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Interactions between CeeNU and Interferon alfa-2a

1 drug interaction and 23 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

lomustine interferon alfa-2a

Applies to: CeeNU (lomustine) and interferon alfa-2a
Monitor

The concomitant or sequential administration of multiple antineoplastic agents may result in additive toxicities, particularly in the bone marrow, gastrointestinal tract and heart.

Management

Close clinical and laboratory monitoring for hematologic and nonhematologic toxicities are recommended when antineoplastic agents are administered concurrently or during close intervals. Dosing adjustments may be necessary. The manufacturers' recommendations and institutional protocols for dosage, treatment regimens, monitoring, and management of toxicities should be consulted.

References (9)
  1. (2001) "Product Information. Paraplatin (carboplatin)." Bristol-Myers Squibb
  2. (2001) "Product Information. Ifex (ifosfamide)." Bristol-Myers Squibb
  3. (2022) "Product Information. Fluorouracil (fluorouracil)." Roche Laboratories
  4. (2001) "Product Information. Zanosar (streptozocin)." Pharmacia and Upjohn
  5. (2001) "Product Information. Ellence (epirubicin)." Pharmacia and Upjohn
  6. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  7. EMEA. European Medicines Agency (2007) EPARs. European Union Public Assessment Reports. http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid
  8. Cerner Multum, Inc. "Australian Product Information."
  9. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html

Food/lifestyle interactions

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

Disease interactions

23 potential interactions Applies to: 20 conditions, including Depression, Underactive Thyroid, Heart Failure, Seizures, and Peripheral Neuropathy.

Arrhythmia

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Arrhythmia.

Hypertension, arrhythmias, angina, myocardial infarction, cardiomyopathy, and congestive heart failure have been reported during interferon therapy. Therapy with interferons should be administered with caution in patients with compromised cardiac function.

Autoimmune Disorders

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Autoimmune Disorders.

Antiviral interferons may exacerbate autoimmune disorders such as myositis, thyroiditis, systemic lupus erythematosus, rheumatoid arthritis, psoriasis, or autoimmune hepatitis. Therapy should be avoided or administered with extreme caution in patients with autoimmune disorders.

Bleeding Disorder

Major:

CeeNU

The lomustine in CeeNU has a major potential interaction with Bleeding Disorder.

Nitrosoureas induce delayed bone marrow suppression that is cumulative and dose-related. Thrombocytopenia is usually more severe than leukopenia. Anemia occurs less frequently and is less severe. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, bleeding or symptoms of anemia. Therapy with nitrosoureas should be administered cautiously in patients with bone marrow suppression. Blood counts should be monitored at least six weeks after a dose and dosage adjustments made based on the nadir blood counts of the previous dose.

Bone Marrow Depression/Low Blood Counts

Major:

CeeNU

The lomustine in CeeNU has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Nitrosoureas induce delayed bone marrow suppression that is cumulative and dose-related. Thrombocytopenia is usually more severe than leukopenia. Anemia occurs less frequently and is less severe. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, bleeding or symptoms of anemia. Therapy with nitrosoureas should be administered cautiously in patients with bone marrow suppression. Blood counts should be monitored at least six weeks after a dose and dosage adjustments made based on the nadir blood counts of the previous dose.

Moderate:

interferon alfa-2a

Interferon alfa-2a has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

Interferons (alfa and gamma) induce a dose-dependent, generally mild, myelosuppression. Leukopenia is the primary manifestation. Thrombocytopenia and anemia occur less frequently. Therapy with interferons (alfa and gamma) should be administered cautiously to patients with bone marrow suppression. Clinical monitoring of hematopoietic function is recommended.

Cardiovascular Conditions and Disorders

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Cardiovascular Conditions and Disorders.

Hypertension, arrhythmias, angina, myocardial infarction, cardiomyopathy, and congestive heart failure have been reported during interferon therapy. Therapy with interferons should be administered with caution in patients with compromised cardiac function.

Depression

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Depression.

Interferons (alfa or beta) can induce depression and suicidal behavior. Suicidal attempts and suicides have been reported. Therapy with interferons (alfa or beta) should be administered cautiously to patients with or predisposed to mental depression. Clinical monitoring of psychological status is recommended.

Diabetes Mellitus

Moderate:

interferon alfa-2a

Interferon alfa-2a has a moderate potential interaction with Diabetes Mellitus.

Flu-like symptoms frequently associated with interferon-alfa therapy can precipitate ketoacidosis in diabetic patients. Therapy with interferon alfa should be administered cautiously in patients with diabetes mellitus. Clinical monitoring of blood glucose concentrations and anti-diabetic therapy is recommended.

Fever

Major:

CeeNU

The lomustine in CeeNU has a major potential interaction with Fever.

Nitrosoureas induce delayed bone marrow suppression that is cumulative and dose-related. Thrombocytopenia is usually more severe than leukopenia. Anemia occurs less frequently and is less severe. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, bleeding or symptoms of anemia. Therapy with nitrosoureas should be administered cautiously in patients with bone marrow suppression. Blood counts should be monitored at least six weeks after a dose and dosage adjustments made based on the nadir blood counts of the previous dose.

Heart Failure

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Heart Failure.

Hypertension, arrhythmias, angina, myocardial infarction, cardiomyopathy, and congestive heart failure have been reported during interferon therapy. Therapy with interferons should be administered with caution in patients with compromised cardiac function.

Hyperthyroidism

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Hyperthyroidism.

Thyroid abnormalities, hypothyroidism or hyperthyroidism, have been reported in patients administered interferons. Therapy with interferons should be administered cautiously to patients with thyroid dysfunction. If thyroid control cannot be maintained within normal limits with medication, interferon-alfa should be discontinued. Clinical monitoring of thyroid function is recommended.

Infection

Major:

CeeNU

The lomustine in CeeNU has a major potential interaction with Infection.

Nitrosoureas can induce delayed myelosuppression. The use of nitrosoureas may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during therapy with nitrosoureas. Close clinical monitoring of hematopoietic function is recommended.

Ischemic Heart Disease

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Ischemic Heart Disease.

Hypertension, arrhythmias, angina, myocardial infarction, cardiomyopathy, and congestive heart failure have been reported during interferon therapy. Therapy with interferons should be administered with caution in patients with compromised cardiac function.

Liver Disease

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Liver Disease.

Hepatotoxicity, including fatal cases, has been reported in patients treated with interferon alpha. Additionally, the risk of hepatic decompensation and death is increased in patients with cirrhosis. Any patient developing liver function abnormalities during treatment should be monitored closely and treatment should be discontinued if appropriate. Interferon-alfa is contraindicated in patients with autoimmune hepatitis and decompensated liver disease.

Minor:

CeeNU

The lomustine in CeeNU has a minor potential interaction with Liver Disease.

A reversible increase in liver transaminase, alkaline phosphatase, and bilirubin levels has been reported during therapy with nitrosoureas. Therapy with nitrosoureas should be administered cautiously in patients with a history of or predisposition to compromised hepatic function.

Parkinsonism

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Parkinsonism.

Reversible CNS effects such as seizures, mental status changes, manic behavior or psychotic reactions, gait disturbances, and dizziness have occurred in patients receiving interferons. Therapy with interferons should be administered cautiously in patients with or predisposed to seizures, psychiatric disorders, or conditions affecting posture or gait.

Peripheral Neuropathy

Moderate:

interferon alfa-2a

Interferon alfa-2a has a moderate potential interaction with Peripheral Neuropathy.

Paresthesia and numbness have been reported during interferon therapy. Therapy with interferons should be administered cautiously in patients with or predisposed to peripheral neuropathy.

Psychosis

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Psychosis.

Reversible CNS effects such as seizures, mental status changes, manic behavior or psychotic reactions, gait disturbances, and dizziness have occurred in patients receiving interferons. Therapy with interferons should be administered cautiously in patients with or predisposed to seizures, psychiatric disorders, or conditions affecting posture or gait.

Pulmonary Impairment

Major:

CeeNU

The lomustine in CeeNU has a major potential interaction with Pulmonary Impairment.

Pulmonary infiltrates and/or fibrosis have been reported during lomustine therapy. Toxicity occurred after 6 months of cumulative doses usually > 1100 mg/m2. Late reduction in pulmonary function, progressive fibrosis, and death have been noted. It is recommended to permanently discontinue therapy in patients diagnosed with pulmonary fibrosis. Therapy with lomustine should be administered cautiously in patients with preexisting pulmonary dysfunction. Pulmonary function studies prior to and during therapy are recommended.

Renal Dysfunction

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Renal Dysfunction.

Proteinuria (rare), not associated with a decrease in serum protein, is the most common renal toxicity observed with interferon- alfa therapy. Increased BUN and serum creatinine levels, hematuria, acute renal failure and nephrotic syndrome have also been reported. Therapy with interferon alfa should be administered cautiously to patients with severe renal dysfunction. Renal function should be evaluated in all patients before initiation of interferon- alfa therapy. In addition, patients with any degree of renal impairment should be carefully monitored for laboratory abnormalities and decreased creatinine clearance. A reduced dose of medication is recommended in patients with low CrCl (less than 50 mL/min - 30 mL/min).

Moderate:

CeeNU

The lomustine in CeeNU has a moderate potential interaction with Renal Dysfunction.

Renal abnormalities such as azotemia, and progressive decline in renal function have been reported after prolonged therapy with large doses of carmustine and lomustine. Lower total doses have also resulted in kidney damage. Therapy with carmustine or lomustine should be administered cautiously in patients with a history of or predisposition to renal dysfunction. Clinical monitoring of renal function is recommended.

Seizures

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Seizures.

Reversible CNS effects such as seizures, mental status changes, manic behavior or psychotic reactions, gait disturbances, and dizziness have occurred in patients receiving interferons. Therapy with interferons should be administered cautiously in patients with or predisposed to seizures, psychiatric disorders, or conditions affecting posture or gait.

Underactive Thyroid

Major:

interferon alfa-2a

Interferon alfa-2a has a major potential interaction with Underactive Thyroid.

Thyroid abnormalities, hypothyroidism or hyperthyroidism, have been reported in patients administered interferons. Therapy with interferons should be administered cautiously to patients with thyroid dysfunction. If thyroid control cannot be maintained within normal limits with medication, interferon-alfa should be discontinued. Clinical monitoring of thyroid function is recommended.

More resources

CeeNU

A total of 296 drugs are known to interact with CeeNU.

interferon alfa-2a

A total of 284 drugs are known to interact with interferon alfa-2a.

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.