Can you take Actos with Pazopanib?

The pioglitazone in Actos has a minor potential interaction with Anemia.

Thiazolidinediones can cause slight decreases in hemoglobin and hematocrit. In clinical studies, hemoglobin levels were reduced primarily within the first 4 to 12 weeks of therapy but remained relatively constant thereafter. These changes may be related to increased plasma volume and have rarely been associated with any significant hematologic clinical effects. Nevertheless, caution may be advisable when thiazolidinediones are prescribed to patients with certain anemias.

The pioglitazone in Actos has a moderate potential interaction with Bladder Cancer.

There are insufficient data to determine if pioglitazone has an effect on preexisting bladder tumors or if it can cause bladder cancer. However, the manufacturer does not recommend the use of pioglitazone in patients with active bladder cancer. In patients with history of bladder cancer the benefit of treatment versus the risk of cancer recurrence during treatment should be considered.

PAZOPanib has a moderate potential interaction with Cardiovascular Conditions and Disorders.

Patients should be carefully monitored for clinical signs or symptoms of congestive heart failure. Baseline and periodic evaluation of LVEF is recommended in patients at risk of cardiac dysfunction including previous anthracycline exposure.

The pioglitazone in Actos has a major potential interaction with Diabetes, Type 1.

Thiazolidinediones exert their hypoglycemic effect only in the presence of insulin. Therefore, these agents should not be used in patients with type I diabetes or for the treatment of diabetic ketoacidosis.

The pioglitazone in Actos has a moderate potential interaction with Diabetes Mellitus.

New onset or worsening diabetic macular edema with decreased visual acuity have been reported in postmarketing reports in some diabetic patients who were taking thiazolidinedione drugs. Some patients presented with blurred vision or decreased visual acuity, but some patients appear to have been diagnosed on routine ophthalmologic examination. Most patients had peripheral edema at the time macular edema was diagnosed. Some patients had improvement in their macular edema after discontinuation of their thiazolidinedione. Patients with diabetes should have regular eye exams by an ophthalmologist according to current standards of care. Additionally, any diabetic who reports any kind of visual symptom should be promptly referred to an ophthalmologist, regardless of the patient's underlying medications or other physical findings.

The pioglitazone in Actos has a major potential interaction with Diabetic Ketoacidosis.

Thiazolidinediones exert their hypoglycemic effect only in the presence of insulin. Therefore, these agents should not be used in patients with type I diabetes or for the treatment of diabetic ketoacidosis.

The pioglitazone in Actos has a moderate potential interaction with Diabetic Macular Edema.

New onset or worsening diabetic macular edema with decreased visual acuity have been reported in postmarketing reports in some diabetic patients who were taking thiazolidinedione drugs. Some patients presented with blurred vision or decreased visual acuity, but some patients appear to have been diagnosed on routine ophthalmologic examination. Most patients had peripheral edema at the time macular edema was diagnosed. Some patients had improvement in their macular edema after discontinuation of their thiazolidinedione. Patients with diabetes should have regular eye exams by an ophthalmologist according to current standards of care. Additionally, any diabetic who reports any kind of visual symptom should be promptly referred to an ophthalmologist, regardless of the patient's underlying medications or other physical findings.

The pioglitazone in Actos has a moderate potential interaction with Fluid Retention.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

PAZOPanib has a major potential interaction with Gastrointestinal Hemorrhage.

Pazopanib may increase the risk of bleeding. Patients who have a history of hemoptysis, cerebral hemorrhage or those who have experienced clinically significant gastrointestinal hemorrhage in the past 6 months should not use this agent.

PAZOPanib has a major potential interaction with Gastrointestinal Obstruction.

Inhibitors of vascular endothelial growth factor receptors (VEGFR) may cause gastrointestinal perforation and fistulae. Avoid use of these agents in patients with ovarian cancer who have evidence of recto-sigmoid involvement by pelvic examination or bowel involvement on CT scan or clinical symptoms of bowel obstruction. Permanently discontinue these agents in patients with gastrointestinal perforation.

PAZOPanib has a major potential interaction with Gastrointestinal Perforation.

Inhibitors of vascular endothelial growth factor receptors (VEGFR) may cause gastrointestinal perforation and fistulae. Avoid use of these agents in patients with ovarian cancer who have evidence of recto-sigmoid involvement by pelvic examination or bowel involvement on CT scan or clinical symptoms of bowel obstruction. Permanently discontinue these agents in patients with gastrointestinal perforation.

The pioglitazone in Actos has a major potential interaction with Heart Failure.

The use of thiazolidinediones, alone or in combination with other antidiabetic agents, has been associated with fluid retention and new onset or exacerbation of heart failure. An increased risk of cardiovascular events (heart failure worsening; new or worsening edema; new or worsening dyspnea; increases in heart failure medication; myocardial infarction; angina; cardiovascular hospitalization and deaths) has been reported with rosiglitazone therapy in type II diabetic patients with New York Heart Association (NYHA) Class I or II congestive heart failure compared to placebo. Likewise, overnight hospitalization for CHF was observed in 9.9% of diabetic patients with NYHA Class II and III heart failure on pioglitazone compared to 4.7% of patients on glyburide. An increased incidence of cardiovascular adverse events including edema and cardiac failure has also been reported in patients receiving a thiazolidinedione in combination with insulin relative to insulin and placebo. Therapy with thiazolidinediones should be administered cautiously and initiated at the lowest recommended dosage in patients with congestive heart failure. Thiazolidinediones are contraindicated for the treatment of patients with NYHA Class III or IV cardiac status. Patients should be monitored for signs of worsening heart failure such as increased dyspnea, edema, and weight gain. Therapy should be discontinued if any deterioration in cardiac status occurs.

PAZOPanib has a moderate potential interaction with Heart Failure.

Patients should be carefully monitored for clinical signs or symptoms of congestive heart failure. Baseline and periodic evaluation of LVEF is recommended in patients at risk of cardiac dysfunction including previous anthracycline exposure.

The pioglitazone in Actos has a moderate potential interaction with High Blood Pressure.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

PAZOPanib has a major potential interaction with History, Radiation Therapy.

Inhibitors of vascular endothelial growth factor receptors (VEGFR) may cause gastrointestinal perforation and fistulae. Avoid use of these agents in patients with ovarian cancer who have evidence of recto-sigmoid involvement by pelvic examination or bowel involvement on CT scan or clinical symptoms of bowel obstruction. Permanently discontinue these agents in patients with gastrointestinal perforation.

PAZOPanib has a moderate potential interaction with History, Thrombotic/Thromboembolic Disorder.

Venous and arterial thromboembolic events (VTE and ATE), some fatal, have been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR). Caution is recommended when using these agents in patients with a reported history of VTE or ATE. These agents should be discontinued in patients with serious or life-threatening VTE or ATE, including pulmonary embolism.

PAZOPanib has a moderate potential interaction with Hypertensive Encephalopathy.

Inhibitors of vascular endothelial growth factor receptors (VEGFR) have been associated with severe increases in blood pressure. Therapy with these agents should be administered cautiously in patients with preexisting hypertension. Blood pressure should be assessed prior to initiating treatment, regularly during treatment and after discontinuation in patients with bevacizumab -induced or -exacerbated hypertension. Temporarily suspend these agents in patients with severe hypertension that is not controlled with medical management. Discontinue these agents in patients with hypertensive crisis or hypertensive encephalopathy.

PAZOPanib has a moderate potential interaction with Interstitial Lung Disease.

Interstitial Lung Disease (ILD)/Pneumonitis has been reported with the use of pazopanib. Monitor patients for pulmonary symptoms indicative of ILD/pneumonitis and discontinue pazopanib in patients developing ILD or pneumonitis.

PAZOPanib has a major potential interaction with Liver Disease.

Severe and fatal hepatotoxicity has been observed with the use of pazopanib. No dose adjustment is required in patients with mild hepatic impairment. Pazopanib dose should be reduced to 200 mg per day in patients with moderate hepatic impairment. Pazopanib is not recommended in patients with severe hepatic impairment. It is recommended to monitor serum liver tests before starting treatment with pazopanib and at weeks 3, 5, 7, and 9. Thereafter, monitor at month 3 and at month 4, and as clinically indicated; periodic monitoring should then continue monthly. The use of this agent should be interrupted in patients presenting significant hepatic dysfunction and restart therapy only if clinically necessary and according to clinical recommendations.

The pioglitazone in Actos has a moderate potential interaction with Liver Disease.

Initiation of rosiglitazone or pioglitazone therapy is not recommended in patients who exhibit clinical evidence of active liver disease or increased baseline serum transaminase levels (ALT exceeding 2.5 times upper limit of normal). Use of these agents is also not recommended in patients who have experienced jaundice during treatment with troglitazone. The use of troglitazone, another agent in the thiazolidinedione class, has been associated with clinically significant elevations in liver enzymes, reversible jaundice, and idiosyncratic hepatocellular injury including rare cases of liver failure, liver transplants, and death. Injury has occurred after both short- and long-term treatment. While these effects have not been associated with other thiazolidinediones in clinical trials, concerns exist because of their structural similarities. In addition, isolated cases of hepatitis and hepatic enzyme elevations to 3 or more times the upper limit of normal have been reported with both rosiglitazone and pioglitazone during postmarketing use. Rarely, these events have involved hepatic failure with and without fatal outcome, although causality has not been established. Until more safety data are available, patients who are prescribed thiazolidinedione therapy should have serum transaminase levels checked at baseline and periodically thereafter as clinically necessary. Mild to moderate elevations (ALT less than or equal to 2.5 times ULN) require cautious use with more frequent monitoring to determine if the elevations resolve or worsen. Patients who develop potential symptoms of hepatic injury such as unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, and dark urine should have liver enzymes checked. Therapy should be withdrawn if ALT is elevated and persists above 3 times ULN or if jaundice develops.

PAZOPanib has a moderate potential interaction with Long QT Syndrome.

Pazopanib can cause QT prolongation which may lead to an increased risk for ventricular arrhythmias, including Torsade de Pointes. This agent should be administered with caution in patients with a history of QT interval prolongation, in patients taking antiarrhythmics or other medications that may prolong QT interval. Serum electrolytes should be corrected before initiating therapy with this agent. Periodic monitoring of ECGs and electrolytes is recommended in these patients.

The pioglitazone in Actos has a moderate potential interaction with Pleural Effusion.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

PAZOPanib has a moderate potential interaction with Posterior Reversible Encephalopathy Syndrome.

Posterior Reversible Encephalopathy Syndrome (PRES) has been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR) in clinical studies. PRES is a neurological disorder which can present with headache, seizure, lethargy, confusion, blindness and other visual and neurologic disturbances. It is recommended to discontinue these agents in patients developing PRES. The safety of restarting therapy is not known. Cation is recommended if therapy is reinitiating in patients previously experiencing PRES.

The pioglitazone in Actos has a moderate potential interaction with Premenopausal Anovulation.

In premenopausal, anovulatory patients with insulin resistance, treatment with thiazolidinediones may result in resumption of ovulation. Due to improved insulin sensitivity, pregnancy can occur if adequate contraception is not used.

PAZOPanib has a moderate potential interaction with Proteinuria.

The incidence and severity of proteinuria is increased in patients taking inhibitors of vascular endothelial growth factor receptors (VEGFR). Therapy with these agents should be administered cautiously in patients with renal dysfunction. Monitoring for proteinuria and hematuria is recommended and perform baseline and periodic urinalyses during treatment, with follow up measurement as clinically indicated. It is recommended to temporarily suspend these agents in patients with moderate to severe proteinuria and to discontinue therapy in patients with nephrotic syndrome.

The pioglitazone in Actos has a moderate potential interaction with Pulmonary Edema.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

PAZOPanib has a moderate potential interaction with Pulmonary Embolism.

Venous and arterial thromboembolic events (VTE and ATE), some fatal, have been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR). Caution is recommended when using these agents in patients with a reported history of VTE or ATE. These agents should be discontinued in patients with serious or life-threatening VTE or ATE, including pulmonary embolism.

PAZOPanib has a moderate potential interaction with Pulmonary Impairment.

Interstitial Lung Disease (ILD)/Pneumonitis has been reported with the use of pazopanib. Monitor patients for pulmonary symptoms indicative of ILD/pneumonitis and discontinue pazopanib in patients developing ILD or pneumonitis.

PAZOPanib has a moderate potential interaction with Renal Dysfunction.

The incidence and severity of proteinuria is increased in patients taking inhibitors of vascular endothelial growth factor receptors (VEGFR). Therapy with these agents should be administered cautiously in patients with renal dysfunction. Monitoring for proteinuria and hematuria is recommended and perform baseline and periodic urinalyses during treatment, with follow up measurement as clinically indicated. It is recommended to temporarily suspend these agents in patients with moderate to severe proteinuria and to discontinue therapy in patients with nephrotic syndrome.

PAZOPanib has a moderate potential interaction with Thrombotic/Thromboembolic Disorder.

Venous and arterial thromboembolic events (VTE and ATE), some fatal, have been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR). Caution is recommended when using these agents in patients with a reported history of VTE or ATE. These agents should be discontinued in patients with serious or life-threatening VTE or ATE, including pulmonary embolism.

PAZOPanib has a moderate potential interaction with Underactive Thyroid.

Hypothyroidism has been reported in patients taking pazopanib. Therapy with pazopanib should be administered cautiously to patients with thyroid dysfunction. Baseline laboratory measurement of thyroid function is recommended and if appropriate, treatment per standard medical practice should be given prior to initiation of therapy. Clinical monitoring of thyroid function is recommended during therapy.

The pioglitazone in Actos has a moderate potential interaction with Weight Loss.

Thiazolidinediones can cause dose-related weight gain, which may be undesirable in obese patients attempting to lose weight. The mechanism of weight gain is unclear but probably involves a combination of fluid retention and fat accumulation. In postmarketing experience with rosiglitazone, there have been reports of unusually rapid increases in weight, greater than those generally observed in clinical trials. Patients who experience such increases should be assessed for fluid retention and volume-related events such as excessive edema and congestive heart failure.