From the Guidelines
Individuals with Gilbert's syndrome should avoid nilotinib due to its potential to cause unconjugated hyperbilirubinemia, although this is typically without clinical impact, as stated in the 2020 European LeukemiaNet recommendations 1. When considering medication management for patients with Gilbert's syndrome, it is essential to prioritize those that may exacerbate the condition or lead to adverse effects.
- Medications that may be problematic for individuals with Gilbert's syndrome include those that are metabolized by the UGT1A1 enzyme, such as certain HIV medications and chemotherapy drugs.
- Nilotinib, a tyrosine kinase inhibitor, is known to compete for UDP glucuronyl transferase, which may result in unconjugated hyperbilirubinemia in patients with Gilbert's disease, as noted in the 2020 study 1.
- While the clinical impact of this interaction is typically minimal, it is crucial to exercise caution when prescribing medications that may affect bilirubin metabolism in patients with Gilbert's syndrome.
- Other medications, such as bosutinib, may also cause hepatotoxicity, although this is usually limited to an increase in transaminases rather than more severe liver injury, as reported in the same study 1.
- Ultimately, careful consideration and monitoring are necessary when managing medication regimens for individuals with Gilbert's syndrome to minimize potential risks and ensure optimal outcomes.
From the Research
Medications to Avoid in Patients with Gilbert's Syndrome
The following medications may be problematic for patients with Gilbert's syndrome:
- Antiepileptic drugs such as valproic acid, lamotrigine, phenobarbital, phenytoin, and carbamazepine, which can impair liver function 2
- Antineoplastic agents, which can have toxic side effects due to altered drug metabolism in patients with Gilbert's syndrome 3
- Irinotecan, which can cause severe toxicity in patients with Gilbert's syndrome due to impaired glucuronidation 4, 5
- Atazanavir, which can also be affected by the impaired glucuronidation associated with Gilbert's syndrome 5
- Rifampicin, which can increase unconjugated bilirubin levels in patients with Gilbert's syndrome, although it may also be used as a diagnostic test 6
- Morphine, which can have problems with metabolism in patients with Gilbert's syndrome 4
Key Considerations
When prescribing medications to patients with Gilbert's syndrome, it is essential to consider the potential impact of the syndrome on drug metabolism and to adjust doses accordingly. Patients with Gilbert's syndrome may require closer monitoring and more frequent liver function tests to ensure safe and effective treatment 2, 3, 4.