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Drug Interactions between Cerebyx and CNJ-016

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

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Moderate

fosphenytoin vaccinia immune globulin

Applies to: Cerebyx (fosphenytoin) and CNJ-016 (vaccinia immune globulin)

MONITOR: A possible interaction between phenytoin and intravenous immunoglobulin (IVIG) was suspected in a case of fatal hypersensitivity myocarditis. The mechanism of interaction has not been described. The case patient was a 43-year-old man with a past history of alcohol abuse who had been receiving phenytoin for the treatment of partial epilepsy for eight years. He was given intravenous immunoglobulin 0.4 g/kg for 5 days for suspected Guillain-Barre syndrome. On the second day after the last administration, the patient complained of abdominal pain, aching shoulders, and backache. He subsequently developed hypotension and died after attempts at resuscitation. An autopsy confirmed Guillain-Barre syndrome and revealed signs of a slight hepatitis with eosinophils as well as hypersensitivity (eosinophilic) myocarditis. There were no signs of alcoholic cardiomyopathy. Since phenytoin alone has been associated with hypersensitivity myocarditis, a contributory role for IVIG could not be established. Moreover, IVIG has been used successfully in some cases to treat anticonvulsant hypersensitivity syndrome, including that associated with phenytoin.

MANAGEMENT: Due to the serious nature of the possible interaction, clinicians should consider monitoring hematologic parameters such as eosinophil counts as well as blood pressure and ECG tracings if immunoglobulins are used in patients receiving phenytoin.

References

  1. Fenoglio JJ, McAllister HA, Mullick FG "Drug related myocarditis: I. Hypersensitivity myocarditis." Hum Pathol 12 (1981): 900-7
  2. Koehler PJ, Koudstaal J "Lethal hypersensitivity myocarditis associated with the use of intravenous gammaglobulin for Guillan-Barre syndrome, in combination with phenytoin." J Neurol 243 (1996): 366-7
  3. Mostella J, Pieroni R, Jones R, Finch CK "Anticonvulsant hypersensitivity syndrome: treatment with corticosteroids and intravenous immunoglobulin." South Med J 97 (2004): 319-21
  4. Cumbo-Nacheli G, Weinberger J, Alkhalil M, Thati N, Baptist AP "Anticonvulsant hypersensitivity syndrome: is there a role for immunomodulation?" Epilepsia 49 (2008): 2108-12
View all 4 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

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

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