Interactions between Baloxavir marboxil and Multitrace-4
1 drug interaction and 6 additional warnings found for the following 2 drugs:
- baloxavir marboxil
- Multitrace-4 (trace elements)
Drug interactions
Moderate drug interactions
Moderate:
zinc sulfate baloxavir marboxil
Applies to: Multitrace-4 (trace elements) and baloxavir marboxil
Generally avoid
Coadministration with polyvalent cation-containing products may decrease the plasma concentrations and therapeutic efficacy of baloxavir. The proposed mechanism is chelation of baloxavir by polyvalent cations, forming a complex that is poorly absorbed from the gastrointestinal tract. A significant decrease in baloxavir exposure was observed in monkeys when the prodrug, baloxavir marboxil, was coadministered with calcium, aluminum, magnesium, or iron. However, clinical data in humans are lacking.
Management
Concurrent administration of baloxavir marboxil with polyvalent cation-containing laxatives, antacids, or oral supplements (e.g., aluminum, calcium, iron, magnesium, selenium, zinc) should generally be avoided.
References (1)
- (2018) "Product Information. Xofluza (baloxavir marboxil)." Genentech
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
baloxavir marboxil Food/Lifestyle
Applies to: baloxavir marboxil
Generally avoid
Coadministration with foods or medications that contain polyvalent cations such as dairy products, calcium-fortified beverages, certain laxatives, antacids, or oral supplements may decrease the plasma concentrations and therapeutic efficacy of baloxavir. The proposed mechanism is chelation of baloxavir by polyvalent cations, forming a complex that is poorly absorbed from the gastrointestinal tract. A significant decrease in baloxavir exposure was observed in monkeys when the prodrug, baloxavir marboxil, was coadministered with calcium, aluminum, magnesium, or iron. However, clinical data in humans are lacking. When baloxavir marboxil was administered with food, baloxavir peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by 48% and 36%, respectively, relative to administration under fasting. These changes are not considered clinically significant.
Management
Baloxavir marboxil may be taken with or without food. However, coadministration with dairy products, calcium-fortified beverages, or polyvalent cation-containing laxatives, antacids, or oral supplements (e.g., calcium, iron, magnesium, selenium, or zinc) should be avoided.
References (2)
- Cerner Multum, Inc. "Australian Product Information."
- (2018) "Product Information. Xofluza (baloxavir marboxil)." Genentech
Disease interactions
5 potential interactions Applies to: 4 conditions, including Liver Disease, Malabsorption Syndrome, Renal Dysfunction, and Biliary Obstruction.
Biliary Obstruction
Moderate:
Multitrace-4
The copper sulfate and manganese sulfate in Multitrace-4 both have a moderate potential interaction with Biliary Obstruction.
The trace elements, copper and manganese, are excreted in the bile. Copper and manganese doses may need to be adjusted, reduced, or omitted in patients with liver disease or biliary obstruction.
Liver Disease
Moderate:
Multitrace-4
The copper sulfate and manganese sulfate in Multitrace-4 both have a moderate potential interaction with Liver Disease.
The trace elements, copper and manganese, are excreted in the bile. Copper and manganese doses may need to be adjusted, reduced, or omitted in patients with liver disease or biliary obstruction.
Malabsorption Syndrome
Moderate:
Multitrace-4
The chromic chloride hexahydrate, copper sulfate, manganese sulfate and zinc sulfate in Multitrace-4 all have a moderate potential interaction with Malabsorption Syndrome.
The trace metals manganese, chromium, copper, selenium, and zinc are absorbed in the GI tract from dietary sources and following administration of oral supplements. GI absorption may be decreased in patients with malabsorption syndromes. Therefore, larger dosages may be required when these supplements are given orally. Parenteral administration may be appropriate.
Renal Dysfunction
Moderate:
Multitrace-4
The manganese sulfate in Multitrace-4 has a moderate potential interaction with Renal Dysfunction.
Manganese sulfate and manganese chloride preparations contain aluminum and may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which also contain aluminum. Patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration. Caution is advised in patients with renal impairment, particularly in premature or neonates patients.
Moderate:
Multitrace-4
The chromic chloride hexahydrate and zinc sulfate in Multitrace-4 both have a moderate potential interaction with Renal Dysfunction.
The trace metals, chromium and zinc, are excreted primarily in the urine. Selenium is partially excreted in the urine. Supplemental doses of these agents may need to be adjusted, reduced, or omitted in patients with renal dysfunction.
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baloxavir marboxil
A total of 53 drugs are known to interact with baloxavir marboxil.
- Baloxavir marboxil is in the drug class miscellaneous antivirals.
- Baloxavir marboxil is used to treat the following conditions:
Multitrace-4
A total of 214 drugs are known to interact with Multitrace-4.
- Multitrace-4 is in the drug class intravenous nutritional products.
- Multitrace-4 is used to treat Parenteral Nutrition.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.