlorpromazine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Chlorpromazine. |
| Chlorthalidone | Fostamatinib may increase the antihypertensive activities of Chlorthalidone. |
| Cilazapril | Fostamatinib may increase the antihypertensive activities of Cilazapril. |
| Cilostazol | The metabolism of Cilostazol can be decreased when combined with Fostamatinib. |
| Ciprofloxacin | The metabolism of Fostamatinib can be decreased when combined with Ciprofloxacin. |
| Cisapride | The metabolism of Cisapride can be decreased when combined with Fostamatinib. |
| Cladribine | Fostamatinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Clarithromycin | The metabolism of Fostamatinib can be decreased when combined with Clarithromycin. |
| Clevidipine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Clevidipine. |
| Clofarabine | Fostamatinib may decrease the excretion rate of Clofarabine which could result in a higher serum level. |
| Clomipramine | The metabolism of Clomipramine can be decreased when combined with Fostamatinib. |
| Clonidine | The metabolism of Clonidine can be decreased when combined with Fostamatinib. |
| Clozapine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Clozapine. |
| Cobicistat | The metabolism of Fostamatinib can be decreased when combined with Cobicistat. |
| Cobimetinib | The metabolism of Cobimetinib can be decreased when combined with Fostamatinib. |
| Colchicine | The metabolism of Colchicine can be decreased when combined with Fostamatinib. |
| Conivaptan | The metabolism of Fostamatinib can be decreased when combined with Conivaptan. |
| Conjugated estrogens | Fostamatinib may decrease the excretion rate of Conjugated estrogens which could result in a higher serum level. |
| Copanlisib | The metabolism of Copanlisib can be decreased when combined with Fostamatinib. |
| Crizotinib | The metabolism of Crizotinib can be decreased when combined with Fostamatinib. |
| Cryptenamine | Fostamatinib may increase the antihypertensive activities of Cryptenamine. |
| Curcumin | The metabolism of Fostamatinib can be decreased when combined with Curcumin. |
| Cyclopenthiazide | Fostamatinib may increase the antihypertensive activities of Cyclopenthiazide. |
| Cyclophosphamide | The metabolism of Cyclophosphamide can be decreased when combined with Fostamatinib. |
| Cyclosporine | The metabolism of Cyclosporine can be decreased when combined with Fostamatinib. |
| Cyclothiazide | Fostamatinib may increase the antihypertensive activities of Cyclothiazide. |
| Dabrafenib | The serum concentration of Fostamatinib can be decreased when it is combined with Dabrafenib. |
| Dacomitinib | The metabolism of Dacomitinib can be decreased when combined with Fostamatinib. |
| Dactinomycin | Fostamatinib may decrease the excretion rate of Dactinomycin which could result in a higher serum level. |
| Danazol | The metabolism of Fostamatinib can be decreased when combined with Danazol. |
| Dapagliflozin | The risk or severity of hypotension can be increased when Fostamatinib is combined with Dapagliflozin. |
| Darolutamide | Fostamatinib may decrease the excretion rate of Darolutamide which could result in a higher serum level. |
| Darunavir | The metabolism of Fostamatinib can be decreased when combined with Darunavir. |
| Dasatinib | The metabolism of Dasatinib can be decreased when combined with Fostamatinib. |
| Dasiglucagon | Fostamatinib may increase the antihypertensive activities of Dasiglucagon. |
| Daunorubicin | Fostamatinib may decrease the excretion rate of Daunorubicin which could result in a higher serum level. |
| Debrisoquine | Fostamatinib may increase the antihypertensive activities of Debrisoquine. |
| Deferasirox | The metabolism of Deferasirox can be decreased when combined with Fostamatinib. |
| Delafloxacin | Fostamatinib may decrease the excretion rate of Delafloxacin which could result in a higher serum level. |
| Delavirdine | The metabolism of Fostamatinib can be decreased when combined with Delavirdine. |
| Deserpidine | Fostamatinib may increase the antihypertensive activities of Deserpidine. |
| Desflurane | The risk or severity of hypotension can be increased when Fostamatinib is combined with Desflurane. |
| Desvenlafaxine | The metabolism of Fostamatinib can be decreased when combined with Desvenlafaxine. |
| Dexamethasone | The metabolism of Fostamatinib can be increased when combined with Dexamethasone. |
| Dexibuprofen | The metabolism of Dexibuprofen can be decreased when combined with Fostamatinib. |
| Dexmedetomidine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Dexmedetomidine. |
| Diazoxide | Fostamatinib may increase the antihypertensive activities of Diazoxide. |
| Diclofenac | The metabolism of Diclofenac can be decreased when combined with Fostamatinib. |
| Diclofenamide | The risk or severity of hypotension can be increased when Fostamatinib is combined with Diclofenamide. |
| Diflunisal | The metabolism of Fostamatinib can be decreased when combined with Diflunisal. |
| Digitoxin | The metabolism of Digitoxin can be decreased when combined with Fostamatinib. |
| Dihydralazine | Fostamatinib may increase the antihypertensive activities of Dihydralazine. |
| Dihydroergocornine | The metabolism of Dihydroergocornine can be decreased when combined with Fostamatinib. |
| Dihydroergocristine | The metabolism of Dihydroergocristine can be decreased when combined with Fostamatinib. |
| Dihydroergotamine | The metabolism of Dihydroergotamine can be decreased when combined with Fostamatinib. |
| Diltiazem | The metabolism of Fostamatinib can be decreased when combined with Diltiazem. |
| Dinutuximab | The risk or severity of hypotension can be increased when Fostamatinib is combined with Dinutuximab. |
| Dipyridamole | The risk or severity of adverse effects can be increased when Dipyridamole is combined with Fostamatinib. |
| Docetaxel | The metabolism of Docetaxel can be decreased when combined with Fostamatinib. |
| Dofetilide | The metabolism of Dofetilide can be decreased when combined with Fostamatinib. |
| Dolutegravir | Fostamatinib may decrease the excretion rate of Dolutegravir which could result in a higher serum level. |
| Donepezil | Fostamatinib may decrease the excretion rate of Donepezil which could result in a higher serum level. |
| Doxazosin | The risk or severity of hypotension can be increased when Fostamatinib is combined with Doxazosin. |
| Doxepin | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Doxepin. |
| Doxorubicin | The metabolism of Doxorubicin can be decreased when combined with Fostamatinib. |
| Dronabinol | The serum concentration of Dronabinol can be increased when it is combined with Fostamatinib. |
| Dronedarone | The metabolism of Dronedarone can be decreased when combined with Fostamatinib. |
| Droperidol | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Droperidol. |
| Drospirenone | The metabolism of Drospirenone can be decreased when combined with Fostamatinib. |
| Duvelisib | Fostamatinib may decrease the excretion rate of Duvelisib which could result in a higher serum level. |
| Ebastine | The metabolism of Ebastine can be decreased when combined with Fostamatinib. |
| Efavirenz | The metabolism of Fostamatinib can be decreased when combined with Efavirenz. |
| Elagolix | The metabolism of Elagolix can be decreased when combined with Fostamatinib. |
| Elexacaftor | The metabolism of Elexacaftor can be decreased when combined with Fostamatinib. |
| Eliglustat | The metabolism of Eliglustat can be decreased when combined with Fostamatinib. |
| Eltrombopag | The metabolism of Eltrombopag can be decreased when combined with Fostamatinib. |
| Elvitegravir | The metabolism of Fostamatinib can be decreased when combined with Elvitegravir. |
| Empagliflozin | The risk or severity of hypotension can be increased when Fostamatinib is combined with Empagliflozin. |
| Enalapril | Fostamatinib may increase the antihypertensive activities of Enalapril. |
| Enalaprilat | Fostamatinib may increase the antihypertensive activities of Enalaprilat. |
| Enasidenib | The metabolism of Enasidenib can be decreased when combined with Fostamatinib. |
| Entrectinib | The metabolism of Entrectinib can be decreased when combined with Fostamatinib. |
| Enzalutamide | The serum concentration of Fostamatinib can be decreased when it is combined with Enzalutamide. |
| Eplerenone | Fostamatinib may increase the antihypertensive activities of Eplerenone. |
| Epoprostenol | Fostamatinib may increase the antihypertensive activities of Epoprostenol. |
| Eprosartan | Fostamatinib may increase the antihypertensive activities of Eprosartan. |
| Erdafitinib | The metabolism of Erdafitinib can be decreased when combined with Fostamatinib. |
| Ergotamine | The metabolism of Fostamatinib can be decreased when combined with Ergotamine. |
| Erlotinib | The metabolism of Erlotinib can be decreased when combined with Fostamatinib. |
| Ertugliflozin | Fostamatinib may decrease the excretion rate of Ertugliflozin which could result in a higher serum level. |
| Erythrityl tetranitrate | The risk or severity of hypotension can be increased when Fostamatinib is combined with Erythrityl tetranitrate. |
| Erythromycin | The metabolism of Fostamatinib can be decreased when combined with Erythromycin. |
| Eslicarbazepine | The metabolism of Eslicarbazepine can be decreased when combined with Fostamatinib. |
| Eslicarbazepine acetate | The metabolism of Eslicarbazepine acetate can be decreased when combined with Fostamatinib. |
| Esmolol | Fostamatinib may increase the antihypertensive activities of Esmolol. |
| Estetrol | The metabolism of Estetrol can be decreased when combined with Fostamatinib. |
| Estradiol | The metabolism of Estradiol can be decreased when combined with Fostamatinib. |
| Estradiol acetate | The metabolism of Estradiol acetate can be decreased when combined with Fostamatinib. |
| Estradiol benzoate | The metabolism of Estradiol benzoate can be decreased when combined with Fostamatinib. |
| Estradiol cypionate | The metabolism of Estradiol cypionate can be decreased when combined with Fostamatinib. |
| Estradiol dienanthate | The metabolism of Estradiol dienanthate can be decreased when combined with Fostamatinib. |
| Estradiol valerate | The metabolism of Estradiol valerate can be decreased when combined with Fostamatinib. |
| Eszopiclone | The metabolism of Eszopiclone can be decreased when combined with Fostamatinib. |
| Etacrynic acid | The risk or severity of hypotension can be increased when Fostamatinib is combined with Etacrynic acid. |
| Ethanol | Ethanol may increase the hypotensive activities of Fostamatinib. |
| Ethinylestradiol | The metabolism of Ethinylestradiol can be decreased when combined with Fostamatinib. |
| Etoposide | The metabolism of Etoposide can be decreased when combined with Fostamatinib. |
| Everolimus | The metabolism of Everolimus can be decreased when combined with Fostamatinib. |
| Ezetimibe | Fostamatinib may decrease the excretion rate of Ezetimibe which could result in a higher serum level. |
| Ezogabine | The metabolism of Ezogabine can be decreased when combined with Fostamatinib. |
| Febuxostat | The metabolism of Febuxostat can be decreased when combined with Fostamatinib. |
| Felodipine | Fostamatinib may increase the antihypertensive activities of Felodipine. |
| Fenofibrate | The metabolism of Fenofibrate can be decreased when combined with Fostamatinib. |
| Fenoldopam | Fostamatinib may increase the antihypertensive activities of Fenoldopam. |
| Fentanyl | The metabolism of Fentanyl can be decreased when combined with Fostamatinib. |
| Finerenone | The serum concentration of Finerenone can be increased when it is combined with Fostamatinib. |
| Fluconazole | The metabolism of Fostamatinib can be decreased when combined with Fluconazole. |
| Fluorouracil | Fostamatinib may decrease the excretion rate of Fluorouracil which could result in a higher serum level. |
| Flupentixol | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Flupentixol. |
| Flurbiprofen | The metabolism of Flurbiprofen can be decreased when combined with Fostamatinib. |
| Fluvastatin | The metabolism of Fluvastatin can be decreased when combined with Fostamatinib. |
| Fluvoxamine | The metabolism of Fostamatinib can be decreased when combined with Fluvoxamine. |
| Folic acid | Fostamatinib may decrease the excretion rate of Folic acid which could result in a higher serum level. |
| Follitropin | The therapeutic efficacy of Follitropin can be decreased when used in combination with Fostamatinib. |
| Fosaprepitant | The metabolism of Fosaprepitant can be decreased when combined with Fostamatinib. |
| Fosinopril | Fostamatinib may increase the antihypertensive activities of Fosinopril. |
| Fosnetupitant | The metabolism of Fostamatinib can be decreased when combined with Fosnetupitant. |
| Fosphenytoin | The metabolism of Fosphenytoin can be decreased when combined with Fostamatinib. |
| Fostemsavir | Fostamatinib may decrease the excretion rate of Fostemsavir which could result in a higher serum level. |
| Fulvestrant | The metabolism of Fulvestrant can be decreased when combined with Fostamatinib. |
| Furosemide | The metabolism of Furosemide can be decreased when combined with Fostamatinib. |
| Fusidic acid | The metabolism of Fostamatinib can be decreased when combined with Fusidic acid. |
| Gefitinib | Fostamatinib may decrease the excretion rate of Gefitinib which could result in a higher serum level. |
| Gemfibrozil | The metabolism of Gemfibrozil can be decreased when combined with Fostamatinib. |
| Gilteritinib | The metabolism of Gilteritinib can be decreased when combined with Fostamatinib. |
| Glasdegib | Fostamatinib may decrease the excretion rate of Glasdegib which could result in a higher serum level. |
| Glecaprevir | Fostamatinib may decrease the excretion rate of Glecaprevir which could result in a higher serum level. |
| Glipizide | The metabolism of Glipizide can be decreased when combined with Fostamatinib. |
| Glyburide | Fostamatinib may decrease the excretion rate of Glyburide which could result in a higher serum level. |
| Guanabenz | Fostamatinib may increase the antihypertensive activities of Guanabenz. |
| Guanadrel | Fostamatinib may increase the antihypertensive activities of Guanadrel. |
| Guanethidine | Fostamatinib may increase the antihypertensive activities of Guanethidine. |
| Guanfacine | Fostamatinib may increase the antihypertensive activities of Guanfacine. |
| Guanoxan | Fostamatinib may increase the antihypertensive activities of Guanoxan. |
| Haloperidol | The serum concentration of Haloperidol can be increased when it is combined with Fostamatinib. |
| Halothane | The risk or severity of hypotension can be increased when Fostamatinib is combined with Halothane. |
| Hydralazine | Fostamatinib may increase the antihypertensive activities of Hydralazine. |
| Hydrochlorothiazide | Fostamatinib may increase the antihypertensive activities of Hydrochlorothiazide. |
| Hydroflumethiazide | Fostamatinib may increase the antihypertensive activities of Hydroflumethiazide. |
| Ibrutinib | The metabolism of Ibrutinib can be decreased when combined with Fostamatinib. |
| Ibuprofen | The metabolism of Ibuprofen can be decreased when combined with Fostamatinib. |
| Idelalisib | The metabolism of Idelalisib can be decreased when combined with Fostamatinib. |
| Ifosfamide | The metabolism of Ifosfamide can be decreased when combined with Fostamatinib. |
| Iloperidone | The metabolism of Iloperidone can be decreased when combined with Fostamatinib. |
| Iloprost | The risk or severity of hypotension can be increased when Fostamatinib is combined with Iloprost. |
| Imatinib | Fostamatinib may decrease the excretion rate of Imatinib which could result in a higher serum level. |
| Imipramine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Imipramine. |
| Indacaterol | The metabolism of Indacaterol can be decreased when combined with Fostamatinib. |
| Indapamide | Fostamatinib may increase the antihypertensive activities of Indapamide. |
| Indinavir | The metabolism of Fostamatinib can be decreased when combined with Indinavir. |
| Indomethacin | The metabolism of Indomethacin can be decreased when combined with Fostamatinib. |
| Indoramin | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Indoramin. |
| Infigratinib | The metabolism of Infigratinib can be decreased when combined with Fostamatinib. |
| Irbesartan | Fostamatinib may increase the antihypertensive activities of Irbesartan. |
| Irinotecan | The risk or severity of neutropenia can be increased when Fostamatinib is combined with Irinotecan. |
| Isavuconazole | The metabolism of Fostamatinib can be decreased when combined with Isavuconazole. |
| Isavuconazonium | The metabolism of Fostamatinib can be decreased when combined with Isavuconazonium. |
| Isocarboxazid | The risk or severity of hypotension can be increased when Fostamatinib is combined with Isocarboxazid. |
| Isoflurane | The risk or severity of hypotension can be increased when Fostamatinib is combined with Isoflurane. |
| Isoniazid | The metabolism of Fostamatinib can be decreased when combined with Isoniazid. |
| Isosorbide | The risk or severity of hypotension can be increased when Fostamatinib is combined with Isosorbide. |
| Isosorbide dinitrate | The risk or severity of hypotension can be increased when Fostamatinib is combined with Isosorbide dinitrate. |
| Isosorbide mononitrate | Fostamatinib may increase the vasodilatory activities of Isosorbide mononitrate. |
| Isoxsuprine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Isoxsuprine. |
| Isradipine | The metabolism of Fostamatinib can be decreased when combined with Isradipine. |
| Itraconazole | The metabolism of Fostamatinib can be decreased when combined with Itraconazole. |
| Ivermectin | Fostamatinib may decrease the excretion rate of Ivermectin which could result in a higher serum level. |
| Ivosidenib | The metabolism of Fostamatinib can be increased when combined with Ivosidenib. |
| Ixabepilone | The metabolism of Ixabepilone can be decreased when combined with Fostamatinib. |
| Ixazomib | The metabolism of Ixazomib can be decreased when combined with Fostamatinib. |
| Ketoconazole | The metabolism of Fostamatinib can be decreased when combined with Ketoconazole. |
| Ketoprofen | The metabolism of Ketoprofen can be decreased when combined with Fostamatinib. |
| Labetalol | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Labetalol. |
| Lacidipine | Fostamatinib may increase the antihypertensive activities of Lacidipine. |
| Lacosamide | The metabolism of Lacosamide can be decreased when combined with Fostamatinib. |
| Lamivudine | Fostamatinib may decrease the excretion rate of Lamivudine which could result in a higher serum level. |
| Lamotrigine | The metabolism of Lamotrigine can be decreased when combined with Fostamatinib. |
| Lefamulin | The metabolism of Lefamulin can be decreased when combined with Fostamatinib. |
| Leflunomide | Fostamatinib may decrease the excretion rate of Leflunomide which could result in a higher serum level. |
| Lenvatinib | Fostamatinib may decrease the excretion rate of Lenvatinib which could result in a higher serum level. |
| Lercanidipine | Fostamatinib may increase the antihypertensive activities of Lercanidipine. |
| Letermovir | The metabolism of Letermovir can be decreased when combined with Fostamatinib. |
| Levacetylmethadol | The metabolism of Levacetylmethadol can be decreased when combined with Fostamatinib. |
| Levamlodipine | The serum concentration of Levamlodipine can be increased when it is combined with Fostamatinib. |
| Levobunolol | The risk or severity of hypotension can be increased when Fostamatinib is combined with Levobunolol. |
| Levobupivacaine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Levobupivacaine. |
| Levodopa | The risk or severity of hypotension can be increased when Fostamatinib is combined with Levodopa. |
| Levoketoconazole | The metabolism of Fostamatinib can be decreased when combined with Levoketoconazole. |
| Levosimendan | The risk or severity of hypotension can be increased when Fostamatinib is combined with Levosimendan. |
| Levothyroxine | The therapeutic efficacy of Levothyroxine can be decreased when used in combination with Fostamatinib. |
| Linagliptin | The metabolism of Fostamatinib can be decreased when combined with Linagliptin. |
| Liothyronine | The therapeutic efficacy of Liothyronine can be decreased when used in combination with Fostamatinib. |
| Liotrix | The therapeutic efficacy of Liotrix can be decreased when used in combination with Fostamatinib. |
| Lisinopril | Fostamatinib may increase the antihypertensive activities of Lisinopril. |
| Lofexidine | Fostamatinib may increase the antihypertensive activities of Lofexidine. |
| Lomitapide | The metabolism of Lomitapide can be decreased when combined with Fostamatinib. |
| Lonafarnib | The metabolism of Fostamatinib can be decreased when combined with Lonafarnib. |
| Lopinavir | The serum concentration of R406, an active metabolite of Fostamatinib, can be increased when used in combination with Lopinavir. |
| Losartan | The metabolism of Losartan can be decreased when combined with Fostamatinib. |
| Lovastatin | The metabolism of Lovastatin can be decreased when combined with Fostamatinib. |
| Lumacaftor | The metabolism of Fostamatinib can be increased when combined with Lumacaftor. |
| Lumateperone | The serum concentration of Lumateperone can be increased when it is combined with Fostamatinib. |
| Lusutrombopag | Fostamatinib may decrease the excretion rate of Lusutrombopag which could result in a higher serum level. |
| Macitentan | Fostamatinib may increase the antihypertensive activities of Macitentan. |
| Manidipine | Fostamatinib may increase the antihypertensive activities of Manidipine. |
| Mannitol | The risk or severity of hypotension can be increased when Fostamatinib is combined with Mannitol. |
| Mavacamten | The serum concentration of Fostamatinib can be decreased when it is combined with Mavacamten. |
| Mecamylamine | Fostamatinib may increase the antihypertensive activities of Mecamylamine. |
| Mefenamic acid | The metabolism of Fostamatinib can be decreased when combined with Mefenamic acid. |
| Meperidine | The metabolism of Meperidine can be decreased when combined with Fostamatinib. |
| Methazolamide | The risk or severity of hypotension can be increased when Fostamatinib is combined with Methazolamide. |
| Methimazole | The metabolism of Fostamatinib can be decreased when combined with Methimazole. |
| Methotrexate | The metabolism of Methotrexate can be decreased when combined with Fostamatinib. |
| Methotrimeprazine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Methotrimeprazine. |
| Methyldopa | Fostamatinib may increase the antihypertensive activities of Methyldopa. |
| Methylene blue | The metabolism of Fostamatinib can be decreased when combined with Methylene blue. |
| Methylprednisone | The metabolism of Methylprednisone can be decreased when combined with Fostamatinib. |
| Methysergide | The metabolism of Methysergide can be decreased when combined with Fostamatinib. |
| Metipranolol | The risk or severity of hypotension can be increased when Fostamatinib is combined with Metipranolol. |
| Metolazone | Fostamatinib may increase the antihypertensive activities of Metolazone. |
| Metoprolol | Fostamatinib may increase the antihypertensive activities of Metoprolol. |
| Metreleptin | The metabolism of Fostamatinib can be increased when combined with Metreleptin. |
| Metronidazole | The metabolism of Metronidazole can be decreased when combined with Fostamatinib. |
| Metyrosine | Fostamatinib may increase the antihypertensive activities of Metyrosine. |
| Miconazole | The metabolism of Fostamatinib can be decreased when combined with Miconazole. |
| Midazolam | The serum concentration of Midazolam can be increased when it is combined with Fostamatinib. |
| Midostaurin | The metabolism of Fostamatinib can be decreased when combined with Midostaurin. |
| Migalastat | The metabolism of Migalastat can be decreased when combined with Fostamatinib. |
| Milnacipran | The metabolism of Fostamatinib can be decreased when combined with Milnacipran. |
| Minoxidil | The metabolism of Minoxidil can be decreased when combined with Fostamatinib. |
| Mitotane | The metabolism of Fostamatinib can be increased when combined with Mitotane. |
| Mitoxantrone | Fostamatinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level. |
| Moexipril | Fostamatinib may increase the antihypertensive activities of Moexipril. |
| Molsidomine | Molsidomine may increase the hypotensive activities of Fostamatinib. |
| Morphine | The metabolism of Morphine can be decreased when combined with Fostamatinib. |
| Moxonidine | Fostamatinib may increase the antihypertensive activities of Moxonidine. |
| Muzolimine | Fostamatinib may increase the antihypertensive activities of Muzolimine. |
| Mycophenolate mofe | Fostamatinib may decrease the excretion rate of Mycophenolate mofetil which could result in a higher serum level. |
| Mycophenolic acid | The metabolism of Mycophenolic acid can be decreased when combined with Fostamatinib. |
| Nabilone | The risk or severity of hypotension can be increased when Fostamatinib is combined with Nabilone. |
| Nadolol | Fostamatinib may increase the antihypertensive activities of Nadolol. |
| Naloxone | The metabolism of Fostamatinib can be decreased when combined with Naloxone. |
| Naltrexone | The metabolism of Naltrexone can be decreased when combined with Fostamatinib. |
| Naproxen | The metabolism of Naproxen can be decreased when combined with Fostamatinib. |
| Nebivolol | Fostamatinib may increase the antihypertensive activities of Nebivolol. |
| Nefazodone | The metabolism of Fostamatinib can be decreased when combined with Nefazodone. |
| Nelfinavir | The metabolism of Fostamatinib can be decreased when combined with Nelfinavir. |
| Neratinib | The metabolism of Neratinib can be decreased when combined with Fostamatinib. |
| Nesiritide | The risk or severity of hypotension can be increased when Fostamatinib is combined with Nesiritide. |
| Netupitant | The metabolism of Fostamatinib can be decreased when combined with Netupitant. |
| Nicardipine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Nicardipine. |
| Nicergoline | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Nicergoline. |
| Nicorandil | Fostamatinib may increase the hypotensive activities of Nicorandil. |
| Nifedipine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Nifedipine. |
| Nilotinib | The metabolism of Fostamatinib can be decreased when combined with Nilotinib. |
| Nilvadipine | The metabolism of Fostamatinib can be decreased when combined with Nilvadipine. |
| Nimodipine | Fostamatinib may increase the antihypertensive activities of Nimodipine. |
| Nintedanib | The metabolism of Nintedanib can be decreased when combined with Fostamatinib. |
| Nisoldipine | Fostamatinib may increase the antihypertensive activities of Nisoldipine. |
| Nitrendipine | Fostamatinib may increase the antihypertensive activities of Nitrendipine. |
| Nitric Oxide | The risk or severity of hypotension can be increased when Fostamatinib is combined with Nitric Oxide. |
| Nitrofurantoin | Fostamatinib may decrease the excretion rate of Nitrofurantoin which could result in a higher serum level. |
| Nitroglycerin | The risk or severity of hypotension can be increased when Fostamatinib is combined with Nitroglycerin. |
| Nitroprusside | Fostamatinib may increase the antihypertensive activities of Nitroprusside. |
| Nitrous acid | The risk or severity of hypotension can be increased when Fostamatinib is combined with Nitrous acid. |
| Norethisterone | The metabolism of Norethisterone can be decreased when combined with Fostamatinib. |
| Norgestimate | The metabolism of Norgestimate can be decreased when combined with Fostamatinib. |
| Nortriptyline | The metabolism of Nortriptyline can be decreased when combined with Fostamatinib. |
| Obinutuzumab | The risk or severity of hypotension can be increased when Fostamatinib is combined with Obinutuzumab. |
| Olanzapine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Olanzapine. |
| Olaparib | The metabolism of Olaparib can be decreased when combined with Fostamatinib. |
| Olmesartan | Fostamatinib may increase the antihypertensive activities of Olmesartan. |
| Ombitasvir | Fostamatinib may decrease the excretion rate of Ombitasvir which could result in a higher serum level. |
| Opicapone | The risk or severity of hypotension can be increased when Fostamatinib is combined with Opicapone. |
| Osimertinib | The metabolism of Osimertinib can be decreased when combined with Fostamatinib. |
| Oxaliplatin | Fostamatinib may decrease the excretion rate of Oxaliplatin which could result in a higher serum level. |
| Oxprenolol | Fostamatinib may increase the antihypertensive activities of Oxprenolol. |
| Ozanimod | Fostamatinib may decrease the excretion rate of Ozanimod which could result in a higher serum level. |
| Paclitaxel | The metabolism of Paclitaxel can be decreased when combined with Fostamatinib. |
| Palbociclib | The metabolism of Palbociclib can be decreased when combined with Fostamatinib. |
| Paliperidone | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Paliperidone. |
| Panobinostat | The metabolism of Panobinostat can be decreased when combined with Fostamatinib. |
| Papaverine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Papaverine. |
| Parathyroid hormone | The therapeutic efficacy of Parathyroid hormone can be decreased when used in combination with Fostamatinib. |
| Pargyline | Fostamatinib may increase the antihypertensive activities of Pargyline. |
| Patent Blue | The therapeutic efficacy of Fostamatinib can be decreased when used in combination with Patent Blue. |
| Pazopanib | The metabolism of Pazopanib can be decreased when combined with Fostamatinib. |
| Penbutolol | Fostamatinib may increase the antihypertensive activities of Penbutolol. |
| Pentaerythritol | The risk or severity of hypotension can be increased when Fostamatinib is combined with Pentaerythritol tetranitrate. |
| Pentobarbital | The metabolism of Fostamatinib can be increased when combined with Pentobarbital. |
| Pentolinium | Fostamatinib may increase the antihypertensive activities of Pentolinium. |
| Periciazine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Periciazine. |
| Perindopril | Fostamatinib may increase the antihypertensive activities of Perindopril. |
| Pexidartinib | The metabolism of Pexidartinib can be decreased when combined with Fostamatinib. |
| Phenelzine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Phenelzine. |
| Phenobarbital | The metabolism of Fostamatinib can be increased when combined with Phenobarbital. |
| Phenoxybenzamine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Phenoxybenzamine. |
| Phenprocoumon | The metabolism of Phenprocoumon can be decreased when combined with Fostamatinib. |
| Phentolamine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Phentolamine. |
| Phenylephrine | The risk or severity of hypertension can be decreased when Fostamatinib is combined with Phenylephrine. |
| Phenytoin | The metabolism of Fostamatinib can be increased when combined with Phenytoin. |
| Pibrentasvir | Fostamatinib may decrease the excretion rate of Pibrentasvir which could result in a higher serum level. |
| Pimavanserin | The metabolism of Pimavanserin can be decreased when combined with Fostamatinib. |
| Pimozide | The metabolism of Pimozide can be decreased when combined with Fostamatinib. |
| Pinacidil | Fostamatinib may increase the antihypertensive activities of Pinacidil. |
| Pindolol | Fostamatinib may increase the antihypertensive activities of Pindolol. |
| Pitavastatin | Fostamatinib may decrease the excretion rate of Pitavastatin which could result in a higher serum level. |
| Pitolisant | The serum concentration of Fostamatinib can be decreased when it is combined with Pitolisant. |
| Pizotifen | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Pizotifen. |
| Polythiazide | Fostamatinib may increase the antihypertensive activities of Polythiazide. |
| Pomalidomide | The metabolism of Pomalidomide can be decreased when combined with Fostamatinib. |
| Ponatinib | The metabolism of Ponatinib can be decreased when combined with Fostamatinib. |
| Ponesimod | The metabolism of Ponesimod can be decreased when combined with Fostamatinib. |
| Posaconazole | The metabolism of Fostamatinib can be decreased when combined with Posaconazole. |
| Potassium Iodide | The therapeutic efficacy of Potassium Iodide can be decreased when used in combination with Fostamatinib. |
| Potassium perchlorate | The therapeutic efficacy of Potassium perchlorate can be decreased when used in combination with Fostamatinib. |
| Practolol | Fostamatinib may increase the antihypertensive activities of Practolol. |
| Pralatrexate | Fostamatinib may decrease the excretion rate of Pralatrexate which could result in a higher serum level. |
| Pralsetinib | Fostamatinib may decrease the excretion rate of Pralsetinib which could result in a higher serum level. |
| Pramipexole | The risk or severity of hypotension can be increased when Fostamatinib is combined with Pramipexole. |
| Pravastatin | Fostamatinib may decrease the excretion rate of Pravastatin which could result in a higher serum level. |
| Prazosin | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Prazosin. |
| Pretomanid | The metabolism of Pretomanid can be decreased when combined with Fostamatinib. |
| Primaquine | The metabolism of Fostamatinib can be decreased when combined with Primaquine. |
| Primidone | The metabolism of Fostamatinib can be increased when combined with Primidone. |
| Promazine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Promazine. |
| Propiomazine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Propiomazine. |
| Propiverine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Propiverine. |
| Propofol | The metabolism of Propofol can be decreased when combined with Fostamatinib. |
| Propranolol | Fostamatinib may increase the antihypertensive activities of Propranolol. |
| Propylthiouracil | The therapeutic efficacy of Propylthiouracil can be decreased when used in combination with Fostamatinib. |
| Protirelin | The therapeutic efficacy of Protirelin can be decreased when used in combination with Fostamatinib. |
| Prucalopride | The metabolism of Prucalopride can be decreased when combined with Fostamatinib. |
| Quetiapine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Quetiapine. |
| Quinapril | Fostamatinib may increase the antihypertensive activities of Quinapril. |
| Quinidine | The metabolism of Quinidine can be decreased when combined with Fostamatinib. |
| Raloxifene | Fostamatinib may decrease the excretion rate of Raloxifene which could result in a higher serum level. |
| Raltegravir | The metabolism of Raltegravir can be decreased when combined with Fostamatinib. |
| Ramipril | Fostamatinib may increase the antihypertensive activities of Ramipril. |
| Rasagiline | The risk or severity of hypotension can be increased when Fostamatinib is combined with Rasagiline. |
| Regorafenib | The metabolism of Regorafenib can be decreased when combined with Fostamatinib. |
| Remifentanil | The risk or severity of hypotension can be increased when Fostamatinib is combined with Remifentanil. |
| Rescinnamine | Fostamatinib may increase the antihypertensive activities of Rescinnamine. |
| Reserpine | Fostamatinib may increase the antihypertensive activities of Reserpine. |
| Retapamulin | The metabolism of Retapamulin can be decreased when combined with Fostamatinib. |
| Revefenacin | Fostamatinib may decrease the excretion rate of Revefenacin which could result in a higher serum level. |
| Ribociclib | The metabolism of Fostamatinib can be decreased when combined with Ribociclib. |
| Rifampicin | The metabolism of Fostamatinib can be increased when combined with Rifampicin. |
| Rifamycin | The metabolism of Fostamatinib can be increased when combined with Rifamycin. |
| Rifapentine | The metabolism of Fostamatinib can be increased when combined with Rifapentine. |
| Rilmenidine | Fostamatinib may increase the antihypertensive activities of Rilmenidine. |
| Riluzole | Fostamatinib may decrease the excretion rate of Riluzole which could result in a higher serum level. |
| Rimegepant | The serum concentration of Rimegepant can be increased when it is combined with Fostamatinib. |
| Riociguat | Fostamatinib may increase the hypotensive activities of Riociguat. |
| Ripretinib | Fostamatinib may decrease the excretion rate of Ripretinib which could result in a higher serum level. |
| Risperidone | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Risperidone. |
| Ritonavir | The serum concentration of R406, an active metabolite of Fostamatinib, can be increased when used in combination with Ritonavir. |
| Rivaroxaban | Fostamatinib may decrease the excretion rate of Rivaroxaban which could result in a higher serum level. |
| Roflumilast | The serum concentration of Roflumilast can be increased when it is combined with Fostamatinib. |
| Romidepsin | The metabolism of Romidepsin can be decreased when combined with Fostamatinib. |
| Ropinirole | The risk or severity of hypotension can be increased when Fostamatinib is combined with Ropinirole. |
| Ropivacaine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Ropivacaine. |
| Rosuvastatin | Fostamatinib may decrease the excretion rate of Rosuvastatin which could result in a higher serum level. |
| Rotigotine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Rotigotine. |
| Rucaparib | Fostamatinib may decrease the excretion rate of Rucaparib which could result in a higher serum level. |
| Ruxolitinib | The metabolism of Ruxolitinib can be decreased when combined with Fostamatinib. |
| Sacituzumab govitecan | The serum concentration of Sacituzumab govitecan can be increased when it is combined with Fostamatinib. |
| Sacubitril | The risk or severity of hypotension can be increased when Fostamatinib is combined with Sacubitril. |
| Salmon calcitonin | The therapeutic efficacy of Salmon calcitonin can be decreased when used in combination with Fostamatinib. |
| Sapropterin | Sapropterin may increase the hypotensive activities of Fostamatinib. |
| Saquinavir | The metabolism of Fostamatinib can be decreased when combined with Saquinavir. |
| Satralizumab | The serum concentration of Fostamatinib can be decreased when it is combined with Satralizumab. |
| Selegiline | The risk or severity of hypotension can be increased when Fostamatinib is combined with Selegiline. |
| Selexipag | Fostamatinib may increase the antihypertensive activities of Selexipag. |
| Selumetinib | Fostamatinib may decrease the excretion rate of Selumetinib which could result in a higher serum level. |
| Sevoflurane | The risk or severity of hypotension can be increased when Fostamatinib is combined with Sevoflurane. |
| Sildenafil | The risk or severity of adverse effects can be increased when Sildenafil is combined with Fostamatinib. |
| Silodosin | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Silodosin. |
| Simeprevir | The metabolism of Fostamatinib can be decreased when combined with Simeprevir. |
| Simvastatin | The metabolism of Simvastatin can be decreased when combined with Fostamatinib. |
| Siponimod | The metabolism of Siponimod can be decreased when combined with Fostamatinib. |
| Sirolimus | The metabolism of Sirolimus can be decreased when combined with Fostamatinib. |
| Sitaxentan | Fostamatinib may increase the antihypertensive activities of Sitaxentan. |
| Sofosbuvir | Fostamatinib may decrease the excretion rate of Sofosbuvir which could result in a higher serum level. |
| Somatrogon | The metabolism of Fostamatinib can be increased when combined with Somatrogon. |
| Sonidegib | The metabolism of Sonidegib can be decreased when combined with Fostamatinib. |
| Sorafenib | The metabolism of Sorafenib can be decreased when combined with Fostamatinib. |
| Sotalol | The risk or severity of hypotension can be increased when Fostamatinib is combined with Sotalol. |
| Sotorasib | The serum concentration of Fostamatinib can be decreased when it is combined with Sotorasib. |
| Spirapril | Fostamatinib may increase the antihypertensive activities of Spirapril. |
| Spironolactone | The risk or severity of hypotension can be increased when Fostamatinib is combined with Spironolactone. |
| St. John’s Wort | The metabolism of Fostamatinib can be increased when combined with St. John’s Wort. |
| Stiripentol | The metabolism of Fostamatinib can be decreased when combined with Stiripentol. |
| Streptokinase | The risk or severity of hypotension can be increased when Fostamatinib is combined with Streptokinase. |
| Sufentanil | The risk or severity of hypotension can be increased when Fostamatinib is combined with Sufentanil. |
| Sulfasalazine | Fostamatinib may decrease the excretion rate of Sulfasalazine which could result in a higher serum level. |
| Sumatriptan | Fostamatinib may decrease the excretion rate of Sumatriptan which could result in a higher serum level. |
| Sunitinib | The metabolism of Sunitinib can be decreased when combined with Fostamatinib. |
| Suvorexant | The metabolism of Suvorexant can be decreased when combined with Fostamatinib |
| Tacrolimus | The serum concentration of Tacrolimus can be increased when it is combined with Fostamatinib. |
| Tadalafil | The risk or severity of adverse effects can be increased when Tadalafil is combined with Fostamatinib. |
| Talazoparib | Fostamatinib may decrease the excretion rate of Talazoparib which could result in a higher serum level. |
| Tamoxifen | The metabolism of Tamoxifen can be decreased when combined with Fostamatinib. |
| Tamsulosin | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Tamsulosin. |
| Tasimelteon | The metabolism of Tasimelteon can be decreased when combined with Fostamatinib. |
| Tazemetostat | Fostamatinib may decrease the excretion rate of Tazemetostat which could result in a higher serum level. |
| Tegaserod | Fostamatinib may decrease the excretion rate of Tegaserod which could result in a higher serum level. |
| Telaprevir | The metabolism of Fostamatinib can be decreased when combined with Telaprevir. |
| Telithromycin | The metabolism of Fostamatinib can be decreased when combined with Telithromycin. |
| Telmisartan | Fostamatinib may increase the antihypertensive activities of Telmisartan. |
| Telotristat ethyl | The serum concentration of Fostamatinib can be decreased when it is combined with Telotristat ethyl. |
| Temsirolimus | The metabolism of Temsirolimus can be decreased when combined with Fostamatinib. |
| Teniposide | The metabolism of Teniposide can be decreased when combined with Fostamatinib. |
| Tenofovir alafenamide | The serum concentration of Tenofovir alafenamide can be increased when it is combined with Fostamatinib. |
| Terazosin | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Terazosin. |
| Terfenadine | The metabolism of Fostamatinib can be decreased when combined with Terfenadine. |
| Teriflunomide | Fostamatinib may decrease the excretion rate of Teriflunomide which could result in a higher serum level. |
| Teriparatide | The therapeutic efficacy of Teriparatide can be decreased when used in combination with Fostamatinib. |
| Testosterone | Fostamatinib may decrease the excretion rate of Testosterone which could result in a higher serum level. |
| Testosterone cypionate | Fostamatinib may decrease the excretion rate of Testosterone cypionate which could result in a higher serum level. |
| Testosterone enanthate | Fostamatinib may decrease the excretion rate of Testosterone enanthate which could result in a higher serum level. |
| Thalidomide | The risk or severity of hypotension can be increased when Fostamatinib is combined with Thalidomide. |
| Theophylline | The metabolism of Theophylline can be decreased when combined with Fostamatinib. |
| Thiopental | The risk or severity of hypotension can be increased when Fostamatinib is combined with Thiopental. |
| Thioridazine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Thioridazine. |
| Thiotepa | The metabolism of Thiotepa can be decreased when combined with Fostamatinib. |
| Thyroid, porcine | The therapeutic efficacy of Thyroid, porcine can be decreased when used in combination with Fostamatinib. |
| Thyrotropin alfa | The therapeutic efficacy of Thyrotropin alfa can be decreased when used in combination with Fostamatinib. |
| Tiagabine | The metabolism of Tiagabine can be decreased when combined with Fostamatinib. |
| Timolol | Fostamatinib may increase the antihypertensive activities of Timolol. |
| Tipranavir | The metabolism of Fostamatinib can be decreased when combined with Tipranavir. |
| Tizanidine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Tizanidine. |
| Tofacitinib | The metabolism of Tofacitinib can be decreased when combined with Fostamatinib. |
| Tolazoline | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Tolazoline. |
| Tolcapone | The risk or severity of hypotension can be increased when Fostamatinib is combined with Tolcapone. |
| Tolvaptan | The metabolism of Tolvaptan can be decreased when combined with Fostamatinib. |
| Topotecan | Fostamatinib may decrease the excretion rate of Topotecan which could result in a higher serum level. |
| Torasemide | Fostamatinib may increase the antihypertensive activities of Torasemide. |
| Trabectedin | The metabolism of Trabectedin can be decreased when combined with Fostamatinib. |
| Tramadol | The metabolism of Tramadol can be decreased when combined with Fostamatinib. |
| Trandolapril | Fostamatinib may increase the antihypertensive activities of Trandolapril. |
| Tranylcypromine | The risk or severity of hypotension can be increased when Fostamatinib is combined with Tranylcypromine. |
| Trastuzumab emtansine | The metabolism of Trastuzumab emtansine can be decreased when combined with Fostamatinib. |
| Trazodone | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Trazodone. |
| Treprostinil | Fostamatinib may increase the antihypertensive activities of Treprostinil. |
| Tretinoin | The risk or severity of hypotension can be increased when Fostamatinib is combined with Tretinoin. |
| Triamterene | The risk or severity of hypotension can be increased when Fostamatinib is combined with Triamterene. |
| Trichlormethiazide | Fostamatinib may increase the antihypertensive activities of Trichlormethiazide. |
| Trifluoperazine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Trifluoperazine. |
| Trilaciclib | Fostamatinib may decrease the excretion rate of Trilaciclib which could result in a higher serum level. |
| Trimethaphan | Fostamatinib may increase the antihypertensive activities of Trimethaphan. |
| Trimipramine | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Trimipramine. |
| Troglitazone | The metabolism of Troglitazone can be decreased when combined with Fostamatinib. |
| Troleandomycin | The metabolism of Fostamatinib can be decreased when combined with Troleandomycin. |
| Tucatinib | The metabolism of Tucatinib can be decreased when combined with Fostamatinib. |
| Ubrogepant | The serum concentration of Ubrogepant can be increased when it is combined with Fostamatinib. |
| Udenafil | The risk or severity of adverse effects can be increased when Udenafil is combined with Fostamatinib. |
| Valproic acid | The metabolism of Valproic acid can be decreased when combined with Fostamatinib. |
| Valsartan | Fostamatinib may increase the antihypertensive activities of Valsartan. |
| Vandetanib | The metabolism of Vandetanib can be decreased when combined with Fostamatinib. |
| Vardenafil | The metabolism of Vardenafil can be decreased when combined with Fostamatinib. |
| Velpatasvir | Fostamatinib may decrease the excretion rate of Velpatasvir which could result in a higher serum level. |
| Vemurafenib | The metabolism of Vemurafenib can be decreased when combined with Fostamatinib. |
| Venetoclax | The metabolism of Venetoclax can be decreased when combined with Fostamatinib. |
| Verapamil | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Verapamil. |
| Vericiguat | The risk or severity of hypotension can be increased when Fostamatinib is combined with Vericiguat. |
| Viloxazine | The metabolism of Fostamatinib can be decreased when combined with Viloxazine. |
| Vinblastine | The metabolism of Vinblastine can be decreased when combined with Fostamatinib. |
| Vincristine | The metabolism of Vincristine can be decreased when combined with Fostamatinib. |
| Vindesine | The metabolism of Vindesine can be decreased when combined with Fostamatinib. |
| Vinflunine | The metabolism of Vinflunine can be decreased when combined with Fostamatinib. |
| Vinorelbine | The metabolism of Vinorelbine can be decreased when combined with Fostamatinib. |
| Vorapaxar | The metabolism of Vorapaxar can be decreased when combined with Fostamatinib. |
| Voriconazole | The serum concentration of Fostamatinib can be increased when it is combined with Voriconazole. |
| Voxelotor | The serum concentration of Voxelotor can be increased when it is combined with Fostamatinib. |
| Voxilaprevir | Fostamatinib may decrease the excretion rate of Voxilaprevir which could result in a higher serum level. |
| Warfarin | The serum concentration of Warfarin can be increased when it is combined with Fostamatinib. |
| Zanubrutinib | The metabolism of Zanubrutinib can be decreased when combined with Fostamatinib. |
| Zidovudine | Fostamatinib may decrease the excretion rate of Zidovudine which could result in a higher serum level. |
| Zimelidine | The metabolism of Fostamatinib can be decreased when combined with Zimelidine. |
| Ziprasidone | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Ziprasidone. |
| Zofenopril | Fostamatinib may increase the antihypertensive activities of Zofenopril. |
| Zonisamide | The metabolism of Zonisamide can be decreased when combined with Fostamatinib. |
| Zopiclone | The metabolism of Zopiclone can be decreased when combined with Fostamatinib. |
| Zuclopenthixol | The risk or severity of hypotension and syncope can be increased when Fostamatinib is combined with Zuclopenthixol. |
Pregnancy and Lactation
US FDA pregnancy category: Not assigned.
Pregnancy
Based on findings from animal studies and the mechanism of action, this drug can cause fetal harm when administered to a pregnant woman. Adequate methods of contraception should be encouraged. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus.
Lactation
- Use is not recommended.
- Excreted into human milk: Data not available
- Excreted into animal milk: Yes
- The effects on the nursing infant are unknown.
- The manufacturer recommends that women do not breastfeed during therapy and for at least 1 month after the last dose.
How should this medicine be used?
Fostamatinib comes as a tablet to take by mouth. It is usually taken with or without food twice daily. Take fostamatinib at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take fostamatinib exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor may need to reduce, interrupt, or discontinue your treatment if you experience certain side effects or depending on your treatment response. If your number of platelets (platelet count) does not increase to a certain level after 12 weeks of treatment, your doctor may have to discontinue your treatment. Talk to your doctor about how you are feeling during your treatment. Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
What special precautions should I follow?
Before taking fostamatinib,
- tell your doctor and pharmacist if you are allergic to fostamatinib, any other medications, or any of the ingredients in fostamatinib tablets. Ask your pharmacist for a list of the ingredients.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: clarithromycin (Biaxin, in Prevpac), digoxin (Lanoxin), itraconazole (Onmel, Sporanox), ketoconazole, rifampin (Rifadin, Rimactane, in Rifamate, in Rifater), and rosuvastatin (Crestor). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with fostamatinib, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
- tell your doctor if you have or have ever had high blood pressure or liver disease.
- tell your doctor if you are pregnant or plan to become pregnant. You will need to have a pregnancy test before you start treatment, and you should use birth control to prevent pregnancy during your fostamatinib treatment and for at least 1 month after your final dose. Talk to your doctor about birth control methods that you can use. If you become pregnant, call your doctor immediately. Fostamatinib may harm the fetus.
- tell your doctor if you are breastfeeding. You should not breastfeed during your treatment with fostamatinib and for at least 1 month after your final dose.
References
