Drug Interactions between acalabrutinib and Arthritis Foundation Pain Reliever
This report displays the potential drug interactions for the following 2 drugs:
- acalabrutinib
- Arthritis Foundation Pain Reliever (aspirin)
Interactions between your drugs
aspirin acalabrutinib
Applies to: Arthritis Foundation Pain Reliever (aspirin) and acalabrutinib
MONITOR CLOSELY: Coadministration of acalabrutinib and drugs that interfere with platelet function or coagulation may potentiate the risk of bleeding complications. Serious and fatal hemorrhagic events have been reported during acalabrutinib therapy. In the combined safety database of 1040 patients with hematologic malignancies treated with acalabrutinib monotherapy, major hemorrhage (serious or >= Grade 3 bleeding events or any central nervous system bleeding) occurred in 3.6% of patients, with fatalities occurring in 0.1% of patients. Overall, bleeding events of any grade, including bruising and petechiae, occurred in 46% of patients. The mechanism is not well understood, as bleeding events have occurred in patients both with and without thrombocytopenia. In clinical trials, major hemorrhagic events were experienced by 3% of patients taking acalabrutinib without concurrent antithrombotic agents. The addition of antithrombotic agents increased this percentage to 4.3%.
MANAGEMENT: Concomitant use of acalabrutinib with antithrombotic agents or other drugs that increase bleeding risk should be approached with caution. Close clinical and laboratory monitoring for bleeding complications is recommended during therapy. Patients should be advised to promptly report any signs and symptoms of bleeding to their physician. Refer to the product labeling for guidance on acalabrutinib dosage adjustments in patients with concurrent Grade 3 thrombocytopenia and bleeding.
References
- (2019) "Product Information. Calquence (acalabrutinib)." AstraZeneca Pty Ltd
- (2023) "Product Information. Calquence (acalabrutinib)." AstraZeneca Canada Inc
- (2021) "Product Information. Calquence (acalabrutinib)." AstraZeneca UK Ltd
- (2022) "Product Information. Calquence (acalabrutinib)." Astra-Zeneca Pharmaceuticals
Drug and food interactions
acalabrutinib food
Applies to: acalabrutinib
GENERALLY AVOID: Consumption of grapefruit and/or grapefruit juice may increase the plasma concentrations of acalabrutinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Inhibition of hepatic CYP450 3A4 may also contribute. The interaction has not been studied with grapefruit juice specifically, but has been reported for other CYP450 3A4 inhibitors. When acalabrutinib was administered with the potent CYP450 3A4 inhibitor itraconazole (200 mg once daily for 5 days) in 17 healthy subjects, acalabrutinib peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 3.9- and 5.1-fold, respectively. Physiologically based pharmacokinetic (PBPK) simulations showed that moderate CYP450 3A4 inhibitors (erythromycin, fluconazole, diltiazem) increased acalabrutinib Cmax and AUC by 2- to nearly 3-fold. In healthy subjects, administration of acalabrutinib with the moderate CYP450 3A4 inhibitors fluconazole (400 mg as a single dose) or isavuconazole (200 mg as a repeated dose for 5 days) increased acalabrutinib Cmax and AUC by 1.4- to 2-fold, while the Cmax and AUC of the active metabolite, ACP-5862, was decreased by 0.65- to 0.88-fold. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Increased acalabrutinib exposure may potentiate the risk of toxicities such as hemorrhage, infection, cytopenias, malignancies, and atrial fibrillation or flutter.
Food may delay the absorption of acalabrutinib, but does not appear to affect the overall extent of absorption. When a single 100 mg tablet or a 75 mg developmental formulation of acalabrutinib was administered with a high-fat, high-calorie meal (approximately 918 calories; 59 grams carbohydrate, 59 grams fat, 39 grams protein) in healthy study subjects, mean acalabrutinib Cmax was decreased by 54% and 73%, respectively, while time to reach Cmax was delayed by 1 to 2 hours compared to administration under fasted conditions. However, mean AUC was not affected.
MANAGEMENT: Acalabrutinib may be administered with or without food. Patients should avoid consumption of grapefruit and grapefruit juice during treatment with acalabrutinib.
References
- (2019) "Product Information. Calquence (acalabrutinib)." AstraZeneca Pty Ltd
- (2023) "Product Information. Calquence (acalabrutinib)." AstraZeneca Canada Inc
- (2021) "Product Information. Calquence (acalabrutinib)." AstraZeneca UK Ltd
- (2022) "Product Information. Calquence (acalabrutinib)." Astra-Zeneca Pharmaceuticals
- Chen B, Zhou D, Wei H, et al. (2022) "Acalabrutinib CYP3A-mediated drug-drug interactions: clinical evaluations and physiologically based pharmacokinetic modelling to inform dose adjustment strategy" Br J Clin Pharmacol, 88, p. 3716-29
aspirin food
Applies to: Arthritis Foundation Pain Reliever (aspirin)
GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.
MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.
References
- (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
aspirin food
Applies to: Arthritis Foundation Pain Reliever (aspirin)
One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.
References
- Yoovathaworn KC, Sriwatanakul K, Thithapandha A (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 71-6
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
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