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Drug Interactions between Iclusig and lenvatinib

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

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Interactions between your drugs

Moderate

PONATinib lenvatinib

Applies to: Iclusig (ponatinib) and lenvatinib

Consumer information for this interaction is not currently available.

MONITOR: Lenvatinib use in combination with or after recent use of other medications associated with osteonecrosis of the jaw (ONJ) may increase the risk of this rare side effect. Theories as to how ONJ develops include inhibition of bone remodeling, inflammation or infection, angiogenesis inhibition, innate or acquired immune dysfunction, as well as genetic predisposition; however, the pathophysiology is likely related to multiple factors. Medication-related ONJ (MRONJ) is a rare, but severe and debilitating condition whose exact cause remains unknown. Known risk factors for MRONJ include cancer, duration of antiresorptive therapy, dentoalveolar operations (such as tooth extraction), preexisting inflammatory dental disease, and concurrent use of multiple medications associated with a risk of ONJ (such as bisphosphonates, denosumab, romosozumab, angiogenesis inhibitors, and corticosteroids).

MANAGEMENT: Caution is advised when lenvatinib is used with other agents that are also associated with the development of ONJ. A routine oral examination should be performed prior to initiation of either treatment. Patients should be advised regarding good oral hygiene practices and to have regular preventive dentistry performed throughout treatment. For patients requiring invasive dental procedures, discontinuation of lenvatinib may be recommended. Patients should be advised to seek medical attention if they experience signs and symptoms of ONJ, such as: pain in the mouth, teeth, or jaw; swelling or sores inside the mouth; numbness or a feeling of heaviness in the jaw; loosening of a tooth; or exposure of bone in the jaw. Those who are suspected of having or who develop ONJ during lenvatinib therapy should receive care by a dentist or an oral surgeon. In all circumstances involving MRONJ, clinical judgment and a risk-benefit assessment should guide the management plan of each patient based on their specific clinical circumstances.

References

  1. "Product Information. Lenvima (lenvatinib)." Eisai Inc (2015):
  2. Zhang X, Hamadeh IS, Song S "Osteonecrosis of the Jaw in the United States Food and Drug Administration's Adverse Event Reporting System (FAERS) https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.2693"
  3. Rosella D, Papi P, Giardino R "Medication-related osteonecrosis of the jaw: Clinical and practical guidelines. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820581/"
  4. AIDhalaan NA, BaQais A, Al-Omar A "Medication-related Osteonecrosis of the Jaw: A Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067354/"
  5. Ruggiero SL, Dodson TB, Aghaloo T "Medication-Related Osteonecrosis of the Jaw - 2022 Update https://www.aaoms.org/docs/govt_affairs/advocacy_white_papers/mronj_position_paper.pdf"
View all 5 references

Drug and food interactions

Moderate

PONATinib food

Applies to: Iclusig (ponatinib)

Do not consume grapefruit, grapefruit juice, or any supplements that contain grapefruit extract during treatment with PONATinib unless directed otherwise by your doctor. Grapefruit juice can increase the blood levels of PONATinib. You may be more likely to experience side effects such as nausea; vomiting; abdominal pain; constipation; skin rash; mouth sores; high blood pressure; blood clots; fluid retention; heart failure; liver damage; and impaired bone marrow function resulting in low numbers of different types of blood cells, which can increase the risk of anemia, bleeding problems and infections. You should contact your doctor immediately if you develop sudden dizziness, fainting, chest pain, palpitation, shortness of breath, weakness on one side of the body, speech impairment, leg pain or swelling, or any signs of infection, as these may be symptoms of potentially serious side effects associated with PONATinib. You should also seek prompt medical attention if you have signs and symptoms of liver damage such as fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, light colored stools, and yellowing of the skin or eyes. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Vegf/vegfr inhibitors

Therapeutic duplication

The recommended maximum number of medicines in the 'VEGF/VEGFR inhibitors' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'VEGF/VEGFR inhibitors' category:

  • Iclusig (ponatinib)
  • lenvatinib

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

Duplication

Multikinase inhibitors

Therapeutic duplication

The recommended maximum number of medicines in the 'multikinase inhibitors' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'multikinase inhibitors' category:

  • Iclusig (ponatinib)
  • lenvatinib

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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