Drug Interactions between Akeega and meloxicam

GENERALLY AVOID: Coadministration with potent or moderate inhibitors of CYP450 2C9 may significantly increase the plasma concentration of meloxicam, which has been shown to be primarily metabolized by this isoenzyme. In a study of healthy volunteers, voriconazole, a weak CYP450 2C9 inhibitor increased the systemic exposure of meloxicam by 47% and prolonged the average meloxicam half-life by 51%. Clinical data for meloxicam use in combination with other more potent CYP450 2C9 inhibitors are unavailable.

MANAGEMENT: Concomitant use of meloxicam with potent or moderate CYP450 2C9 inhibitors should generally be avoided. If coadministration is required, monitor patients for NSAID-related side effects and toxicity including gastrointestinal bleeding or perforation. Dose adjustment of meloxicam may be warranted.

MONITOR: Coadministration of niraparib and drugs that interfere with platelet function or coagulation may potentiate the risk of bleeding complications. In pooled safety population data of patients (n=1,314) with advanced ovarian, fallopian tube, or primary peritoneal cancer treated with niraparib monotherapy, thrombocytopenia was reported in 60% of patients. Two niraparib clinical trials reported greater than or equal to Grade 3 thrombocytopenia in 29% to 39% of patients with niraparib discontinuation due to thrombocytopenia occurring in approximately 3% to 4% of patients. The MAGNITUDE study, which included an evaluation of niraparib in combination with abiraterone for breast cancer gene (BRCA)-mutated metastatic castration-resistant prostate cancer (mCRPC) reported Grade 3 or more thrombocytopenia in 8% of patients.

MANAGEMENT: Concomitant use of anticoagulants or other medications known to reduce platelet count should be approached with caution. Recommendations for holding, adjusting the dose of, or discontinuing niraparib can be found in the manufacturer's labeling. If the patient has additional risk factors for bleeding, such as coadministration with an anticoagulant or antiplatelet, it may be advisable to consider a platelet transfusion at a higher platelet count. For hematologic adverse reactions requiring transfusion, withhold niraparib and consider interrupting any drugs that interfere with platelet function or coagulation. Niraparib may be resumed at a reduced dose per manufacturer recommendations. If hematologic toxicity does not resolve within 28 days following interruption, discontinue niraparib and consider referral to a hematologist. Blood counts should be monitored as recommended by the manufacturer. Patients should be advised to promptly report any signs or symptoms of bleeding to their primary care provider.