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Drug Interactions between Akeega and streptococcus salivarius

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

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Interactions between your drugs

Moderate

niraparib streptococcus salivarius

Applies to: Akeega (abiraterone / niraparib) and streptococcus salivarius

MONITOR: Probiotic use during immunosuppressant or intense antineoplastic therapy may theoretically increase the risk of infections from the live microorganisms contained in probiotic products. Patients may be immunosuppressed if they have recently received or are receiving alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents, or long-term topical or inhaled corticosteroids. Although probiotics are generally considered safe, with minimal to low pathogenicity, infections such as bacteremia and endocarditis with various strains commonly found in probiotics (e.g., lactobacilli, bifidobacteria, Bacillus subtilis) have been rarely reported, primarily in critically ill patients or patients with significant underlying medical conditions such as malignancy, organ transplantation, AIDS, valvular heart disease, diabetes mellitus, recent surgery, or compromised immune system. Lactobacillus bacteremia has also been reported following endoscopy. In addition, cases of lactobacillus pneumonia and liver abscess, as well as Saccharomyces fungemia, pneumonia, liver abscess, peritonitis and vaginitis, have been described in the medical literature.

MANAGEMENT: Caution is advised when probiotics are used during immunosuppressant or intense antineoplastic therapy. It may be advisable to avoid using probiotics, particularly products containing saccharomyces boulardii, in patients who are significantly immunosuppressed unless benefits are anticipated to outweigh the potential risk of infection.

References (12)
  1. Salminen MK, Rautelin H, Tynkkynen S, et al. (2004) "Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG." Clin Infect Dis, 38, p. 62-9
  2. Salminen MK, Tynkkynen S, Rautelin H, et al. (2002) "Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland." Clin Infect Dis, 35, p. 1155-60
  3. Rautio M, Jousimies-Somer H, Kauma H, et al. (1999) "Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG." Clin Infect Dis, 28, p. 1159-60
  4. Schlegel L, Lemerle S, Geslin P (1998) "Lactobacillus species as opportunistic pathogens in immunocompromised patients." Eur J Clin Microbiol Infect Dis, 17, p. 887-8
  5. Saxelin M, Chuang NH, Chassy B, et al. (1996) "Lactobacilli and bacteremia in southern Finland, 1989-1992" Clin Infect Dis, 22, p. 564-6
  6. Husni RN, Gordon SM, Washington JA, Longworth DL (1997) "Lactobacillus bacteremia and endocarditis: review of 45 cases." Clin Infect Dis, 25, p. 1048-55
  7. Oggioni MR, Pozzi G, Valensin PE, Galieni P, Bigazzi C (1998) "Recurrent septicemia in an immunocompromised patient due to probiotic strains of Bacillus subtilis." J Clin Microbiol, 36, p. 325-6
  8. Mackay AD, Taylor MB, Kibbler CC, Hamilton-Miller JM (1999) "Lactobacillus endocarditis caused by a probiotic organism." Clin Microbiol Infect, 5, p. 290-2
  9. Borriello SP, Hammes WP, Holzapfel W, et al. (2003) "Safety of probiotics that contain lactobacilli or bifidobacteria." Clin Infect Dis, 36, p. 775-80
  10. Lolis N, Veldekis D, Moraitou H, et al. (2008) "Saccharomyces boulardii fungaemia in an intensive care unit patient treated with caspofungin." Crit Care, 12, epub
  11. Boyle RJ, Robins-Browne RM, Tang ML (2006) "Probiotic use in clinical practice: what are the risks?" Am J Clin Nutr, 83, p. 1256-64
  12. Pruccoli G, Silvestro E, Napoleone CP, Aidala E, Garazzino S, Scolfaro C (2024) Are probiotics safe? Bifidobacterium bacteremia in a child with severe heart failure. https://www.researchgate.net/publication/333853508_Are_probiotics_safe_Bifidobacterium_bacteremia_in_a_child_with_severe_heart_failure

Drug and food interactions

Moderate

abiraterone food

Applies to: Akeega (abiraterone / niraparib)

ADJUST DOSING INTERVAL: Food may significantly increase the oral bioavailability of some formulations of abiraterone acetate. Compared to administration in the fasted state, abiraterone peak plasma concentration (Cmax) and systemic exposure (AUC) were approximately 7- and 5-fold higher, respectively, when a single dose of abiraterone acetate was administered with a low-fat meal (7% fat; 300 calories) and approximately 17- and 10-fold higher, respectively, when it was administered with a high-fat meal (57% fat; 825 calories). Given the normal variation in the content and composition of meals, taking abiraterone acetate with meals has the potential to result in increased and highly variable exposures. The safety of these increased exposures during multiple dosing has not been assessed. However, the abiraterone acetate 125 mg tablet, commonly marketed as Yonsa, was found to have an approximately 6.5-fold higher Cmax and 4.4-fold higher AUC when a single dose of 500 mg (4 tablets) was administered with a high-fat meal (56% - 60% fat, 900 - 1000 calories) compared to overnight fasting in healthy volunteers. These differences were not considered clinically significant for this formulation.

MANAGEMENT: Some formulations of abiraterone acetate must be taken on an empty stomach. No food should be consumed for at least two hours before and one hour after the abiraterone acetate dose. However, the abiraterone acetate 125 mg tablet, commonly marketed as Yonsa, can be taken with or without food. The manufacturer's product labeling should be consulted for specific guidance.

References (8)
  1. (2023) "Product Information. Akeega (abiraterone-niraparib)." Janssen Biotech, Inc.
  2. (2023) "Product Information. Akeega (abiraterone-niraparib)." Janssen Inc
  3. (2021) "Product Information. Zytiga (abiraterone)." Janssen Biotech, Inc.
  4. (2022) "Product Information. Yonsa (abiraterone)." Sun Pharmaceutical Industries
  5. (2023) "Product Information. Apo-Abiraterone (abiraterone)." Apotex Inc
  6. (2021) "Product Information. Zytiga (abiraterone)." Janssen-Cilag Pty Ltd
  7. (2023) "Product Information. Abiraterone (abiraterone)." Wockhardt UK Ltd
  8. (2023) "Product Information. Yonsa Mpred (abiraterone-methylprednisolone)." Sun Pharma ANZ Pty Ltd

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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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

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