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Interactions between Bexarotene and TicoVac

1 drug interaction and 9 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

bexarotene tick-borne encephalitis (inactivated) vaccine

Applies to: bexarotene and TicoVac (tick-borne encephalitis (inactivated) vaccine)
Monitor

The administration of inactivated, killed, or otherwise noninfectious vaccines to immunosuppressed patients is generally safe but may be associated with a diminished or suboptimal immunologic response due to antibody inhibition. Such patients may include those who have recently received or are receiving immunosuppressive agents, antilymphocyte globulins, alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (e.g., greater than or equal to 2 mg/kg/day or 20 mg/day of prednisone or equivalent for 14 consecutive days or more), or long-term topical or inhaled corticosteroids.

Management

In general, the U.S. Advisory Committee on Immunization Practices (ACIP) recommends that inactivated or killed vaccines be administered to non-HIV immunosuppressed patients according to the same guidelines as for healthy patients. However, higher dosages, more frequent boosters, and/or serological testing may be required in some cases. Local guidelines and prescribing information for individual vaccines should be consulted. For Haemophilus influenzae b vaccine, some experts recommend that it be administered at least 2 weeks before starting or 3 months after discontinuing chemotherapy when used in patients with Hodgkin's disease. For rabies vaccine, some authorities suggest that immunosuppressive agents should generally be avoided during postexposure therapy except when absolutely necessary for the treatment of other conditions. Vaccines may generally be administered to patients receiving corticosteroids as replacement therapy (e.g., for Addison's disease).

References (15)
  1. "Product Information. Fluzone (influenza virus vaccine, inactivated)." Connaught Laboratories Inc
  2. "Product Information. Omnihib (haemophilus b conjugate vaccine (obsolete))." SmithKline Beecham
  3. "Product Information. Havrix (HepA) (hepatitis A adult vaccine)." SmithKline Beecham
  4. (2022) "Product Information. Imovax Rabies (rabies vaccine, human diploid cell)." sanofi pasteur
  5. (2003) "Product Information. Biothrax (anthrax vaccine adsorbed)." Emergent BioSolutions Inc.
  6. Cerner Multum, Inc. "Australian Product Information."
  7. (2022) "Product Information. Influenza Virus Vaccine, H5N1, Inactivated (influenza virus vaccine, H5N1, inactivated)." GlaxoSmithKline
  8. CDC Centers for Disease Control and Prevention (2019) General Best Practice Guidelines for Immunization: Altered Immunocompetence. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.pdf
  9. Department of Health. National Health Service (2019) Immunisation Against Infectious Disease - "The Green Book". Chapter 6: Contraindications and special considerations. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/655225/Greenbook_chapter_6.pdf
  10. CDC Centers for Disease Control and Prevention (2022) Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html
  11. Centers for Disease Control and Prevention (2023) Use of COVID-19 vaccines in the U.S. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html
  12. UK Health Security Agency (2023) COVID-19: the green book, chapter 14a https://www.gov.uk/government/publications/covid-19-the-green-book-chapter-14a
  13. Public Health Agency of Canada (2023) Immunization of immunocompromised persons: Canadian immunization guide https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-3-vaccination-specific-populations/page-8-immunization-immunocompromised-p
  14. Public Health Agency of Canada (2023) COVID-19 vaccines: Canadian immunization guide. https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-26-covid-19-vaccine.html
  15. Australian Government. Department of Health and Aged Care (2023) Australian immunisation handbook: COVID-19. https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/covid-19

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)
  1. (2001) "Product Information. Targretin (bexarotene)." Ligand Pharmaceuticals
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."

Disease interactions

8 potential interactions Applies to: 8 conditions, including High Cholesterol, Underactive Thyroid, Diabetes Mellitus, Cataract, and Liver Disease.

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.

Immunodeficiency

Moderate:

TicoVac

The tick-borne encephalitis (inactivated) vaccine in TicoVac has a moderate potential interaction with Immunodeficiency.

Immune responses to tick-borne encephalitis vaccine may be reduced in some patients with altered immunocompetence.

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.

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.

TicoVac

A total of 340 drugs are known to interact with TicoVac.

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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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