Drug Interactions between Calquence and HalfLytely and Bisacodyl

ADJUST DOSING INTERVAL: By increasing gastric pH, antacids may reduce the resistance of the enteric coating of bisacodyl tablets, resulting in earlier release of bisacodyl and gastric irritation and dyspepsia.

MANAGEMENT: The administration of antacids and bisacodyl should be separated by at least one hour.

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ADJUST DOSING INTERVAL: Coadministration of acalabrutinib in its capsule formulation with drugs that increase gastric pH may significantly decrease the oral bioavailability of acalabrutinib and reduce its concentrations in plasma. The solubility of acalabrutinib is pH-dependent and decreases with increasing pH. According to the product labeling, acalabrutinib is freely soluble in water at pH below 3 and practically insoluble at pH above 6. Coadministration of acalabrutinib capsules with an antacid (1 gram calcium carbonate) decreased acalabrutinib systemic exposure (AUC) by 53% in healthy subjects, and coadministration with a proton pump inhibitor (omeprazole 40 mg for 5 days) decreased acalabrutinib AUC by 43%. Due to the long-lasting effect of proton pump inhibitors, separation of dosing may not eliminate the interaction with acalabrutinib capsules. By contrast, no clinically significant differences in the pharmacokinetics of acalabrutinib were observed when the tablet formulation, which contains acalabrutinib maleate, was coadministered with the proton pump inhibitor, rabeprazole.

MANAGEMENT: No adjustments to therapy are required when using the tablet formulation containing acalabrutinib maleate. However, if gastric acid reducing agents are required during treatment with acalabrutinib capsules, H2-receptor antagonists and/or antacids should be considered. The manufacturer recommends taking acalabrutinib 2 hours before (or 10 hours after) H2-receptor antagonists and separating the dosing with antacids by at least 2 hours.

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GENERALLY AVOID: Concomitant use of stimulant laxatives (e.g., bisacodyl, sodium picosulfate) may increase the risk of serious gastrointestinal adverse effects associated with certain osmotic laxatives (e.g., polyethylene glycol (PEG), oral sulfate solution), such as colonic mucosal ulcerations or ischemic colitis. There have been isolated case reports of ischemic colitis occurring with the use of PEG-based bowel cleansing products in combination with higher dosages of bisacodyl (usually greater than 10 mg). Bisacodyl can cause colonic ischemia due to transient reduction in splanchnic blood flow. When administered in conjunction with an osmotic laxative such as PEG, increased intramural pressure secondary to increased peristalsis may lead to ischemic colitis and perforation.

MANAGEMENT: The manufacturers for some osmotic bowel cleansing products recommend avoiding the concurrent use of stimulant laxatives. However, stimulant laxatives, in particular bisacodyl and sodium picosulfate, are sometimes used with PEG in certain bowel cleansing regimens to help reduce dose volume and improve patient tolerability and acceptance. Please consult individual product labeling for specific recommendations and guidance. Patients using osmotic bowel cleansing products and stimulant laxatives who present with sudden abdominal pain, rectal bleeding, or other symptoms of ischemic colitis should be evaluated promptly.

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