Interactions between Bosentan and Irinotecan

Bosentan has a moderate potential interaction with Anemia.

Clinical studies have shown that most endothelin receptor antagonists decrease hemoglobin concentration and hematocrit levels. There are some postmarketing reports of anemia cases which needed blood transfusion. Hemoglobin and hematocrit levels should be measured prior to treatment initiation and should be monitored periodically thereafter. Initiation of therapy is not recommended in patients with clinically significant anemia.

Irinotecan has a major potential interaction with Bleeding Disorder.

Irinotecan induces myelosuppression, causing leukopenia, thrombocytopenia and anemia. Deaths due to sepsis following severe neutropenia have been reported in patients treated with irinotecan. Hold irinotecan if neutropenic fever occurs or if the absolute neutrophil count drops <1000/mm3. After recovery to an absolute neutrophil count =1000/mm3, subsequent doses of irinotecan should be reduced. Therapy with irinotecan should be administered cautiously in patients who have received previous irradiation therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

Irinotecan has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Irinotecan induces myelosuppression, causing leukopenia, thrombocytopenia and anemia. Deaths due to sepsis following severe neutropenia have been reported in patients treated with irinotecan. Hold irinotecan if neutropenic fever occurs or if the absolute neutrophil count drops <1000/mm3. After recovery to an absolute neutrophil count =1000/mm3, subsequent doses of irinotecan should be reduced. Therapy with irinotecan should be administered cautiously in patients who have received previous irradiation therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

Irinotecan has a major potential interaction with Fever.

Irinotecan induces myelosuppression, causing leukopenia, thrombocytopenia and anemia. Deaths due to sepsis following severe neutropenia have been reported in patients treated with irinotecan. Hold irinotecan if neutropenic fever occurs or if the absolute neutrophil count drops <1000/mm3. After recovery to an absolute neutrophil count =1000/mm3, subsequent doses of irinotecan should be reduced. Therapy with irinotecan should be administered cautiously in patients who have received previous irradiation therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

Bosentan has a moderate potential interaction with Heart Failure.

Peripheral edema and fluid retention are known clinical consequences of pulmonary hypertension and also known effects of endothelin receptor antagonists. Caution and monitoring is recommended if these agents are used in patients with underlying left ventricular dysfunction or underlying heart failure, as they have an increased risk for developing significant fluid retention that may need treatment or require discontinuation.

Irinotecan has a major potential interaction with Infection.

Irinotecan induces myelosuppression, causing leukopenia, thrombocytopenia and anemia. Deaths due to sepsis following severe neutropenia have been reported in patients treated with irinotecan. Hold irinotecan if neutropenic fever occurs or if the absolute neutrophil count drops <1000/mm3. After recovery to an absolute neutrophil count =1000/mm3, subsequent doses of irinotecan should be reduced. Therapy with irinotecan should be administered cautiously in patients who have received previous irradiation therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

Bosentan has a major potential interaction with Liver Disease.

Endothelin receptor antagonists (ERAs) have been associated with aminotransferase elevations, hepatotoxicity, and cases of liver failure. Hepatic function should be assessed before treatment initiation and closely monitored during treatment. Therapy should be discontinued if aminotransferase elevations are accompanied by increases in bilirubin, or clinical symptoms of hepatotoxicity such as nausea, vomiting, fever, abdominal pain or jaundice. Treatment should be avoided in patients with elevated aminotransferases at baseline as monitoring for hepatotoxicity may be more difficult. In general, the use of ERAs is not recommended for patients with moderate to severe hepatic impairment.

Irinotecan has a moderate potential interaction with Liver Disease.

Irinotecan clearance is diminished in patients with hepatic impairment. The magnitude of these effects is proportional to the degree of liver impairment as measured by elevations in total bilirubin and transaminase concentrations. However, the tolerability of irinotecan in patients with hepatic dysfunction (bilirubin greater than 2 mg/dl) has not been assessed sufficiently, and no recommendations for dosing are made by the manufacturers. Therapy with irinotecan should be administered cautiously to patients with or predisposed to compromised hepatic function. Clinical monitoring of hepatic function is recommended.

Irinotecan has a moderate potential interaction with Pulmonary Impairment.

Irinotecan can cause severe and fatal interstitial pulmonary disease (IPD). Risk factors include preexisting-existing lung disease. It is recommended to withhold treatment with irinotecan in patients with new or progressive dyspnea, cough, and fever, pending diagnostic evaluation and to discontinue treatment in patients with a confirmed diagnosis of IPD. Exercise caution when using this agent in patients presenting symptoms of dyspnea and patients with pulmonary impairment.

Irinotecan has a moderate potential interaction with Renal Dysfunction.

The influence of renal impairment on the pharmacokinetics of irinotecan has not been evaluated. Therefore, caution should be undertaken in patients with impaired renal function. Irinotecan hydrochloride is not recommended for use in patients on dialysis.