Drug Interactions between alemtuzumab and rituximab

MONITOR: The use of alemtuzumab with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Alemtuzumab alone may cause severe and prolonged myelosuppression, lymphopenia, and rarely, fatal bone marrow aplasia/hypoplasia, autoimmune idiopathic thrombocytopenia, and autoimmune hemolytic anemia. Serious, sometimes fatal opportunistic infections have been reported, and the risk may theoretically increase when coadministered with other immunosuppressive therapy. Agents that may be significantly myelo- or immunosuppressive include antineoplastic agents, radiation, zidovudine, linezolid, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (greater than 10 mg/day to 1 mg/kg/day, whichever is less, of prednisone or equivalent for more than 2 weeks), and long-term topical or inhaled corticosteroids.

MANAGEMENT: Caution is advised if alemtuzumab must be used in patients who have recently received or are receiving treatment with other immunosuppressive or myelosuppressive drugs, and vice versa. The manufacturer recommends that single doses of alemtuzumab not exceed 30 mg and cumulative weekly doses not exceed 90 mg, since higher dosages are associated with an increased incidence of pancytopenia. Close clinical and laboratory monitoring for the development of severe hematologic adverse effects is recommended both during and after discontinuation of therapy.

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