Details of the Drug

General Information of Drug (ID: DMP6SC2)

Drug Name

Irinotecan

Synonyms

Biotecan; Camptosar; Irinotecanum; IRINOTECAN HYDROCHLORIDE Trihydrate; Irinotecan Hcl; Irinotecan hydrochloride; CP0; Biotecan (TN); Campto (TN); Camptosar (TN); Irinotecan (INN); Irinotecan [INN:BAN]; Irinotecanum [INN-Latin]; IRINOTECAN, CPT-11; Camptosar, Campto, CPT-11, Irinotecan; (+)-Irinotecan; (4S)-4,11-DIETHYL-4-HYDROXY-3,14-DIOXO-3,4,12,14-TETRAHYDRO-1H-PYRANO[3',4':6,7]INDOLIZINO[1,2-B]QUINOLIN-9-YL 1,4'-BIPIPERIDINE-1'-CARBOXYLATE; (4S)-4,11-Diethyl-4-hydroxy-3,14-dioxo-4,12-dihydro-1H-pyrano[3,4-f]quinolino[2,3-a]indolizin-9-yl 4-piperidylpiperidinecarboxylate; Irinotecan (TOPO1 inhibitor); Onivyde

Indication

Disease Entry	ICD 11	Status	REF
Adenocarcinoma	2D40	Approved	[1]
Advanced cancer	2A00-2F9Z	Approved	[1]
Appendiceal neoplasm	N.A.	Approved	[1]
Astrocytoma	2A00.0Y	Approved	[1]
Brain glioma	N.A.	Approved	[1]
Colon adenocarcinoma	N.A.	Approved	[1]
Colorectal cancer	2B91.Z	Approved	[2]
Endocrine gland neoplasm	N.A.	Approved	[1]
Kidney neoplasm	N.A.	Approved	[1]
Metastasis from malignant tumor of colon	N.A.	Approved	[1]
Peritoneal neoplasm	N.A.	Approved	[1]
Rectal adenocarcinoma	2B92	Approved	[1]
Rectal neoplasm	N.A.	Approved	[1]
Rectum mucinous adenocarcinoma	N.A.	Approved	[1]
Adult glioblastoma	N.A.	Investigative	[1]
Colon cancer	2B90.Z	Investigative	[1]
Colon mucinous adenocarcinoma	N.A.	Investigative	[1]
Diarrhea	ME05.1	Investigative	[1]
Gastric cancer	2B72	Investigative	[1]
Neuroblastoma	2D11.2	Investigative	[1]
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Therapeutic Class

Anticancer Agents

Drug Type

Small molecular drug

Structure

3D MOL

2D MOL

#Ro5 Violations (Lipinski): 1

Molecular Weight (mw)

586.7

Logarithm of the Partition Coefficient (xlogp)

Rotatable Bond Count (rotbonds)

Hydrogen Bond Donor Count (hbonddonor)

Hydrogen Bond Acceptor Count (hbondacc)

ADMET Property

Absorption AUC: The area under the plot of plasma concentration (AUC) of drug is 10,200 mcgh/L []
Absorption Cmax: The maximum plasma concentration (Cmax) of drug is 1660 mcg/L []
BDDCS Class: Biopharmaceutics Drug Disposition Classification System (BDDCS) Class 1: high solubility and high permeability [3]
Clearance: The drug present in the plasma can be removed from the body at the rate of 7 mL/min/kg [4]
Elimination: 16.7% of drug is excreted from urine in the unchanged form [3]
Half-life: The concentration or amount of drug in body reduced by one-half in 6 - 12 hours [4]
Metabolism: The drug is metabolized via the hepatic []
MRTD: The Maximum Recommended Therapeutic Dose (MRTD) of drug that ensured maximising efficacy and moderate side effect is 0.7548 micromolar/kg/day [5]
Unbound Fraction: The unbound fraction of drug in plasma is 0.51% [4]
Vd: Fluid volume that would be required to contain the amount of drug present in the body at the same concentration as in the plasma 3.5 L/kg [4]
Water Solubility: The ability of drug to dissolve in water is measured as 10 mg/mL [3]

Adverse Drug Reaction (ADR)

ADR Term	Variation	Related DOT	DOT ID	REF
Drug toxicity	rs2745761	PLCB1	OT9HYT7A	[6]
Drug toxicity	rs1517114	C8orf34	OTXCTHDG	[6]
Neutropenia	rs17318866	FAM50B	OTP3H38A	[7]
Neutropenias	rs4149056	SLCO1B1	OTNEN8QK	[8]
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Chemical Identifiers

Formula: C33H38N4O6
IUPAC Name: [(19S)-10,19-diethyl-19-hydroxy-14,18-dioxo-17-oxa-3,13-diazapentacyclo[11.8.0.02,11.04,9.015,20]henicosa-1(21),2,4(9),5,7,10,15(20)-heptaen-7-yl] 4-piperidin-1-ylpiperidine-1-carboxylate
Canonical SMILES: CCC1=C2CN3C(=CC4=C(C3=O)COC(=O)[C@@]4(CC)O)C2=NC5=C1C=C(C=C5)OC(=O)N6CCC(CC6)N7CCCCC7
InChI: InChI=1S/C33H38N4O6/c1-3-22-23-16-21(43-32(40)36-14-10-20(11-15-36)35-12-6-5-7-13-35)8-9-27(23)34-29-24(22)18-37-28(29)17-26-25(30(37)38)19-42-31(39)33(26,41)4-2/h8-9,16-17,20,41H,3-7,10-15,18-19H2,1-2H3/t33-/m0/s1
InChIKey: UWKQSNNFCGGAFS-XIFFEERXSA-N

Cross-matching ID

PubChem CID: 60838
ChEBI ID: CHEBI:80630
CAS Number: 97682-44-5
DrugBank ID: DB00762
TTD ID: D07HOB
VARIDT ID: DR00112
INTEDE ID: DR0881

Combinatorial Drugs (CBD)

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Repurposed Drugs (RPD)

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Molecular Interaction Atlas of This Drug

Drug Therapeutic Target (DTT)

DTT Name	DTT ID	UniProt ID	MOA	REF
DNA topoisomerase I (TOP1)	TTGTQHC	TOP1_HUMAN	Modulator	[9]

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Drug Transporter (DTP)

DTP Name	DTP ID	UniProt ID	MOA	REF
Multidrug resistance-associated protein 5 (ABCC5)	DTYVM24	MRP5_HUMAN	Substrate	[10]
Multidrug resistance-associated protein 2 (ABCC2)	DTFI42L	MRP2_HUMAN	Substrate	[11]
Multidrug resistance-associated protein 4 (ABCC4)	DTCSGPB	MRP4_HUMAN	Substrate	[12]
Multidrug resistance-associated protein 1 (ABCC1)	DTSYQGK	MRP1_HUMAN	Substrate	[13]
Breast cancer resistance protein (ABCG2)	DTI7UX6	ABCG2_HUMAN	Substrate	[14]
P-glycoprotein 1 (ABCB1)	DTUGYRD	MDR1_HUMAN	Substrate	[11]

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Drug-Metabolizing Enzyme (DME)

DME Name	DME ID	UniProt ID	MOA	REF
Cytochrome P450 3A4 (CYP3A4)	DE4LYSA	CP3A4_HUMAN	Substrate	[15]
Cytochrome P450 3A5 (CYP3A5)	DEIBDNY	CP3A5_HUMAN	Substrate	[16]
Cytochrome P450 2B6 (CYP2B6)	DEPKLMQ	CP2B6_HUMAN	Substrate	[17]
Cytochrome P450 3A7 (CYP3A7)	DERD86B	CP3A7_HUMAN	Substrate	[18]
Carboxylesterase 1 (CES1)_{Main DME}	DEB30C5	EST1_HUMAN	Substrate	[15]
Carboxylesterase 2 (CES2)_{Main DME}	DETHCPD	EST2_HUMAN	Substrate	[19]
Carboxylesterase 3 (CES3)_{Main DME}	DEMI4VE	EST3_HUMAN	Substrate	[19]
Beta-glucuronidase (uidA)	DE9RA0I	BGLR_ECOLI	Substrate	[20]

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Drug Off-Target (DOT)

DOT Name	DOT ID	UniProt ID	Interaction	REF
1-phosphatidylinositol 4,5-bisphosphate phosphodiesterase beta-1 (PLCB1)	OT9HYT7A	PLCB1_HUMAN	Drug Response	[6]
2-(3-amino-3-carboxypropyl)histidine synthase subunit 2 (DPH2)	OT9P91XR	DPH2_HUMAN	Gene/Protein Processing	[21]
3',5'-cyclic-AMP phosphodiesterase 4B (PDE4B)	OTOA8WU2	PDE4B_HUMAN	Gene/Protein Processing	[22]
3-mercaptopyruvate sulfurtransferase (MPST)	OTCDPH5D	THTM_HUMAN	Gene/Protein Processing	[23]
5'-AMP-activated protein kinase catalytic subunit alpha-1 (PRKAA1)	OT7TNF0L	AAPK1_HUMAN	Gene/Protein Processing	[21]
5-aminolevulinate synthase, erythroid-specific, mitochondrial (ALAS2)	OTJXOUCL	HEM0_HUMAN	Gene/Protein Processing	[22]
5-formyltetrahydrofolate cyclo-ligase (MTHFS)	OTZ39JNR	MTHFS_HUMAN	Gene/Protein Processing	[22]
A-kinase anchor protein 10, mitochondrial (AKAP10)	OTPNFTOU	AKA10_HUMAN	Gene/Protein Processing	[22]
Abl interactor 2 (ABI2)	OT8GIIS5	ABI2_HUMAN	Gene/Protein Processing	[23]
Acetyl-CoA acetyltransferase, mitochondrial (ACAT1)	OTJC60Q7	THIL_HUMAN	Drug Response	[24]

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Molecular Interaction Atlas (MIA)

MIA Detail

Jump to Detail Molecular Interaction Atlas of This Drug

Drug-Drug Interaction (DDI) Information of This Drug

Coadministration of a Drug Treating the Same Disease as Irinotecan

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Disease	REF
Regorafenib	DMHSY1I	Moderate	Decreased metabolism of Irinotecan caused by Regorafenib mediated inhibition of UGT.	Colorectal cancer [2B91]	[25]
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Coadministration of a Drug Treating the Disease Different from Irinotecan (Comorbidity)

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Comorbidity	REF
Metreleptin	DM1NOEK	Moderate	Increased metabolism of Irinotecan caused by Metreleptin mediated induction of CYP450 enzyme.	Acute diabete complication [5A2Y]	[26]
Ivosidenib	DM8S6T7	Moderate	Increased metabolism of Irinotecan caused by Ivosidenib mediated induction of CYP450 enzyme.	Acute myeloid leukaemia [2A60]	[26]
Midostaurin	DMI6E0R	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Midostaurin.	Acute myeloid leukaemia [2A60]	[27]
Arn-509	DMT81LZ	Major	Increased metabolism of Irinotecan caused by Arn-509 mediated induction of CYP450 enzyme.	Acute myeloid leukaemia [2A60]	[26]
Gilteritinib	DMTI0ZO	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Gilteritinib.	Acute myeloid leukaemia [2A60]	[28]
Dronedarone	DMA8FS5	Moderate	Decreased metabolism of Irinotecan caused by Dronedarone mediated inhibition of CYP450 enzyme.	Angina pectoris [BA40]	[25]
Nifedipine	DMSVOZT	Moderate	Decreased metabolism of Irinotecan caused by Nifedipine mediated inhibition of CYP450 enzyme.	Angina pectoris [BA40]	[25]
Methylphenobarbital	DMDSWAG	Moderate	Increased metabolism of Irinotecan caused by Methylphenobarbital mediated induction of CYP450 enzyme.	Anxiety disorder [6B00-6B0Z]	[29]
Posaconazole	DMUL5EW	Major	Decreased metabolism of Irinotecan caused by Posaconazole mediated inhibition of CYP450 enzyme.	Aspergillosis [1F20]	[25]
Roflumilast	DMPGHY8	Moderate	Additive immunosuppressive effects by the combination of Irinotecan and Roflumilast.	Asthma [CA23]	[27]
Ofloxacin	DM0VQN3	Minor	Decreased absorption of Irinotecan due to intestinal mucosa variation caused by Ofloxacin.	Bacterial infection [1A00-1C4Z]	[30]
Dalfopristin	DM4LTKV	Moderate	Decreased metabolism of Irinotecan caused by Dalfopristin mediated inhibition of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[28]
Clarithromycin	DM4M1SG	Major	Decreased metabolism of Irinotecan caused by Clarithromycin mediated inhibition of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[25]
Sparfloxacin	DMB4HCT	Minor	Decreased absorption of Irinotecan due to intestinal mucosa variation caused by Sparfloxacin.	Bacterial infection [1A00-1C4Z]	[30]
Gemifloxacin	DMHT34O	Minor	Decreased absorption of Irinotecan due to intestinal mucosa variation caused by Gemifloxacin.	Bacterial infection [1A00-1C4Z]	[30]
Norfloxacin	DMIZ6W2	Minor	Decreased absorption of Irinotecan due to intestinal mucosa variation caused by Norfloxacin.	Bacterial infection [1A00-1C4Z]	[30]
ABT-492	DMJFD2I	Minor	Decreased absorption of Irinotecan due to intestinal mucosa variation caused by ABT-492.	Bacterial infection [1A00-1C4Z]	[30]
Levofloxacin	DMS60RB	Minor	Decreased absorption of Irinotecan due to intestinal mucosa variation caused by Levofloxacin.	Bacterial infection [1A00-1C4Z]	[30]
Troleandomycin	DMUZNIG	Major	Decreased metabolism of Irinotecan caused by Troleandomycin mediated inhibition of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[25]
Lomefloxacin	DMVRH9C	Minor	Decreased absorption of Irinotecan due to intestinal mucosa variation caused by Lomefloxacin.	Bacterial infection [1A00-1C4Z]	[30]
Telithromycin	DMZ4P3A	Major	Decreased metabolism of Irinotecan caused by Telithromycin mediated inhibition of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[25]
Ag-221	DMS0ZBI	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Ag-221.	BCR-ABL1-negative chronic myeloid leukaemia [2A41]	[28]
Pexidartinib	DMS2J0Z	Moderate	Increased metabolism of Irinotecan caused by Pexidartinib mediated induction of CYP450 enzyme.	Bone/articular cartilage neoplasm [2F7B]	[26]
Lapatinib	DM3BH1Y	Moderate	Decreased metabolism of Irinotecan caused by Lapatinib mediated inhibition of CYP450 enzyme.	Breast cancer [2C60-2C6Y]	[25]
Tucatinib	DMBESUA	Major	Decreased metabolism of Irinotecan caused by Tucatinib mediated inhibition of CYP450 enzyme.	Breast cancer [2C60-2C6Y]	[25]
Palbociclib	DMD7L94	Moderate	Decreased metabolism of Irinotecan caused by Palbociclib mediated inhibition of CYP450 enzyme.	Breast cancer [2C60-2C6Y]	[25]
PF-04449913	DMSB068	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by PF-04449913.	Chronic myelomonocytic leukaemia [2A40]	[27]
Phenylbutazone	DMAYL0T	Moderate	Increased metabolism of Irinotecan caused by Phenylbutazone mediated induction of CYP450 enzyme.	Chronic pain [MG30]	[26]
Atracurium	DM42HXN	Minor	Antagonize the effect of Irinotecan when combined with Atracurium.	Corneal disease [9A76-9A78]	[31]
Mivacurium	DM473VD	Minor	Antagonize the effect of Irinotecan when combined with Mivacurium.	Corneal disease [9A76-9A78]	[31]
Pancuronium	DMB0VY8	Minor	Antagonize the effect of Irinotecan when combined with Pancuronium.	Corneal disease [9A76-9A78]	[31]
Tubocurarine	DMBZIVP	Minor	Antagonize the effect of Irinotecan when combined with Tubocurarine.	Corneal disease [9A76-9A78]	[31]
Mifepristone	DMGZQEF	Major	Decreased metabolism of Irinotecan caused by Mifepristone mediated inhibition of CYP450 enzyme.	Cushing syndrome [5A70]	[25]
Osilodrostat	DMIJC9X	Moderate	Decreased metabolism of Irinotecan caused by Osilodrostat mediated inhibition of CYP450 enzyme.	Cushing syndrome [5A70]	[25]
Lumacaftor	DMCLWDJ	Major	Increased metabolism of Irinotecan caused by Lumacaftor mediated induction of CYP450 enzyme.	Cystic fibrosis [CA25]	[32]
Ivacaftor	DMZC1HS	Moderate	Decreased metabolism of Irinotecan caused by Ivacaftor mediated inhibition of CYP450 enzyme.	Cystic fibrosis [CA25]	[25]
MK-8228	DMOB58Q	Moderate	Decreased metabolism of Irinotecan caused by MK-8228 mediated inhibition of CYP450 enzyme.	Cytomegaloviral disease [1D82]	[25]
Nefazodone	DM4ZS8M	Major	Decreased metabolism of Irinotecan caused by Nefazodone mediated inhibition of CYP450 enzyme.	Depression [6A70-6A7Z]	[25]
Primidone	DM0WX6I	Major	Increased metabolism of Irinotecan caused by Primidone mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[26]
Felbamate	DM1V5ZS	Moderate	Increased metabolism of Irinotecan caused by Felbamate mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[26]
Oxcarbazepine	DM5PU6O	Moderate	Increased metabolism of Irinotecan caused by Oxcarbazepine mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[26]
Cenobamate	DM8KLU9	Moderate	Increased metabolism of Irinotecan caused by Cenobamate mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[26]
Stiripentol	DMMSDOY	Moderate	Decreased metabolism of Irinotecan caused by Stiripentol mediated inhibition of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[25]
Fosphenytoin	DMOX3LB	Major	Increased metabolism of Irinotecan caused by Fosphenytoin mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[26]
Rufinamide	DMWE60C	Moderate	Increased metabolism of Irinotecan caused by Rufinamide mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[26]
Phenobarbital	DMXZOCG	Major	Increased metabolism of Irinotecan caused by Phenobarbital mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[26]
Eslicarbazepine	DMZREFQ	Moderate	Increased metabolism of Irinotecan caused by Eslicarbazepine mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[26]
Tazemetostat	DMWP1BH	Moderate	Increased metabolism of Irinotecan caused by Tazemetostat mediated induction of CYP450 enzyme.	Follicular lymphoma [2A80]	[26]
Itraconazole	DMCR1MV	Major	Decreased metabolism of Irinotecan caused by Itraconazole mediated inhibition of CYP450 enzyme.	Fungal infection [1F29-1F2F]	[25]
Miconazole	DMPMYE8	Moderate	Decreased metabolism of Irinotecan caused by Miconazole mediated inhibition of CYP450 enzyme.	Fungal infection [1F29-1F2F]	[25]
Ketoconazole	DMPZI3Q	Major	Decreased metabolism of Irinotecan caused by Ketoconazole mediated inhibition of CYP450 enzyme.	Fungal infection [1F29-1F2F]	[25]
Sulfinpyrazone	DMEV954	Moderate	Increased metabolism of Irinotecan caused by Sulfinpyrazone mediated induction of CYP450 enzyme.	Gout [FA25]	[26]
Boceprevir	DMBSHMF	Major	Decreased metabolism of Irinotecan caused by Boceprevir mediated inhibition of CYP450 enzyme.	Hepatitis virus infection [1E50-1E51]	[25]
Telaprevir	DMMRV29	Major	Decreased metabolism of Irinotecan caused by Telaprevir mediated inhibition of CYP450 enzyme.	Hepatitis virus infection [1E50-1E51]	[25]
Isoniazid	DM5JVS3	Moderate	Decreased metabolism of Irinotecan caused by Isoniazid mediated inhibition of CYP450 enzyme.	HIV-infected patients with tuberculosis [1B10-1B14]	[25]
Rifampin	DMA8J1G	Major	Increased metabolism of Irinotecan caused by Rifampin mediated induction of CYP450 enzyme.	HIV-infected patients with tuberculosis [1B10-1B14]	[32]
Rifapentine	DMCHV4I	Major	Increased metabolism of Irinotecan caused by Rifapentine mediated induction of CYP450 enzyme.	HIV-infected patients with tuberculosis [1B10-1B14]	[26]
Fosamprenavir	DM4W9B3	Major	Decreased metabolism of Irinotecan caused by Fosamprenavir mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[25]
Fostemsavir	DM50ILT	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Fostemsavir.	Human immunodeficiency virus disease [1C60-1C62]	[33]
Cobicistat	DM6L4H2	Major	Decreased metabolism of Irinotecan caused by Cobicistat mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[25]
Saquinavir	DMG814N	Major	Decreased metabolism of Irinotecan caused by Saquinavir mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[25]
Etravirine	DMGV8QU	Moderate	Increased metabolism of Irinotecan caused by Etravirine mediated induction of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[26]
Darunavir	DMN3GCH	Moderate	Decreased metabolism of Irinotecan caused by Darunavir mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[25]
Atazanavir	DMSYRBX	Major	Decreased metabolism of Irinotecan caused by Atazanavir mediated inhibition of UGT.	Human immunodeficiency virus disease [1C60-1C62]	[25]
Bempedoic acid	DM1CI9R	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Bempedoic acid.	Hyper-lipoproteinaemia [5C80]	[34]
Gemfibrozil	DMD8Q3J	Major	Decreased metabolism of Irinotecan caused by Gemfibrozil mediated inhibition of UGT.	Hyper-lipoproteinaemia [5C80]	[28]
Teriflunomide	DMQ2FKJ	Major	Additive immunosuppressive effects by the combination of Irinotecan and Teriflunomide.	Hyper-lipoproteinaemia [5C80]	[35]
BMS-201038	DMQTAGO	Moderate	Decreased metabolism of Irinotecan caused by BMS-201038 mediated inhibition of CYP450 enzyme.	Hyper-lipoproteinaemia [5C80]	[25]
Conivaptan	DM1V329	Major	Decreased metabolism of Irinotecan caused by Conivaptan mediated inhibition of CYP450 enzyme.	Hypo-osmolality/hyponatraemia [5C72]	[25]
Berotralstat	DMWA2DZ	Moderate	Decreased metabolism of Irinotecan caused by Berotralstat mediated inhibition of CYP450 enzyme.	Innate/adaptive immunodeficiency [4A00]	[25]
Amobarbital	DM0GQ8N	Moderate	Increased metabolism of Irinotecan caused by Amobarbital mediated induction of CYP450 enzyme.	Insomnia [7A00-7A0Z]	[26]
Denosumab	DMNI0KO	Moderate	Additive myelosuppressive effects by the combination of Irinotecan and Denosumab.	Low bone mass disorder [FB83]	[36]
Crizotinib	DM4F29C	Moderate	Decreased metabolism of Irinotecan caused by Crizotinib mediated inhibition of CYP450 enzyme.	Lung cancer [2C25]	[25]
Ceritinib	DMB920Z	Major	Decreased metabolism of Irinotecan caused by Ceritinib mediated inhibition of CYP450 enzyme.	Lung cancer [2C25]	[25]
PF-06463922	DMKM7EW	Moderate	Increased metabolism of Irinotecan caused by PF-06463922 mediated induction of CYP450 enzyme.	Lung cancer [2C25]	[26]
Capmatinib	DMYCXKL	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Capmatinib.	Lung cancer [2C25]	[37]
Selpercatinib	DMZR15V	Moderate	Decreased metabolism of Irinotecan caused by Selpercatinib mediated inhibition of CYP450 enzyme.	Lung cancer [2C25]	[25]
Idelalisib	DM602WT	Major	Decreased metabolism of Irinotecan caused by Idelalisib mediated inhibition of CYP450 enzyme.	Mature B-cell leukaemia [2A82]	[25]
Vemurafenib	DM62UG5	Moderate	Increased metabolism of Irinotecan caused by Vemurafenib mediated induction of CYP450 enzyme.	Melanoma [2C30]	[26]
Dabrafenib	DMX6OE3	Moderate	Increased metabolism of Irinotecan caused by Dabrafenib mediated induction of CYP450 enzyme.	Melanoma [2C30]	[27]
Lasmiditan	DMXLVDT	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Lasmiditan.	Migraine [8A80]	[38]
Exjade	DMHPRWG	Moderate	Increased metabolism of Irinotecan caused by Exjade mediated induction of CYP450 enzyme.	Mineral absorption/transport disorder [5C64]	[26]
Thalidomide	DM70BU5	Major	Additive thrombogenic effects by the combination of Irinotecan and Thalidomide.	Multiple myeloma [2A83]	[39]
Tecfidera	DM2OVDT	Moderate	Additive immunosuppressive effects by the combination of Irinotecan and Tecfidera.	Multiple sclerosis [8A40]	[40]
Siponimod	DM2R86O	Major	Additive immunosuppressive effects by the combination of Irinotecan and Siponimod.	Multiple sclerosis [8A40]	[28]
Fingolimod	DM5JVAN	Major	Additive immunosuppressive effects by the combination of Irinotecan and Fingolimod.	Multiple sclerosis [8A40]	[41]
Ocrelizumab	DMEZ2KH	Moderate	Additive immunosuppressive effects by the combination of Irinotecan and Ocrelizumab.	Multiple sclerosis [8A40]	[42]
Ozanimod	DMT6AM2	Major	Additive immunosuppressive effects by the combination of Irinotecan and Ozanimod.	Multiple sclerosis [8A40]	[27]
Nilotinib	DM7HXWT	Moderate	Decreased metabolism of Irinotecan caused by Nilotinib mediated inhibition of CYP450 enzyme.	Myeloproliferative neoplasm [2A20]	[25]
Dasatinib	DMJV2EK	Moderate	Decreased metabolism of Irinotecan caused by Dasatinib mediated inhibition of CYP450 enzyme.	Myeloproliferative neoplasm [2A20]	[25]
Omacetaxine mepesuccinate	DMPU2WX	Moderate	Additive immunosuppressive effects by the combination of Irinotecan and Omacetaxine mepesuccinate.	Myeloproliferative neoplasm [2A20]	[43]
Rolapitant	DM8XP26	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Rolapitant.	Nausea/vomiting [MD90]	[44]
Netupitant	DMEKAYI	Moderate	Decreased metabolism of Irinotecan caused by Netupitant mediated inhibition of CYP450 enzyme.	Nausea/vomiting [MD90]	[28]
Entrectinib	DMMPTLH	Moderate	Decreased metabolism of Irinotecan caused by Entrectinib mediated inhibition of CYP450 enzyme.	Non-small cell lung cancer [2C25]	[25]
Rucaparib	DM9PVX8	Moderate	Decreased metabolism of Irinotecan caused by Rucaparib mediated inhibition of CYP450 enzyme.	Ovarian cancer [2C73]	[25]
Abametapir	DM2RX0I	Moderate	Decreased metabolism of Irinotecan caused by Abametapir mediated inhibition of CYP450 enzyme.	Pediculosis [1G00]	[45]
Lefamulin	DME6G97	Moderate	Decreased metabolism of Irinotecan caused by Lefamulin mediated inhibition of CYP450 enzyme.	Pneumonia [CA40]	[46]
Lonafarnib	DMGM2Z6	Major	Decreased metabolism of Irinotecan caused by Lonafarnib mediated inhibition of CYP450 enzyme.	Premature ageing appearance [LD2B]	[25]
ABIRATERONE	DM8V75C	Moderate	Decreased metabolism of Irinotecan caused by ABIRATERONE mediated inhibition of CYP450 enzyme.	Prostate cancer [2C82]	[25]
Enzalutamide	DMGL19D	Major	Increased metabolism of Irinotecan caused by Enzalutamide mediated induction of CYP450 enzyme.	Prostate cancer [2C82]	[26]
Darolutamide	DMV7YFT	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Darolutamide.	Prostate cancer [2C82]	[47]
Bicalutamide	DMZMSPF	Moderate	Decreased metabolism of Irinotecan caused by Bicalutamide mediated inhibition of CYP450 enzyme.	Prostate cancer [2C82]	[25]
Temsirolimus	DMS104F	Moderate	Increased plasma concentrations of Irinotecan and Temsirolimus due to competitive inhibition of the same metabolic pathway.	Renal cell carcinoma [2C90]	[48]
Gatifloxacin	DMSL679	Minor	Decreased absorption of Irinotecan due to intestinal mucosa variation caused by Gatifloxacin.	Respiratory infection [CA07-CA4Z]	[30]
Canakinumab	DM8HLO5	Moderate	Additive immunosuppressive effects by the combination of Irinotecan and Canakinumab.	Rheumatoid arthritis [FA20]	[49]
Rilonacept	DMGLUQS	Moderate	Additive immunosuppressive effects by the combination of Irinotecan and Rilonacept.	Rheumatoid arthritis [FA20]	[49]
Golimumab	DMHZV7X	Major	Additive immunosuppressive effects by the combination of Irinotecan and Golimumab.	Rheumatoid arthritis [FA20]	[50]
Dexamethasone	DMMWZET	Moderate	Increased metabolism of Irinotecan caused by Dexamethasone mediated induction of CYP450 enzyme.	Rheumatoid arthritis [FA20]	[26]
Leflunomide	DMR8ONJ	Major	Additive immunosuppressive effects by the combination of Irinotecan and Leflunomide.	Rheumatoid arthritis [FA20]	[35]
Anthrax vaccine	DM9GSWY	Moderate	Antagonize the effect of Irinotecan when combined with Anthrax vaccine.	Sepsis [1G40-1G41]	[51]
Voxelotor	DMCS6M5	Moderate	Decreased metabolism of Irinotecan caused by Voxelotor mediated inhibition of CYP450 enzyme.	Sickle-cell disorder [3A51]	[25]
Telotristat ethyl	DMDIYFZ	Moderate	Increased metabolism of Irinotecan caused by Telotristat ethyl mediated induction of CYP450 enzyme.	Small intestine developmental anomaly [DA90]	[27]
Larotrectinib	DM26CQR	Moderate	Decreased metabolism of Irinotecan caused by Larotrectinib mediated inhibition of CYP450 enzyme.	Solid tumour/cancer [2A00-2F9Z]	[25]
Armodafinil	DMGB035	Moderate	Increased metabolism of Irinotecan caused by Armodafinil mediated induction of CYP450 enzyme.	Solid tumour/cancer [2A00-2F9Z]	[26]
LEE011	DMMX75K	Moderate	Decreased metabolism of Irinotecan caused by LEE011 mediated inhibition of CYP450 enzyme.	Solid tumour/cancer [2A00-2F9Z]	[25]
Pitolisant	DM8RFNJ	Moderate	Accelerated clearance of Irinotecan due to the transporter induction by Pitolisant.	Somnolence [MG42]	[27]
Fostamatinib	DM6AUHV	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Fostamatinib.	Thrombocytopenia [3B64]	[52]
Eltrombopag	DMOGFIX	Moderate	Decreased clearance of Irinotecan due to the transporter inhibition by Eltrombopag.	Thrombocytopenia [3B64]	[53]
Brilinta	DMBR01X	Moderate	Decreased metabolism of Irinotecan caused by Brilinta mediated inhibition of CYP450 enzyme.	Thrombosis [DB61-GB90]	[25]
Pipecuronium	DM5F84A	Minor	Antagonize the effect of Irinotecan when combined with Pipecuronium.	Tonus and reflex abnormality [MB47]	[31]
Doxacurium	DMKE7L9	Minor	Antagonize the effect of Irinotecan when combined with Doxacurium.	Tonus and reflex abnormality [MB47]	[31]
Vecuronium	DMP0UK2	Minor	Antagonize the effect of Irinotecan when combined with Vecuronium.	Tonus and reflex abnormality [MB47]	[31]
Sirolimus	DMGW1ID	Moderate	Increased plasma concentrations of Irinotecan and Sirolimus due to competitive inhibition of the same metabolic pathway.	Transplant rejection [NE84]	[48]
Azathioprine	DMMZSXQ	Moderate	Additive myelosuppressive effects by the combination of Irinotecan and Azathioprine.	Transplant rejection [NE84]	[28]
Tacrolimus	DMZ7XNQ	Moderate	Increased plasma concentrations of Irinotecan and Tacrolimus due to competitive inhibition of the same metabolic pathway.	Transplant rejection [NE84]	[48]
Cinoxacin	DM4EWNS	Minor	Decreased absorption of Irinotecan due to intestinal mucosa variation caused by Cinoxacin.	Urinary tract infection [GC08]	[30]
Nalidixic acid	DMRM0JV	Minor	Decreased absorption of Irinotecan due to intestinal mucosa variation caused by Nalidixic acid.	Urinary tract infection [GC08]	[30]
Elagolix	DMB2C0E	Moderate	Increased metabolism of Irinotecan caused by Elagolix mediated induction of CYP450 enzyme.	Uterine fibroid [2E86]	[26]
Amiodarone	DMUTEX3	Moderate	Decreased metabolism of Irinotecan caused by Amiodarone mediated inhibition of CYP450 enzyme.	Ventricular tachyarrhythmia [BC71]	[25]
Ganciclovir	DM1MBYQ	Moderate	Additive myelosuppressive effects by the combination of Irinotecan and Ganciclovir.	Virus infection [1A24-1D9Z]	[28]
Valganciclovir	DMS2IUH	Moderate	Additive myelosuppressive effects by the combination of Irinotecan and Valganciclovir.	Virus infection [1A24-1D9Z]	[28]
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