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Drug Interactions between chloroquine and nilutamide

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

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Interactions between your drugs

Moderate

chloroquine nilutamide

Applies to: chloroquine and nilutamide

GENERALLY AVOID: Long-term androgen deprivation therapy (ADT) can prolong the QT interval. Coadministration of ADT with other agents that may prolong the QT interval could also result in additive effects and an increased risk of ventricular arrhythmias including torsade de pointes and sudden death. The risk may be increased in patients with certain underlying risk factors like congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). Studies in young men have shown that endogenous serum testosterone levels are inversely associated with QTc (QT interval corrected for heart rate) duration. Clinical trials in men with low serum testosterone levels have reported testosterone administration being associated with a shortening of QTc. Likewise, studies using ADT have shown that it may prolong the QT interval; however, this effect may vary by drug, dose, or even each drug class that can be used to reduce testosterone levels. A clinical study comparing abarelix to a luteinizing hormone-releasing hormone agonist plus nonsteroidal antiandrogen therapy found that both therapies prolonged the mean Fridericia-corrected QT interval (QTcF) by more than 10 msec from baseline. Approximately 20% of patients in both groups had either changes from baseline QTc of >30 msec or end-of-treatment QTc values >450 msec. Similarly, a study comparing degarelix to leuprolide found that approximately 20% of patients on each drug had QT/QTc intervals >450 msec after 1 year of treatment. From baseline to end of study, the median change in QTcF was 12.3 msec for degarelix and 16.7 msec for leuprolide. Some drugs used to lower testosterone levels may also have other side effects that can predispose a patient to QT prolongation and torsade de pointes. For example, inhibitors of 17 alpha-hydroxylase/C17,20-lyase (CYP17) like abiraterone may cause hypokalemia as a result of increased mineralocorticoid levels. Clinical data on ADT prolonging the QT interval in women and children are lacking.

MANAGEMENT: The benefits of androgen deprivation therapy (ADT) should be carefully assessed against the potential risk in patients receiving other drugs known to prolong the QT interval. Electrolyte abnormalities should be corrected prior to initiating therapy, and monitoring of electrocardiograms and electrolytes may be advisable. The manufacturer's labeling as well as current clinical guidelines should be consulted for monitoring recommendations.

References

  1. "Product Information. Lupron (leuprolide)." TAP Pharmaceuticals Inc PROD (2002):
  2. "Product Information. Zoladex (goserelin)." Astra-Zeneca Pharmaceuticals PROD (2001):
  3. "Product Information. Trelstar (triptorelin)." Pharmacia and Upjohn PROD (2001):
  4. "Product Information. Eligard (leuprolide)." Sanofi Winthrop Pharmaceuticals (2002):
  5. "Product Information. Plenaxis (abarelix)." Praecis Pharmaceuticals Inc (2003):
  6. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  7. "Product Information. Vantas (histrelin)." Endo Pharmaceuticals (formally Indevus Pharmaceuticals Inc) (2010):
  8. "Product Information. Firmagon (degarelix)." Ferring Pharmaceuticals Inc (2013):
  9. Krishna KB, Fuqua JS, rogol ad, et al. "Use of gonadotropin-releasing hormone analogs in children: update by an international consortium." Horm Res Paediatr 91 (2019): 357-72
  10. Lazzerini PE, Bertolozzi I, Acampa M, et al. "Androgen deprivation therapy for prostatic cancer in patients with torsades de pointes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239032/" (2023):
  11. Gagliano-Juca T, Travison TG, kantoff pw, et al. "Androgen deprivation therapy is associated with prolongation of QTc interval in men with prostate cancer." J Endocr Soc 2 (2018): 485-96
  12. Gheorghe GS, Hodorogea AS, Ciobanu A, Nanea IT, Gheorghe ACD "Androgen deprivation therapy, hypogonadism and cardiovascular toxicity in men with advanced prostate cancer." Curr Oncol 28 (2021): 3331-46
  13. "Product Information. Firmagon (degarelix)." Ferring Pharmaceuticals Pty Ltd (2023):
  14. "Product Information. Firmagon (degarelix)." Ferring Pharmaceuticals Inc (2020):
View all 14 references

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Drug and food interactions

Moderate

chloroquine food

Applies to: chloroquine

GENERALLY AVOID: Theoretically, grapefruit and grapefruit juice may increase the plasma concentrations of hydroxychloroquine or chloroquine and the risk of toxicities such as QT interval prolongation and ventricular arrhythmias. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruit. Following coadministration with cimetidine, a weak to moderate CYP450 3A4 inhibitor, a 2-fold increase in chloroquine exposure occurred. Since chloroquine and hydroxychloroquine have similar structures and metabolic elimination pathways, a similar interaction may be observed with hydroxychloroquine. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Although clinical data are lacking, it may be advisable to avoid the consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract during hydroxychloroquine or chloroquine therapy.

References

  1. Cerner Multum, Inc. "Australian Product Information." O 0

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Moderate

nilutamide food

Applies to: nilutamide

GENERALLY AVOID: Alcohol intolerance has been reported in 5% to 20% of patients following administration of nilutamide in clinical studies. Symptoms include facial flushes, malaise, and hypotension.

MANAGEMENT: Consumption of alcoholic beverages should be avoided in patients who experience alcohol intolerance with nilutamide.

References

  1. "Product Information. Nilandron (nilutamide)." Hoechst Marion Roussel PROD (2001):
  2. Decensi A, Guarneri D, Paoletti MC, Lalanne JM, Merlo F, Boccardo F "Phase II study of the pure non-steroidal antiandrogen nilutamide in prostatic cancer. Italian Prostatic Cancer Project (PONCAP)." Eur J Cancer 27 (1991): 1100-4

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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