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Drug Interactions between asparaginase escherichia coli and prednisolone

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

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Interactions between your drugs

Moderate

prednisoLONE asparaginase Escherichia coli

Applies to: prednisolone and asparaginase escherichia coli

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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Drug and food interactions

Moderate

asparaginase Escherichia coli food

Applies to: asparaginase escherichia coli

MONITOR: Concomitant use of asparaginase with other hepatotoxic agents may potentiate the risk of liver injury. Asparaginase-associated hepatotoxicity has been reported more commonly in adults than in children and has been strongly associated with obesity. Hepatomegaly, acute severe hepatotoxicity, and fatal liver failure have been reported with asparaginase treatment in adults. Also, asparaginase may increase the toxicity of drugs bound to plasma proteins or metabolized by the liver.

MANAGEMENT: The risk of additive hepatotoxicity should be considered when asparaginase is used with other hepatotoxic agents (e.g., alcohol, androgens, antituberculosis agents, azole antifungal agents, ACE inhibitors, macrolide antibiotics, nonsteroidal anti-inflammatory agents, nucleoside reverse transcriptase inhibitors, sulfonamides, thiazolidinediones, and statins). Liver function tests should be monitored at regular intervals during asparaginase treatment with or without other hepatotoxic drugs. Patients should be advised to seek medical attention if they experience potential symptoms of hepatotoxicity such as right upper quadrant pain, increasing abdominal size, fever, rash, itching, anorexia, nausea, vomiting, fatigue, malaise, dark urine, pale stools, and jaundice.

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. Cerner Multum, Inc (2015) "ANVISA Bulário Eletrônico."
  7. (2019) "Product Information. Asparlas (calaspargase pegol)." Servier
  8. Al-Nawakil C, Willems L, Mauprivez C, et al. (2014) "Successful treatment of l-asparaginase-induced severe acute hepatotoxicity using mitochondrial cofactors." Leuk Lymphoma, 55, p. 1670-4
  9. 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
  10. Jenkins R, Perlin E (1987) "Severe hepatotoxicity from Escherichia coli L-asparaginase." J Natl Med Assoc, 79, p. 775-9
  11. Lu G, Karur V, Herrington JD, Walker MG (2016) "Successful treatment of pegaspargase-induced acute hepatotoxicity with vitamin B complex and L-carnitine" Proc (Bayl Univ Med Cent), 29, p. 46-7
  12. Bodmer M, Sulz M, Stadlmann S, Droll A, Terracciano L, Krahenbuhl S (2006) "Fatal liver failure in an adult patient with acute lymphoblastic leukemia following treatment with L-asparaginase." Digestion, 74, epub
  13. Burke PW, Aldoss I, Lunning MA, et al. (2013) "High-grade PEGylated asparaginase-related hepatotoxicity occurrence in a pediatric-inspired adult acute lymphoblastic leukemia regimen does not necessarily predict recurrent hepatotoxicity in subsequent cycles." Blood, 122, p. 2671
View all 13 references

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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.

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