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Drug Interactions between bortezomib and pomalidomide

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

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Interactions between your drugs

Moderate

bortezomib pomalidomide

Applies to: bortezomib and pomalidomide

MONITOR: Bortezomib can cause peripheral neuropathy, and concurrent use of other agents that are also associated with this adverse effect can potentiate the risk and/or severity of nerve damage. Bortezomib treatment causes a peripheral neuropathy that is predominantly sensory, although cases of mixed sensorimotor neuropathy have also been reported. During clinical trials, 37% of the patients experienced treatment emergent neuropathy. Of these, more than 70% had previously been treated with neurotoxic agents and more than 80% of these patients had signs or symptoms of peripheral neuropathy at baseline. The incidence of grade 3 neuropathy (i.e., that which interferes with activities of daily life) was 5% in patients without baseline neuropathy.

MANAGEMENT: Caution is advised if bortezomib is used with other neurotoxic agents. Patients should be closely monitored for symptoms of neuropathy such as visual disturbances or burning, tingling, pain, numbness, and/or weakness in the extremities. Patients experiencing new or worsening peripheral neuropathy may require an adjustment in the dosage and schedule of bortezomib in accordance with the product labeling. Symptoms may improve or return to baseline in some patients upon discontinuation of bortezomib, although the complete time course of this toxicity has not been fully characterized.

References

  1. (2003) "Product Information. Velcade (bortezomib)." Millennium Pharmaceuticals Inc
  2. Argov Z, Mastaglia FL (1979) "Drug-induced peripheral neuropathies." Br Med J, 1, p. 663-6
  3. Cavaletti G, Jakubowiak AJ (2010) "Peripheral neuropathy during bortezomib treatment of multiple myeloma: a review of recent studies." Leuk Lymphoma, 51, p. 1178-87

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Drug and food interactions

Moderate

bortezomib food

Applies to: bortezomib

GENERALLY AVOID: Data from in vitro and animal (mice) studies suggest that green tea may antagonize the cytotoxic effects of bortezomib. Polyphenols in green tea such as (-)-epigallocatechin gallate (EGCG) have been shown to block the proteasome inhibitory action of bortezomib in multiple myeloma and glioblastoma cancer cell lines. The mechanism appears to involve a direct chemical reaction between the boronic acid moiety of bortezomib and the 1,2-benzenediol groups present in certain polyphenols leading to inactivation of bortezomib. However, one group of investigators reported that no antagonism of bortezomib was observed in preclinical in vivo experiments where EGCG plasma concentrations are commensurate with dietary or supplemental intake.

MANAGEMENT: Until more data are available, it may be advisable to avoid or limit consumption of green tea and green tea products during treatment with bortezomib. The interaction has not been demonstrated for other, non-boronic acid proteasome inhibitors.

References

  1. Bannerman B, Xu L, Jones M, et al. (2011) "Preclinical evaluation of the antitumor activity of bortezomib in combination with vitamin C or with epigallocatechin gallate, a component of green tea." Cancer Chemother Pharmacol, 68, p. 1145-54
  2. Golden EB, Lam PY, Kardosh A, et al. (2009) "Green tea polyphenols block the anticancer effects of bortezomib and other boronic acid–based proteasome inhibitors." Blood, 113, p. 5927-37
  3. Jia L, Liu FT (2013) "Why bortezomib cannot go with 'green'?" Cancer Biol Med, 10, p. 206-13

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Moderate

pomalidomide food

Applies to: pomalidomide

MONITOR: Cigarette smoking may reduce pomalidomide exposure due to induction of CYP450 1A2, the isoenzyme that is responsible for the metabolic clearance of pomalidomide along with CYP450 3A4.

MANAGEMENT: Patients should be advised that smoking may reduce the efficacy of pomalidomide therapy. Pomalidomide should be taken on an empty stomach, at least 2 hours before or 2 hours after a meal.

References

  1. (2013) "Product Information. Pomalyst (pomalidomide)." QLT Phototherapeutics Inc

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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

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

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