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Drug Interactions between asparaginase erwinia chrysanthemi and budesonide / formoterol

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

budesonide asparaginase Erwinia chrysanthemi

Applies to: budesonide / formoterol and asparaginase erwinia chrysanthemi

ADJUST DOSING INTERVAL: The administration of asparaginase with or immediately preceding prednisone may increase the risk of hyperglycaemia. Although they are often combined in clinical practice, asparaginase and corticosteroids may increase the risk of hyperglycemia in some patients, especially in children 10 years of age or older.

MONITOR: Concomitant use of asparaginase and corticosteroids may increase the risk of thrombosis or hemorrhage. The proposed mechanism may be related to asparaginase-induced fluctuation of coagulation proteins. In addition, the potential hypercoagulability induced by asparaginase may increase the risk of glucocorticoid-induced osteonecrosis in children older than 10 years of age, particularly females. Increased incidence of thromboembolism has been reported with concomitant use of asparaginase and prednisone or dexamethasone as compared to asparaginase alone. Other corticosteroids may interact.

MANAGEMENT: If combination therapy is necessary, the Australian product labeling for asparaginase (Leunase(R)) recommends that asparaginase be administered after prednisone. Close monitoring for clinical and laboratory evidence of hyperglycemia and/or altered coagulation is also recommended at baseline and periodically throughout concurrent treatment with corticosteroids and asparaginase-derived products. Patients should be advised to promptly report any signs and symptoms of hyperglycemia, bleeding, blood clots or bone pain.

References

  1. (2001) "Product Information. Oncaspar (pegaspargase)." Rhone Poulenc Rorer
  2. (2001) "Product Information. Elspar (asparaginase)." Merck & Co., Inc
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. Cerner Multum, Inc. "Australian Product Information."
  5. "Product Information. Erwinaze (asparaginase Erwinia chrysanthemi)." EUSA Pharma
  6. (2019) "Product Information. Asparlas (calaspargase pegol)." Servier
  7. Duarte X, Esteves S, Neto AM, Pereira F (2016) "Incidence and risk factors for central nervous system thrombosis in paediatric acute lymphoblastic leukaemia during intensive asparaginase treatment: a single-centre study." Br J Haematol, 174, p. 280-91
  8. Athale UH, Atkinson HH, Athale A, Nayiager T, Chan A (2015) "Effect of asparaginase and dexamethasone on FVIIa-at complex and F1.2 in children with acute lymphoblastic leukemia: evidence of a hypercoagulable state." Blood, 126, p. 3522
  9. Appel IM, van Kessel-Bakvis C, Stigter R, Pieters R (2007) "Influence of two different regimens of concomitant treatment with asparaginase and dexamethasone on hemostasis in childhood acute lymphoblastic leukemia." Leukemia, 21, p. 2377-80
  10. Caruso V, Iacoviello L, Di Castelnuovo A, et al. (2006) "Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients." Blood, 108, p. 2216-22
  11. Athale UH, Chan AK (2003) "Thrombosis in children with acute lymphoblastic leukemia. Part II. Pathogenesis of thrombosis in children with acute lymphoblastic leukemia: effects of the disease and therapy." Thromb Res, 111, p. 199-212
  12. Truelove E, Fielding AK, Hunt BJ (2013) "The coagulopathy and thrombotic risk associated with L-asparaginase treatment in adults with acute lymphoblastic leukaemia." Leukemia, 27, p. 553-9
  13. Christ TN, Stock W, Knoebel RW (2018) "Incidence of asparaginase-related hepatotoxicity, pancreatitis, and thrombotic events in adults with acute lymphoblastic leukemia treated with a pediatric-inspired regimen." J Oncol Pharm Pract, 24, p. 299-308
View all 13 references

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Minor

budesonide formoterol

Applies to: budesonide / formoterol and budesonide / formoterol

Although they are often combined in clinical practice, the concomitant use of beta-2 adrenergic agonists and corticosteroids may result in additive hypokalemic effects. Since beta-2 agonists can sometimes cause QT interval prolongation, the development of hypokalemia may potentiate the risk of ventricular arrhythmias including torsade de pointes. However, clinical data are limited, and the potential significance is unknown. Patients who are receiving systemic or nebulized formulations of beta-2 agonists, high dosages of inhaled beta-2 agonists, or systemic corticosteroid therapy may be at a greater risk of developing hypokalemia.

References

  1. (2001) "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
View all 4 references

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Drug and food interactions

Moderate

budesonide food

Applies to: budesonide / formoterol

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations and systemic effects of orally administered budesonide. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. According to the manufacturer, the systemic exposure of oral budesonide approximately doubles after extensive intake of grapefruit juice.

MANAGEMENT: Patients receiving budesonide should avoid the regular consumption of grapefruits and grapefruit juice to prevent undue increases in plasma budesonide levels and systemic effects.

References

  1. (2001) "Product Information. Entocort (budesonide)." AstraZeneca Pharma Inc

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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.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor 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.
Unknown No interaction information available.

Further information

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