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Caution should also be taken in people with a predisposition to long QT syndrome as the drug can provoke this.[1] Adverse effects Very common (greater than 10% of clinical trial subjects) adverse effects include diarrhea, stomatitis, rashes, dry or itchy skin, infections where finger or toenails abut skin, low platelet counts, low leukocyte counts, and low neutrophil counts.[6] Common (between 1% and 10% of clinical trial subjects) adverse effects include interstitial lung disease.[6] Interactions Osimertinib is metabolized by CYP3A4 and CYP3A5, so substances that strongly inhibit either enyzme, like macrolide antibiotics, antifungals, and antivirals may increase exposure to osimertinib, and substances like rifampicin that activate either enzyme will decrease the effectiveness of osimertinib.[1][6] Pharmacology Osimertinib binds irreversibly to epidermal growth factor receptor proteins expressed by EGFR with a T790M mutation;[6] it also binds irreversibly to EGFR with a L858R mutation and with an exon 19 deletion.[1] It exhibits linear pharmacokinetics