Management of Patients with Nonmetastatic Castration-Resistant Prostate Cancer: Recommendations of a Multidisciplinary Panel of Experts from South America

Box 4

Recommendations regarding the management of drug-drug interactions in patients with M0CRPC.

Owing to limited phase IV clinical data on second-generation antiandrogens and the multimorbid profile of patients with M0CRPC, clinicians should carefully review potential drug-to-drug interactions when prescribing therapies in this setting

Particular attention should be given to drugs frequently present in the therapeutic plan of M0CRPC patients and to suspected or confirmed interactions with some second-generation antiandrogens Hypertension Diltiazem (CYP3A4 inhibitor) Carvedilol, verapamil (P-gp inhibitor) Dyslipidemia Lovastatin, simvastatin (CYP3A4 substrate) Rosuvastatin (BCRP substrate) Gemfibrozil (CYP2C8 inhibitor) Cardiac disease Clopidogrel (CYP2C8 inhibitor) Amiodarone, carvedilol, verapamil (P-gp inhibitor) Amiodarone, diltiazem (CYP3A4 inhibitor) Dabigatran, digoxin (P-gp substrate) Warfarin (CYP2C9 substrate) Rivaroxaban (CYP3A substrate) Pain management in CRPC Oxycodone (CYP3A4 substrate) Fentanyl (CYP3A4 substrate) Midazolam (CYP3A4 substrate)