Daraxonrasib

Strong CYP3A Inhibitors with P-gp Inhibition : Avoid concomitant use. ( 7.1 ) Strong CYP3A Inhibitors without P-gp Inhibition : Reduce RASONQUE dosage. ( 2.4 ) Moderate CYP3A Inhibitors with or without P-gp Inhibition : Reduce RASONQUE dosage. ( 2.4 ) P-gp Inhibitors : Reduce RASONQUE dosage. ( 2.4 ) Cyclosporine A : Avoid concomitant use. ( 7.1 ) Strong CYP3A Inducers : Avoid concomitant use. Increase RASONQUE dosage if concomitant use cannot be avoided. ( 2.4 , 7.1 ) Moderate CYP3A Inducers : Increase RASONQUE dosage. ( 2.4 ) P-gp Substrates : Take at least 4 hours apart from RASONQUE. ( 7.2 )

7.1 Effects of Other Drugs on RASONQUE Table 5: Effects of Other Drugs on RASONQUE Strong or Moderate CYP3A Inhibitors with or without P-gp Inhibition Prevention or Management Strong CYP3A inhibitors with P-glycoprotein (P-gp) inhibition : Avoid concomitant use. Strong CYP3A inhibitors without P-gp inhibition : Reduce RASONQUE dosage to 150 mg once daily [see Dosage and Administration (2.4) ] . Moderate CYP3A inhibitors with P-gp inhibition : Reduce RASONQUE dosage to 100 mg once daily [see Dosage and Administration (2.4) ] . Moderate CYP3A inhibitors without P-gp inhibition : Reduce RASONQUE dosage to 200 mg once daily [see Dosage and Administration (2.4) ] .

Mechanism and Clinical Effect Daraxonrasib is a CYP3A and P-gp substrate. Moderate or strong CYP3A inhibitors with or without P-gp inhibition increase daraxonrasib exposure [see Clinical Pharmacology (12.3) ] , which may increase the risk of adverse reactions. P-gp Inhibitors Prevention or Management Reduce RASONQUE dosage to 150 mg once daily [see Dosage and Administration (2.4) ] . Mechanism and Clinical Effect Daraxonrasib is a P-gp substrate. P-gp inhibitors increase daraxonrasib exposure [see Clinical Pharmacology (12.3) ] , which may increase the risk of adverse reactions.

Cyclosporine A Prevention or Management Avoid concomitant use of RASONQUE with systemic cyclosporine A or its derivatives. Mechanism and Clinical Effect Cyclosporine A or its derivatives and daraxonrasib bind to cyclophilin A. Coadministration of systemic cyclosporine A or its derivatives and RASONQUE may have the potential to alter daraxonrasib pharmacokinetics, efficacy, and safety. Strong or Moderate CYP3A Inducers Prevention or Management Strong CYP3A inducers : Avoid concomitant use. If concomitant use cannot be avoided, increase RASONQUE dosage to 400 mg once daily [see Dosage and Administration (2.4) ] .

Moderate CYP3A inducers : Increase RASONQUE dosage to 400 mg once daily [see Dosage and Administration (2.4) ] . Mechanism and Clinical Effect Daraxonrasib is a CYP3A substrate. Strong CYP3A inducers reduce daraxonrasib exposure [see Clinical Pharmacology (12.3) ] , which may reduce the effectiveness of RASONQUE.

7.2 Effects of RASONQUE on Other Drugs P-gp Substrates Take a P-gp substrate at least 4 hours apart from RASONQUE. Daraxonrasib is a P-gp inhibitor. Coadministration with RASONQUE increases exposure of P-gp substrates [see Clinical Pharmacology (12.3) ] , which may increase the risk of adverse reactions related to these substrates.

8.1 Pregnancy Risk Summary Based on findings in animals, RASONQUE can cause fetal harm when administered to pregnant women. There are no available data on RASONQUE use in pregnant women to inform a drug-associated risk. In an animal reproduction study, oral administration of daraxonrasib to pregnant female mice during the period of organogenesis resulted in adverse developmental outcomes including mortality, alterations to growth, and structural abnormalities at exposures ≥ 2.5 times the recommended dose based on AUC (see Data ) . Advise pregnant women of the potential risk to a fetus. In the U.S.

general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Data Animal Data Daraxonrasib was administered orally to pregnant female mice during the period of organogenesis at doses of 25, 50, and 75 mg/kg/day. Daraxonrasib at a dose of ≥ 50 mg/kg/day (≥ 2.5 times the exposure at the recommended dose based on AUC) was associated with post-implantation loss, reduced number of live fetuses, decreased fetal body weights, and malformations including eyes, limbs, palate, gonads, great vessels, kidneys, and bones.