Why Revumenib Drug Interactions Matter

When you are taking Revumenib (brand name Revuforj), what else you take — including other prescriptions, over-the-counter medications, supplements, and even certain foods — can change how the drug works in your body. Some interactions can make Revumenib less effective. Others can increase your risk of dangerous side effects.

This guide covers the most important Revumenib drug interactions so you know what to avoid and what to discuss with your doctor.

How Drug Interactions Work with Revumenib

Revumenib is processed in your body primarily by an enzyme called CYP3A4. Think of CYP3A4 as a machine in your liver that breaks down Revumenib and removes it from your system.

When another drug speeds up that machine (a CYP3A4 inducer), Revumenib gets broken down too fast, and there may not be enough of it in your blood to fight your leukemia. When another drug slows down that machine (a CYP3A4 inhibitor), Revumenib builds up in your blood, increasing the risk of side effects — particularly QTc prolongation.

On top of that, Revumenib itself can affect your heart rhythm. So combining it with other drugs that also affect heart rhythm multiplies the risk.

Medications That Interact with Revumenib

Major Interactions: Strong CYP3A4 Inhibitors

These drugs significantly slow down how your body processes Revumenib. If you must take one of them, your Revumenib dose must be reduced from 270 mg to 160 mg twice daily:

• Posaconazole (Noxafil) — an antifungal commonly used in leukemia patients
• Itraconazole (Sporanox) — another antifungal
• Voriconazole (Vfend) — another antifungal
• Cobicistat (Tybost) — used in HIV treatment, often combined with other antivirals

Your doctor will adjust your Revumenib dose if any of these are necessary. Do not adjust your dose on your own.

Major Interactions: Strong and Moderate CYP3A4 Inducers

These drugs speed up Revumenib's breakdown and should be avoided entirely during treatment:

• Rifampin (Rifadin) — an antibiotic used for tuberculosis and other infections
• Carbamazepine (Tegretol) — a seizure medication
• Phenytoin (Dilantin) — another seizure medication
• Phenobarbital — a sedative and seizure medication
• Enzalutamide (Xtandi) — a prostate cancer drug
• Efavirenz (Sustiva) — an HIV medication
• Modafinil (Provigil) — a wakefulness-promoting drug (moderate inducer)

Using CYP3A4 inducers with Revumenib can reduce the drug's effectiveness and increase QT prolongation risk from Revumenib's M1 metabolite. This is a double problem — less cancer-fighting power and more cardiac risk.

Major Interactions: QTc-Prolonging Drugs

Because Revumenib carries a boxed warning for QTc prolongation, combining it with other drugs that affect heart rhythm is particularly dangerous. If possible, these should be avoided:

• Ondansetron (Zofran) — a common anti-nausea medication
• Azithromycin (Zithromax, Z-Pack) — a widely used antibiotic
• Fluoroquinolone antibiotics — such as Levofloxacin (Levaquin) and Moxifloxacin (Avelox)
• Methadone — used for pain management and opioid addiction treatment
• Haloperidol (Haldol) — an antipsychotic
• Sotalol — a heart rhythm medication
• Amiodarone (Pacerone) — another heart rhythm medication

If you absolutely must take a QTc-prolonging drug with Revumenib, your doctor should monitor your heart with more frequent ECGs.

Moderate Interactions: Moderate CYP3A4 Inhibitors

These may increase Revumenib levels in your blood. Your doctor should monitor you more closely if you take:

• Fluconazole (Diflucan) — an antifungal
• Erythromycin — an antibiotic
• Diltiazem (Cardizem) — a blood pressure and heart medication
• Verapamil (Calan) — another heart/blood pressure medication

Supplements and Over-the-Counter Drugs to Watch

Several common supplements and OTC products can interact with Revumenib:

• St. John's Wort — This herbal supplement is a strong CYP3A4 inducer. It can significantly reduce Revumenib levels. Do not take St. John's Wort while on Revumenib.
• Grapefruit and grapefruit juice — These inhibit CYP3A4 and could increase Revumenib levels. Your doctor may advise you to avoid them.
• Turmeric/curcumin supplements — May have mild CYP3A4 inhibiting effects. Discuss with your doctor.
• Antacids and acid reducers — While not a major interaction with Revumenib specifically, always tell your doctor about any acid-reducing medications you take (such as Omeprazole or Famotidine).

Food and Drink Interactions

High-Fat Meals

This is an important one. Revumenib should be taken fasting or with a low-fat meal. A low-fat meal means no more than 400 calories with no more than 25% of those calories from fat.

High-fat meals can change how much Revumenib your body absorbs, which may affect its effectiveness. Plan your medication timing around lighter meals or take it on an empty stomach.

Grapefruit

As mentioned above, grapefruit and grapefruit juice inhibit CYP3A4 and could cause Revumenib to build up in your system. It is safest to avoid grapefruit products while on this medication.

Alcohol

While there is no specific alcohol interaction listed for Revumenib, alcohol can worsen side effects like nausea, fatigue, and liver strain. Given that Revumenib can increase liver enzymes (AST and ALT), it is wise to limit or avoid alcohol during treatment. Ask your doctor for personalized advice.

What to Tell Your Doctor

Before starting Revumenib, give your doctor a complete list of everything you take. This includes:

• All prescription medications
• Over-the-counter drugs (pain relievers, cold medicine, antacids)
• Vitamins and supplements (especially St. John's Wort, turmeric, and herbal products)
• Any recreational substances

Also tell your doctor if:

• You have a history of heart rhythm problems or a prolonged QTc interval
• You are taking any antifungal medications — these are especially common in leukemia patients and many interact with Revumenib
• You are pregnant, planning to become pregnant, or breastfeeding
• You start or stop any medication during your Revumenib treatment — even something that seems minor

Do not stop or change any medication on your own. Always talk to your doctor first.

Final Thoughts

Drug interactions with Revumenib are serious — some can reduce the drug's ability to fight your leukemia, and others can increase the risk of dangerous heart rhythm problems. The most important thing you can do is keep your medical team fully informed about everything you take.

For more information about Revumenib, check out our guides on what Revumenib is and how it is used and Revumenib side effects. If you need help finding Revumenib in stock, use Medfinder to search pharmacy availability near you.