Interactions between Cisplatin and Flora-Q
1 drug interaction and 10 additional warnings found for the following 2 drugs:
- cisplatin
- Flora-Q (lactobacillus acidophilus)
Drug interactions
Moderate drug interactions
Moderate:
CISplatin lactobacillus acidophilus
Applies to: cisplatin and Flora-Q (lactobacillus acidophilus)
Monitor
Probiotic use during immunosuppressant or intense antineoplastic therapy may theoretically increase the risk of infections from the live microorganisms contained in probiotic products. Patients may be immunosuppressed if they have recently received or are receiving alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents, or long-term topical or inhaled corticosteroids. Although probiotics are generally considered safe, with minimal to low pathogenicity, infections such as bacteremia and endocarditis with various strains commonly found in probiotics (e.g., lactobacilli, bifidobacteria, Bacillus subtilis) have been rarely reported, primarily in critically ill patients or patients with significant underlying medical conditions such as malignancy, organ transplantation, AIDS, valvular heart disease, diabetes mellitus, recent surgery, or compromised immune system. Lactobacillus bacteremia has also been reported following endoscopy. In addition, cases of lactobacillus pneumonia and liver abscess, as well as Saccharomyces fungemia, pneumonia, liver abscess, peritonitis and vaginitis, have been described in the medical literature.
Management
Caution is advised when probiotics are used during immunosuppressant or intense antineoplastic therapy. It may be advisable to avoid using probiotics, particularly products containing saccharomyces boulardii, in patients who are significantly immunosuppressed unless benefits are anticipated to outweigh the potential risk of infection.
References (12)
- Salminen MK, Rautelin H, Tynkkynen S, et al. (2004) "Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG." Clin Infect Dis, 38, p. 62-9
- Salminen MK, Tynkkynen S, Rautelin H, et al. (2002) "Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland." Clin Infect Dis, 35, p. 1155-60
- Rautio M, Jousimies-Somer H, Kauma H, et al. (1999) "Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG." Clin Infect Dis, 28, p. 1159-60
- Schlegel L, Lemerle S, Geslin P (1998) "Lactobacillus species as opportunistic pathogens in immunocompromised patients." Eur J Clin Microbiol Infect Dis, 17, p. 887-8
- Saxelin M, Chuang NH, Chassy B, et al. (1996) "Lactobacilli and bacteremia in southern Finland, 1989-1992" Clin Infect Dis, 22, p. 564-6
- Husni RN, Gordon SM, Washington JA, Longworth DL (1997) "Lactobacillus bacteremia and endocarditis: review of 45 cases." Clin Infect Dis, 25, p. 1048-55
- Oggioni MR, Pozzi G, Valensin PE, Galieni P, Bigazzi C (1998) "Recurrent septicemia in an immunocompromised patient due to probiotic strains of Bacillus subtilis." J Clin Microbiol, 36, p. 325-6
- Mackay AD, Taylor MB, Kibbler CC, Hamilton-Miller JM (1999) "Lactobacillus endocarditis caused by a probiotic organism." Clin Microbiol Infect, 5, p. 290-2
- Borriello SP, Hammes WP, Holzapfel W, et al. (2003) "Safety of probiotics that contain lactobacilli or bifidobacteria." Clin Infect Dis, 36, p. 775-80
- Lolis N, Veldekis D, Moraitou H, et al. (2008) "Saccharomyces boulardii fungaemia in an intensive care unit patient treated with caspofungin." Crit Care, 12, epub
- Boyle RJ, Robins-Browne RM, Tang ML (2006) "Probiotic use in clinical practice: what are the risks?" Am J Clin Nutr, 83, p. 1256-64
- Pruccoli G, Silvestro E, Napoleone CP, Aidala E, Garazzino S, Scolfaro C (2024) Are probiotics safe? Bifidobacterium bacteremia in a child with severe heart failure. https://www.researchgate.net/publication/333853508_Are_probiotics_safe_Bifidobacterium_bacteremia_in_a_child_with_severe_heart_failure
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
10 potential interactions Applies to: 10 conditions, including Peripheral Neuropathy, Anemia, Fever, Hearing Loss, and Infection.
Anemia
Moderate:
cisplatin
CISplatin has a moderate potential interaction with Anemia.
A (+) Coombs' hemolytic anemia has been reported with the use of cisplatin. Subsequent therapy may result in increased hemolysis. If need outweighs the risk, extreme caution should be exercised in administering cisplatin. Patients should be instructed to immediately report signs and symptoms suggesting anemia such as fatigue, weakness, and/or bloody urine. Therapy with cisplatin should be administered cautiously in patients with anemia and those with a history of or a predisposition to hemolytic syndromes. Close clinical monitoring of hematopoietic function for hemolysis and anemia is recommended.
Bleeding Disorder
Major:
cisplatin
CISplatin has a major potential interaction with Bleeding Disorder.
Myelosuppression has been reported in 25% to 30% of patients administered cisplatin. Fever and infection have been reported in patients with neutropenia. Potential fatalities due to infection (secondary to myelosuppression) have been reported. Therapy with cisplatin should be administered cautiously in patients whose bone marrow reserve may be severely depressed by prior chemotherapy or irradiation or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended. For patients who develop severe myelosuppression during treatment with cisplatin injection, consider dose modifications and manage according to clinical treatment guidelines.
Bone Marrow Depression/Low Blood Counts
Major:
cisplatin
CISplatin has a major potential interaction with Bone Marrow Depression/Low Blood Counts.
Myelosuppression has been reported in 25% to 30% of patients administered cisplatin. Fever and infection have been reported in patients with neutropenia. Potential fatalities due to infection (secondary to myelosuppression) have been reported. Therapy with cisplatin should be administered cautiously in patients whose bone marrow reserve may be severely depressed by prior chemotherapy or irradiation or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended. For patients who develop severe myelosuppression during treatment with cisplatin injection, consider dose modifications and manage according to clinical treatment guidelines.
Fever
Major:
cisplatin
CISplatin has a major potential interaction with Fever.
Myelosuppression has been reported in 25% to 30% of patients administered cisplatin. Fever and infection have been reported in patients with neutropenia. Potential fatalities due to infection (secondary to myelosuppression) have been reported. Therapy with cisplatin should be administered cautiously in patients whose bone marrow reserve may be severely depressed by prior chemotherapy or irradiation or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended. For patients who develop severe myelosuppression during treatment with cisplatin injection, consider dose modifications and manage according to clinical treatment guidelines.
Hearing Loss
Major:
cisplatin
CISplatin has a major potential interaction with Hearing Loss.
Cisplatin injection can cause ototoxicity, which is cumulative and may be severe. Consider audiometric and vestibular function monitoring. Ototoxicity can occur during or after treatment and can be unilateral or bilateral. Deafness after the initial dose of cisplatin injection has been reported. Vestibular toxicity has also been reported. Ototoxic effects can be more severe and detrimental in pediatric patients, particularly in patients less than 5 years of age. The prevalence of hearing loss in pediatric patients is estimated to be 40-60%. Additional risk factors for ototoxicity include simultaneous cranial irradiation, treatment with other ototoxic drugs and renal impairment. Consider audiometric and vestibular testing in all pediatric patients receiving cisplatin.
Immunodeficiency
Moderate:
Flora-Q
The lactobacillus acidophilus in Flora-Q has a moderate potential interaction with Immunodeficiency.
Probiotics, especially those containing lactobacillus, should be used with caution in immunosuppressed patients.
Infection
Major:
cisplatin
CISplatin has a major potential interaction with Infection.
Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs 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 antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.
Peripheral Neuropathy
Major:
cisplatin
CISplatin has a major potential interaction with Peripheral Neuropathy.
Cisplatin injection can cause dose-related peripheral neuropathy that becomes more severe with repeated courses of the drug. Neurologic symptoms have been reported to occur after a single dose. Neuropathy can also have a delayed onset from 3 to 8 weeks after the last dose of cisplatin injection. Manifestations include paresthesias in a stocking-glove distribution, areflexia, and loss of proprioception and vibratory sensation. The neuropathy may progress further even after stopping treatment. Peripheral neuropathy may be irreversible in some patients. Therapy with cisplatin should be administered cautiously in patients with or predisposed to peripheral neuropathy.
Renal Dysfunction
Major:
cisplatin
CISplatin has a major potential interaction with Renal Dysfunction.
Patients with baseline renal impairment may be more susceptible to cisplatin nephrotoxicity. Ensure adequate hydration before, during, and after cisplatin injection administration. Measure serum creatinine, blood urea nitrogen, creatinine clearance, and serum electrolytes prior to initiating therapy, and as clinically indicated. Consider alternative treatments or reduce the dose of cisplatin injection for patients with baseline renal impairment or who develop significant reductions in creatinine clearance during treatment with cisplatin injection according to clinical treatment guidelines
Visual Defect/Disturbance
Moderate:
cisplatin
CISplatin has a moderate potential interaction with Visual Defect/Disturbance.
Optic neuritis, papilledema, and cortical blindness have been reported in patients receiving standard recommended doses of cisplatin injection. Blurred vision and altered color perception have been reported after the use of regimens with higher doses and dose frequencies of cisplatin injection. Improvement and/or total recovery usually occurs after discontinuing cisplatin injection but can be delayed. Caution is advised in patients with visual disabilities.
More resources
cisplatin
A total of 492 drugs are known to interact with cisplatin.
- Cisplatin is in the drug class alkylating agents.
- Cisplatin is used to treat the following conditions:
Flora-Q
A total of 370 drugs are known to interact with Flora-Q.
- Flora-q is in the following drug classes: antidiarrheals, probiotics.
- Flora-q is used to treat the following conditions:
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.