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Pembrolizumab Disease Interactions

There are 10 disease interactions with pembrolizumab:

Major

Antineoplastics (Includes Pembrolizumab) ↔ Infections

Severe 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. Fludara (fludarabine)." Berlex, Richmond, CA.
  4. "Product Information. Gemzar (gemcitabine)." Lilly, Eli and Company, Indianapolis, IN.
  5. Frame JN, Dahut WL, Crowley S "Fludarabine and acute tumor lysis in chronic lymphocytic leukemia." N Engl J Med 327 (1992): 1396-7
  6. "Product Information. Taxol (paclitaxel)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Matulane (procarbazine)." Roche Laboratories, Nutley, NJ.
  8. "Product Information. Leukeran Tablets (chlorambucil)." Glaxo Welcome, Research Triangle Pk, NC.
  9. "Product Information. Mutamycin (mitomycin)." Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Adriamycin PFS (doxorubicin)." Pharmacia and Upjohn, Kalamazoo, MI.
  11. "Product Information. Alkeran Tablets (melphalan)." Glaxo Wellcome, Research Triangle Pk, NC.
  12. 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
  13. "Product Information. Leustatin (cladribine)." Ortho Biotech Inc, Raritan, NJ.
  14. "Product Information. Hycamtin (topotecan)." SmithKline Beecham, Philadelphia, PA.
  15. "Product Information. Taxotere (docetaxel)." Rhone-Poulenc Rorer, Collegeville, PA.
  16. "Product Information. Cytosar-U (cytarabine)." Pharmacia and Upjohn, Kalamazoo, MI.
  17. "Product Information. Purinethol (mercaptopurine)." Glaxo Wellcome, Research Triangle Pk, NC.
  18. "Product Information. Platinol (cisplatin)." Bristol-Myers Squibb, Princeton, NJ.
  19. 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
  20. "Product Information. Methotrexate (methotrexate)." Lederle Laboratories, Wayne, NJ.
  21. Girmenia C, Mauro FR, Rahimi S "Late listeriosis after fludarabine plus prednisone treatment." Br J Haematol 87 (1994): 407-8
  22. "Product Information. Xeloda (capecitabine)." Roche Laboratories, Nutley, NJ.
  23. "Product Information. Vepesid (etoposide)." Bristol-Myers Squibb, Princeton, NJ.
  24. "Product Information. Tabloid (thioguanine)." Glaxo Wellcome, Research Triangle Park, NC.
  25. "Product Information. Idamycin (idarubicin)." Pharmacia and Upjohn, Kalamazoo, MI.
  26. "Product Information. Uracil Mustard (uracil mustard)." Roberts Pharmaceutical Corporation, Eatontown, NJ.
  27. "Product Information. Nipent (pentostatin)." Parke-Davis, Morris Plains, NJ.
  28. "Product Information. Ifex (ifosfamide)." Bristol-Myers Squibb, Princeton, NJ.
  29. "Product Information. DTIC-Dome (dacarbazine)." Bayer, West Haven, CT.
  30. "Product Information. Thiotepa (thiotepa)." Lederle Laboratories, Wayne, NJ.
  31. 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
View all 31 references
Major

Monoclonal Antibodies (Includes Pembrolizumab) ↔ Infusion Reactions

Severe 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 Pembrolizumab) ↔ Tumor Lysis Syndrome

Severe 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

Pembrolizumab (Includes Pembrolizumab) ↔ Colitis

Moderate Potential Hazard, Moderate plausibility

Applies to: Inflammatory Bowel Disease

Immune-mediated colitis has been reported with the use of pembrolizumab. 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 moderate to severe or life-threatening colitis. Withhold treatment for moderate or severe colitis, and permanently discontinue therapy for life-threatening colitis. If appropriate modify the dose according to manufacturer recommendations. Care should be taken when using pembrolizumab in patients with inflammatory bowel disease.

Moderate

Pembrolizumab (Includes Pembrolizumab) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

Pembrolizumab can cause type 1 diabetes mellitus, including diabetic ketoacidosis. Monitor for hyperglycemia or other signs and symptoms of diabetes. Administer insulin for type 1 diabetes, and withhold pembrolizumab and administer anti-hyperglycemics in patients with severe hyperglycemia. Care should be exercised when using pembrolizumab in diabetic patients.

Moderate

Pembrolizumab (Includes Pembrolizumab) ↔ Hepatic Impairment

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Pembrolizumab can cause immune-mediated hepatitis. Based on a population pharmacokinetic analysis, no dose adjustment is recommended for patients with mild hepatic impairment. Caution is recommended when using pembrolizumab in patients with moderate or severe hepatic impairment as there is insufficient information to determine whether there are clinically important differences in the CL of pembrolizumab 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 0.5 to 1 mg/kg/day prednisone equivalents for grade 2 hepatitis and 1 to 2 mg/kg/day prednisone equivalents for grade 3 or greater hepatitis followed by corticosteroid taper and, based on severity of liver enzyme elevations, withhold or discontinue treatment. If appropriate modify the dose according to manufacturer recommendations. Care should be taken when using pembrolizumab in patients with hepatic impairment.

Moderate

Pembrolizumab (Includes Pembrolizumab) ↔ Multiple Myeloma

Moderate Potential Hazard, Moderate plausibility

Applies to: Multiple Myeloma

The use of pembrolizumab is not recommended in patients with multiple myeloma with a PD-1 or PD-L1 blocking antibody in combination with a thalidomide analog plus dexamethasone. In two randomized clinical trials in patients with multiple myeloma, the addition of pembrolizumab to a thalidomide analog plus dexamethasone, a use for which no PD-1 or PD-L1 blocking antibody is indicated, resulted in increased mortality.

Moderate

Pembrolizumab (Includes Pembrolizumab) ↔ Pneumonitis

Moderate Potential Hazard, Moderate plausibility

Applies to: Pleuropulmonary Infection

Immune-mediated pneumonitis, including fatal cases have been reported with the use of pembrolizumab. 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, life-threatening or recurrent moderate pneumonitis and withhold therapy until resolution for moderate pneumonitis. If appropriate modify the dose according to manufacturer recommendations. Care should be taken when using pembrolizumab in patients with pulmonary infections.

Moderate

Pembrolizumab (Includes Pembrolizumab) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Pembrolizumab can cause immune-mediated nephritis. Monitor patients for changes in renal function, including 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 moderate or greater nephritis. Withhold pembrolizumab for moderate and permanently discontinue treatment for severe or life-threatening nephritis. Care should be taken when using pembrolizumab in patients with renal dysfunction.

Moderate

Pembrolizumab (Includes Pembrolizumab) ↔ Thyroid Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Thyroid Disease

Pembrolizumab can cause autoimmune thyroid disorders. Monitor thyroid function prior to, periodically during treatment, and as indicated based on clinical evaluation. Administer hormone-replacement therapy for hypothyroidism. Initiate medical management for control of hyperthyroidism. Withhold or discontinue pembrolizumab for severe or life-threatening hyperthyroidism. Care should be take when using this agent in patients with thyroid disease.

pembrolizumab drug Interactions

There are 3 drug interactions with pembrolizumab

pembrolizumab alcohol/food Interactions

There is 1 alcohol/food interaction with pembrolizumab

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
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 information available.

Do not stop taking any medications without consulting your healthcare provider.

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