Interactions between Bexarotene and Ospomyv
1 drug interaction and 13 additional warnings found for the following 2 drugs:
- bexarotene
- Ospomyv (denosumab)
Drug interactions
Moderate drug interactions
Moderate:
bexarotene denosumab
Applies to: bexarotene and Ospomyv (denosumab)
Monitor
Concomitant use of immunosuppressive or myelosuppressive agents with denosumab may increase the risk of serious infections. Denosumab binds to and inhibits the receptor activator of nuclear factor kappa-B ligand (RANKL), which is expressed on activated T and B lymphocytes and in lymph nodes. Thus, denosumab alone may increase the risk of infections. In a clinical trial of over 7800 women with postmenopausal osteoporosis, the incidence of nonfatal serious infections was 3.3% in the placebo group and 4.0% in the denosumab group. Specifically, hospitalizations due to skin infections including erysipelas and cellulitis (<0.1% placebo vs. 0.4% denosumab) and serious infections in the abdomen (0.7% placebo vs. 0.9% denosumab), urinary tract (0.5% placebo vs. 0.7% denosumab), and ear (0.0% placebo vs. 0.1% denosumab) were reported. Endocarditis was reported in no placebo patients and 3 denosumab-treated patients. There was no difference in the incidence of opportunistic infections or infections resulting in death between the placebo and denosumab groups. The overall incidence of infections was also similar between the two groups.
Management
Caution is advised if denosumab must be used in combination with immuno- or myelosuppressive agents. Patients should be advised to contact their physician if they develop signs and symptoms of infection such as fever, chills, diarrhea, sore throat, muscle aches, shortness of breath, blood in phlegm, weight loss, red or inflamed skin, body sores, and pain or burning during urination. The need for continued denosumab therapy should be assessed when serious infections occur during treatment.
References (1)
- (2010) "Product Information. Prolia (denosumab)." Amgen Inc
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
bexarotene Food/Lifestyle
Applies to: bexarotene
Adjust dosing interval
Food may enhance the oral bioavailability of bexarotene. In one clinical study, bexarotene peak plasma concentration (Cmax) and systemic exposure (AUC) resulting from a 75 to 300 mg dose were 35% and 48% higher, respectively, when administered after a fat-containing meal relative to a glucose solution. In all clinical trials, patients were instructed to take bexarotene with or immediately following a meal. Coadministration with inhibitors of CYP450 3A4 such as grapefruit juice may theoretically increase the plasma concentrations of bexarotene. In vitro studies suggest that bexarotene is metabolized by CYP450 3A4. However, concomitant administration with multiple doses of ketoconazole, a potent CYP450 3A4 inhibitor, did not alter bexarotene plasma concentrations, which would imply that bexarotene elimination is not substantially dependent on CYP450 3A4 metabolism in vivo.
Management
Because safety and efficacy data are based upon administration with food, bexarotene should be administered once daily with a meal. Patients may want to avoid consuming large amounts of grapefruit or grapefruit juice.
References (2)
- (2001) "Product Information. Targretin (bexarotene)." Ligand Pharmaceuticals
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
Disease interactions
12 potential interactions Applies to: 12 conditions, including High Cholesterol, Underactive Thyroid, Hypocalcemia, Diabetes Mellitus, and Hypoparathyroidism.
Cataract
Moderate:
bexarotene
Bexarotene has a moderate potential interaction with Cataract.
The use of bexarotene may cause new cataracts or worsening of previous cataracts. It is recommended to monitor closely for the development of any visual difficulties and to have an appropriate ophthalmologic evaluation. Exercise caution when using this agent in patients with a history of cataracts.
Diabetes Mellitus
Moderate:
bexarotene
Bexarotene has a moderate potential interaction with Diabetes Mellitus.
The use of bexarotene may cause hypoglycemia in diabetic patients. It is recommended to measure baseline blood glucose levels and to keep monitoring them closely during treatment. Exercise caution when using this agent in diabetic patients.
High Cholesterol
Moderate:
bexarotene
Bexarotene has a moderate potential interaction with High Cholesterol.
The use of bexarotene may cause elevations in lipids. It is recommended to monitor lipid levels closely and to obtain a fasting blood lipid reading at baseline and weekly until lipid response to the drug is established. Exercise caution when using this agent in patients with hyperlipidemia.
Hypocalcemia
Major:
Ospomyv
The denosumab in Ospomyv has a major potential interaction with Hypocalcemia.
Preexisting hypocalcemia must be corrected prior to initiating treatment with denosumab. Caution should be exercised in patients predisposed to hypocalcemia and any disturbances of mineral metabolism, such as history of hypoparathyroidism, thyroid or parathyroid surgery, malabsorption syndromes, excision of small intestine, severe renal impairment or dialysis. Clinical monitoring of calcium and mineral levels (phosphorus and magnesium) are highly recommended within 14 days of denosumab injection. It is important to maintain calcium levels with adequate calcium and vitamin D supplementation.
Hypoparathyroidism
Major:
Ospomyv
The denosumab in Ospomyv has a major potential interaction with Hypoparathyroidism.
Preexisting hypocalcemia must be corrected prior to initiating treatment with denosumab. Caution should be exercised in patients predisposed to hypocalcemia and any disturbances of mineral metabolism, such as history of hypoparathyroidism, thyroid or parathyroid surgery, malabsorption syndromes, excision of small intestine, severe renal impairment or dialysis. Clinical monitoring of calcium and mineral levels (phosphorus and magnesium) are highly recommended within 14 days of denosumab injection. It is important to maintain calcium levels with adequate calcium and vitamin D supplementation.
Immunodeficiency
Moderate:
Ospomyv
The denosumab in Ospomyv has a moderate potential interaction with Immunodeficiency.
Denosumab should be used with caution in patients with impaired immune systems or taking concomitant immunosuppressant agents as they may be at increased risk for serious infections.
Liver Disease
Moderate:
bexarotene
Bexarotene has a moderate potential interaction with Liver Disease.
In vitro studies suggest that cytochrome P450 3A4 is the major cytochrome P450 responsible for formation of the oxidative metabolites and that the oxidative metabolites may be glucuronidated. It is recommended to monitor for signs of toxicity due to increased drug exposure if bexarotene is used in patients with hepatic impairment as these patients are expected to have a decreased drug clearance.
Neutropenia
Moderate:
bexarotene
Bexarotene has a moderate potential interaction with Neutropenia.
The use of bexarotene causes neutropenia. Neutropenia is reversible after dose reduction or discontinuation of treatment. Care should be exercised in patients at risk. It is recommended to obtain complete blood counts at baseline and periodically during treatment.
Pancreatitis
Moderate:
bexarotene
Bexarotene has a moderate potential interaction with Pancreatitis.
Pancreatitis, including a fatal case, has occurred in patients receiving bexarotene. It is recommended to monitor for pancreatitis and to interrupt treatment if pancreatitis is suspected. Close monitoring is recommended in patients who have risk factors for pancreatitis, such as high alcohol consumption, uncontrolled diabetes or hyperlipidemia, and prior pancreatitis, as these patients might be at greater risk.
Renal Dysfunction
Major:
Ospomyv
The denosumab in Ospomyv has a major potential interaction with Renal Dysfunction.
Preexisting hypocalcemia must be corrected prior to initiating treatment with denosumab. Caution should be exercised in patients predisposed to hypocalcemia and any disturbances of mineral metabolism, such as history of hypoparathyroidism, thyroid or parathyroid surgery, malabsorption syndromes, excision of small intestine, severe renal impairment or dialysis. Clinical monitoring of calcium and mineral levels (phosphorus and magnesium) are highly recommended within 14 days of denosumab injection. It is important to maintain calcium levels with adequate calcium and vitamin D supplementation.
Thyroid Disease
Major:
Ospomyv
The denosumab in Ospomyv has a major potential interaction with Thyroid Disease.
Preexisting hypocalcemia must be corrected prior to initiating treatment with denosumab. Caution should be exercised in patients predisposed to hypocalcemia and any disturbances of mineral metabolism, such as history of hypoparathyroidism, thyroid or parathyroid surgery, malabsorption syndromes, excision of small intestine, severe renal impairment or dialysis. Clinical monitoring of calcium and mineral levels (phosphorus and magnesium) are highly recommended within 14 days of denosumab injection. It is important to maintain calcium levels with adequate calcium and vitamin D supplementation.
Underactive Thyroid
Moderate:
bexarotene
Bexarotene has a moderate potential interaction with Underactive Thyroid.
The use of bexarotene may cause hypothyroidism. It is recommended to consider thyroid hormone supplementation in patients with hypothyroidism, to obtain baseline thyroid function tests, and to closely monitor patients during treatment.
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More resources
bexarotene
A total of 672 drugs are known to interact with bexarotene.
- Bexarotene is in the drug class miscellaneous antineoplastics.
- Bexarotene is used to treat Cutaneous T-cell Lymphoma.
Ospomyv
A total of 324 drugs are known to interact with Ospomyv.
- Ospomyv is in the drug class miscellaneous bone resorption inhibitors.
- Ospomyv is used to treat Osteoporosis.
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
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