etopophos and fingolimod Interactions
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etoposide phosphate and fingolimod (Moderate Drug-Drug)
MONITOR: Coadministration of fingolimod with antineoplastic, immunosuppressive, or other immune-modulating therapies may increase the risk of infections. Fingolimod causes reversible sequestration of lymphocytes in lymphoid tissues. A dose-dependent reduction in peripheral lymphocyte count to 20% to 30% of baseline values has been observed, which may increase the risk of infections. In a placebo-controlled study of 1272 multiple sclerosis patients, 18% of patients on fingolimod 0.5 mg daily reached a nadir of less than 200 cells/mcL on at least one occasion, compared to no patient on placebo. Low lymphocyte counts are maintained with chronic daily dosing of fingolimod 0.5 mg daily. In addition, a mild decrease in the neutrophil count to approximately 80% of baseline occurs during chronic therapy. Serious infections requiring admission to hospital have been reported with fingolimod alone, and the risk may theoretically increase when coadministered with other immunosuppressive therapy.
MANAGEMENT: The safety and efficacy of fingolimod in combination with antineoplastic, immunosuppressive, or immune-modulating agents have not been evaluated. Caution is advised during coadministration. A complete blood count is recommended prior to starting fingolimod if a recent one (i.e., within 6 months) is not available. Treatment suspension should be considered in patients who develop a serious infection, and the benefits and risks reassessed prior to restarting treatment. Because clearance of fingolimod may take up to two months following discontinuation, it is necessary to continue monitoring for infections throughout this period.
