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Drug Interactions between calaspargase pegol and Dexamethasone Intensol

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

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Moderate

dexAMETHasone calaspargase pegol

Applies to: Dexamethasone Intensol (dexamethasone) and calaspargase pegol

ADJUST DOSING INTERVAL: The administration of asparaginase with or immediately preceding prednisone may increase the risk of hyperglycaemia. Although they are often combined in clinical practice, asparaginase and corticosteroids may increase the risk of hyperglycemia in some patients, especially in children 10 years of age or older.

MONITOR: Concomitant use of asparaginase and corticosteroids may increase the risk of thrombosis or hemorrhage. The proposed mechanism may be related to asparaginase-induced fluctuation of coagulation proteins. In addition, the potential hypercoagulability induced by asparaginase may increase the risk of glucocorticoid-induced osteonecrosis in children older than 10 years of age, particularly females. Increased incidence of thromboembolism has been reported with concomitant use of asparaginase and prednisone or dexamethasone as compared to asparaginase alone. Other corticosteroids may interact.

MANAGEMENT: If combination therapy is necessary, the Australian product labeling for asparaginase (Leunase(R)) recommends that asparaginase be administered after prednisone. Close monitoring for clinical and laboratory evidence of hyperglycemia and/or altered coagulation is also recommended at baseline and periodically throughout concurrent treatment with corticosteroids and asparaginase-derived products. Patients should be advised to promptly report any signs and symptoms of hyperglycemia, bleeding, blood clots or bone pain.

References

  1. "Product Information. Oncaspar (pegaspargase)." Rhone Poulenc Rorer PROD (2001):
  2. "Product Information. Elspar (asparaginase)." Merck & Co., Inc PROD (2001):
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  4. Cerner Multum, Inc. "Australian Product Information." O 0
  5. "Product Information. Erwinaze (asparaginase Erwinia chrysanthemi)." EUSA Pharma PROD
  6. "Product Information. Asparlas (calaspargase pegol)." Servier (2019):
  7. Duarte X, Esteves S, Neto AM, Pereira F "Incidence and risk factors for central nervous system thrombosis in paediatric acute lymphoblastic leukaemia during intensive asparaginase treatment: a single-centre study." Br J Haematol 174 (2016): 280-91
  8. Athale UH, Atkinson HH, Athale A, Nayiager T, Chan A "Effect of asparaginase and dexamethasone on FVIIa-at complex and F1.2 in children with acute lymphoblastic leukemia: evidence of a hypercoagulable state." Blood 126 (2015): 3522
  9. Appel IM, van Kessel-Bakvis C, Stigter R, Pieters R "Influence of two different regimens of concomitant treatment with asparaginase and dexamethasone on hemostasis in childhood acute lymphoblastic leukemia." Leukemia 21 (2007): 2377-80
  10. Caruso V, Iacoviello L, Di Castelnuovo A, et al. "Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients." Blood 108 (2006): 2216-22
  11. Athale UH, Chan AK "Thrombosis in children with acute lymphoblastic leukemia. Part II. Pathogenesis of thrombosis in children with acute lymphoblastic leukemia: effects of the disease and therapy." Thromb Res 111 (2003): 199-212
  12. Truelove E, Fielding AK, Hunt BJ "The coagulopathy and thrombotic risk associated with L-asparaginase treatment in adults with acute lymphoblastic leukaemia." Leukemia 27 (2013): 553-9
  13. Christ TN, Stock W, Knoebel RW "Incidence of asparaginase-related hepatotoxicity, pancreatitis, and thrombotic events in adults with acute lymphoblastic leukemia treated with a pediatric-inspired regimen." J Oncol Pharm Pract 24 (2018): 299-308
View all 13 references

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

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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.

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