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Nivolumab Disease Interactions

There are 11 disease interactions with nivolumab:

Major

Antineoplastics (Includes nivolumab) ↔ infections

Major Potential Hazard, Moderate plausibility. Applies to: Infection - Bacterial/Fungal/Protozoal/Viral

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

References

  1. "Product Information. Novantrone (mitoxantrone)." Immunex Corporation, Seattle, WA.
  2. "Product Information. Doxil (doxorubicin liposomal)." Sequis Pharmaceuticals Inc, Menlo Park, CA.
  3. "Product Information. Gemzar (gemcitabine)." Lilly, Eli and Company, Indianapolis, IN.
  4. "Product Information. Taxol (paclitaxel)." Bristol-Myers Squibb, Princeton, NJ.
  5. "Product Information. Leukeran Tablets (chlorambucil)." Glaxo Welcome, Research Triangle Pk, NC.
  6. Frame JN, Dahut WL, Crowley S "Fludarabine and acute tumor lysis in chronic lymphocytic leukemia." N Engl J Med 327 (1992): 1396-7
  7. "Product Information. Leustatin (cladribine)." Ortho Biotech Inc, Raritan, NJ.
  8. "Product Information. Matulane (procarbazine)." Roche Laboratories, Nutley, NJ.
  9. "Product Information. Adriamycin PFS (doxorubicin)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. Schilling PJ, Vadhan-Raj S "Concurrent cytomegalovirus and pneumocystis pneumonia after fludarabine therapy for chronic lymphocytic leukemia." N Engl J Med 323 (1990): 833-4
  11. "Product Information. Mutamycin (mitomycin)." Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Alkeran Tablets (melphalan)." Glaxo Wellcome, Research Triangle Pk, NC.
  13. Sanders C, Perez EA, Lawrence HJ "Opportunistic infections in patients with chronic lymphocytic leukemia following treatment with fludarabine." Am J Hematol 39 (1992): 314-5
  14. "Product Information. Tabloid (thioguanine)." Prasco Laboratories, Cincinnati, OH.
  15. "Product Information. Idamycin (idarubicin)." Pharmacia and Upjohn, Kalamazoo, MI.
  16. "Product Information. Hycamtin (topotecan)." SmithKline Beecham, Philadelphia, PA.
  17. "Product Information. Cytosar-U (cytarabine)." Pharmacia and Upjohn, Kalamazoo, MI.
  18. "Product Information. Purinethol (mercaptopurine)." Glaxo Wellcome, Research Triangle Pk, NC.
  19. Girmenia C, Mauro FR, Rahimi S "Late listeriosis after fludarabine plus prednisone treatment." Br J Haematol 87 (1994): 407-8
  20. "Product Information. Methotrexate (methotrexate)." Lederle Laboratories, Wayne, NJ.
  21. "Product Information. Xeloda (capecitabine)." Roche Laboratories, Nutley, NJ.
  22. "Product Information. Vepesid (etoposide)." Bristol-Myers Squibb, Princeton, NJ.
  23. "Product Information. Uracil Mustard (uracil mustard)." Roberts Pharmaceutical Corporation, Eatontown, NJ.
  24. Bastion Y, Coiffier B, Tigaud JD, Espinouse D, Bryon PA "Pneumocystis pneumonia in a patient treated with fludarabine for chronic lymphocytic leukemia." Eur J Cancer 27 (1991): 671
  25. "Product Information. Ifex (ifosfamide)." Bristol-Myers Squibb, Princeton, NJ.
  26. "Product Information. Fludara (fludarabine)." Berlex, Richmond, CA.
  27. "Product Information. Taxotere (docetaxel)." Rhone-Poulenc Rorer, Collegeville, PA.
  28. "Product Information. Platinol (cisplatin)." Bristol-Myers Squibb, Princeton, NJ.
  29. "Product Information. Nipent (pentostatin)." Hospira Inc, Lake Forest, IL.
  30. "Product Information. DTIC-Dome (dacarbazine)." Bayer, West Haven, CT.
  31. "Product Information. Thiotepa (thiotepa)." Hikma USA (formerly West-Ward Pharmaceutical Corporation), Eatontown, NJ.
View all 31 references
Major

Monoclonal antibodies (Includes nivolumab) ↔ infusion reactions

Major Potential Hazard, Moderate plausibility. Applies to: Pulmonary Impairment, Angioedema, Urticaria, Hypotension, Hypertension

The use of monoclonal antibodies administered via IV infusion may cause serious infusion reactions, including bronchospasm, hypoxia, dyspnea, fluctuations in blood pressure, laryngeal edema and pulmonary edema. Caution should be taken in patients with a history of cardiopulmonary disease as they may require additional post-infusion medications to manage respiratory complications. It is recommended to administer required intravenous hydration and premedication with antihistamines, analgesics, and antipyretics before administration. Monitor closely for signs and symptoms of infusion reactions during and for at least 4 hours following completion of each infusion in a setting where cardiopulmonary resuscitation medication and equipment are available. Immediately interrupt or permanently discontinue treatment and institute supportive management for severe or prolonged infusion reactions as appropriate.

Major

Monoclonal antibodies (Includes nivolumab) ↔ tumor lysis syndrome

Major Potential Hazard, Moderate plausibility. Applies to: Tumor Lysis Syndrome

Tumor lysis syndrome (TLS) has occurred in patients receiving certain monoclonal antibodies. Patients with high tumor burden and those with high circulating lymphocyte counts of greater than 25 X 10^9/L have a higher risk of developing TLS. Consider tumor lysis prophylaxis prior to the infusion with anti-hyperuricemics and hydration beginning 12 to 24 hours prior to infusion. It is recommended to correct electrolytes abnormalities, and monitor renal function in patients who develop TLS. Monitor for signs and symptoms of TLS and temporary interruption or discontinuation of therapy might be required.

Moderate

Nivolumab (Includes nivolumab) ↔ colitis

Moderate Potential Hazard, Moderate plausibility. Applies to: Inflammatory Bowel Disease

Immune-mediated colitis has been reported with the use of nivolumab. Monitor patients for signs and symptoms of colitis. It is recommended to administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by corticosteroid taper for severe or life-threatening colitis. Administer corticosteroids at a dose of 0.5 to 1 mg/kg/day prednisone equivalents followed by corticosteroid taper for moderate colitis of more than 5 days duration; if worsening or no improvement occurs despite initiation of corticosteroids, increase dose to 1 to 2 mg/kg/day prednisone equivalents. If appropriate modify the dose according to manufacturer recommendations when nivolumab is administered in combination with ipilimumab, and if nivolumab is withheld, ipilimumab should also be withheld. Permanently discontinue nivolumab and ipilimumab for life-threatening or for recurrent colitis. Care should be taken when using nivolumab in patients with inflammatory bowel disease.

Moderate

Nivolumab (Includes nivolumab) ↔ diabetes

Moderate Potential Hazard, Moderate plausibility. Applies to: Diabetes Mellitus

Nivolumab can cause type 1 diabetes mellitus. Monitor for hyperglycemia or other signs and symptoms of diabetes. Withhold treatment in cases of severe hyperglycemia until metabolic control is achieved. Permanently discontinue nivolumab for life-threatening hyperglycemia. If appropriate modify the dose according to manufacturer recommendations when nivolumab is administered in combination with ipilimumab, and if nivolumab is withheld, ipilimumab should also be withheld. Care should be exercised when using nivolumab in diabetic patients.

Moderate

Nivolumab (Includes nivolumab) ↔ hepatic impairment

Moderate Potential Hazard, Moderate plausibility. Applies to: Liver Disease

Nivolumab can cause immune-mediated hepatitis. Based on a population pharmacokinetic analysis, no dose adjustment is recommended for patients with mild or moderate hepatic impairment. Caution is recommended when using nivolumab in patients with severe hepatic impairment as this agent has not been studied in these patients. Monitor patients for abnormal liver tests prior to and periodically during treatment. It is recommended to administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by corticosteroid taper for severe or life-threatening transaminase elevations, with or without concomitant elevation in total bilirubin. Administer corticosteroids at a dose of 0.5 to 1 mg/kg/day prednisone equivalents for moderate transaminase elevations. If appropriate modify the dose according to manufacturer recommendations when nivolumab is administered in combination with ipilimumab, and if nivolumab is withheld, ipilimumab should also be withheld. Care should be taken when using nivolumab in patients with liver disease.

Moderate

Nivolumab (Includes nivolumab) ↔ neurologic disorders

Moderate Potential Hazard, Moderate plausibility. Applies to: Neurologic Disorder

Nivolumab can cause immune-mediated encephalitis with no clear alternate etiology. It is recommended to evaluate patients with neurologic symptoms with consultation with a neurologist, brain MRI, lumbar puncture, and as clinically indicated. Withhold nivolumab in patients with new-onset moderate to severe neurologic signs or symptoms and evaluate to rule out infectious or other causes of moderate to severe neurologic deterioration. If other etiologies are ruled out, administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents for patients with immune-mediated encephalitis, followed by corticosteroid taper. Permanently discontinue nivolumab for immune-mediated encephalitis. If appropriate modify the dose according to manufacturer recommendations when nivolumab is administered in combination with ipilimumab, and if nivolumab is withheld, ipilimumab should also be withheld. Care should be taken when using nivolumab in patients with neurologic disorders.

Moderate

Nivolumab (Includes nivolumab) ↔ pneumonitis

Moderate Potential Hazard, Moderate plausibility. Applies to: Pleuropulmonary Infection

Immune-mediated pneumonitis, including fatal cases have been reported with the use of nivolumab. Monitor patients for signs with radiographic imaging and for symptoms of pneumonitis. It is recommended to administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents for moderate or more severe pneumonitis, followed by corticosteroid taper. Permanently discontinue therapy for severe or life-threatening pneumonitis and withhold therapy until resolution for moderate pneumonitis. If appropriate modify the dose according to manufacturer recommendations when nivolumab is administered in combination with ipilimumab, and if nivolumab is withheld, ipilimumab should also be withheld. Care should be taken when using nivolumab in patients with pulmonary infections.

Moderate

Nivolumab (Includes nivolumab) ↔ renal dysfunction

Moderate Potential Hazard, Moderate plausibility. Applies to: Renal Dysfunction

Nivolumab can cause immune-mediated nephritis. Monitor patients for elevated serum creatinine prior to and periodically during treatment. It is recommended to administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by corticosteroid taper for life-threatening increased serum creatinine. Administer corticosteroids at a dose of 0.5 to 1 mg/kg/day prednisone equivalents for moderate or severe increased serum creatinine, if worsening or no improvement occurs, increase dose of corticosteroids to 1 to 2 mg/kg/day prednisone equivalents. Withhold nivolumab for moderate or severe increased serum creatinine. Permanently discontinue nivolumab for life-threatening increased serum creatinine. If appropriate modify the dose according to manufacturer recommendations when nivolumab is administered in combination with ipilimumab, and if nivolumab is withheld, ipilimumab should also be withheld. Care should be taken when using nivolumab in patients with renal dysfunction.

Moderate

Nivolumab (Includes nivolumab) ↔ thyroid disease

Moderate Potential Hazard, Moderate plausibility. Applies to: Thyroid Disease

Nivolumab can cause autoimmune thyroid disorders. Monitor thyroid function prior to and periodically during treatment. Administer hormone-replacement therapy for hypothyroidism. Initiate medical management for control of hyperthyroidism. There are no recommended dose adjustments of nivolumab for hypothyroidism or hyperthyroidism. Care should be taken when using this agent in patients with thyroid disease.

Moderate

PD-1 inhibitors (Includes nivolumab) ↔ myasthenia gravis

Moderate Potential Hazard, Moderate plausibility. Applies to: Myasthenia Gravis

Certain PD-1 inhibitors such as nivolumab and pembrolizumab should be used with caution in patients with myasthenia gravis (MG). Worsening of myasthenic weakness has been reported in people with previously diagnosed MG. It is recommended to advise patients with MG and cancer considering cancer immunotherapy about this possible side effect.

Nivolumab drug interactions

There are 4 drug interactions with nivolumab

Nivolumab alcohol/food interactions

There is 1 alcohol/food interaction with nivolumab

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.