Interactions between Copiktra and Topotecan

Topotecan has a major potential interaction with Bleeding Disorder.

Topotecan induces myelosuppression. Severe thrombocytopenia (< 25,000/mm3) has been reported during topotecan therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bleeding such as petechiae, purpura, hematuria, or melena. Close clinical monitoring of hematopoietic function is recommended. Therapy with topotecan should not be initiated in patients with platelet counts < 100,000/mm3. Subsequent courses of topotecan should be withheld until platelet counts exceed 100,000/mm3.

Topotecan has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Topotecan induces myelosuppression. Severe neutropenia (< 500/mm3), severe thrombocytopenia (< 25,000/mm3), and severe anemia (< 8 g/dl) have been reported frequently. 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. Therapy with topotecan should not be initiated in patients with neutrophil counts < 1500/mm3 and/or platelet counts < 100,000/mm3. Subsequent courses of topotecan should be withheld until neutrophil counts exceed 1000/mm3, platelet counts exceed 100,000/mm3, and/or hemoglobin levels are at least 9 g/dl.

Topotecan has a moderate potential interaction with Diarrhea.

Topotecan capsules can cause severe and life-threatening diarrhea that may require hospitalization. It is recommended to withhold treatment for severe diarrhea. Manage diarrhea caused by topotecan aggressively and do no administer topotecan capsules to patients with Grade 3 or 4 diarrhea. Reduce the dose of therapy after recovery to Grade 1 or less. Close monitoring is recommended.

Topotecan has a major potential interaction with Fever.

Topotecan induces myelosuppression. Severe neutropenia (< 500/mm3), severe thrombocytopenia (< 25,000/mm3), and severe anemia (< 8 g/dl) have been reported frequently. 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. Therapy with topotecan should not be initiated in patients with neutrophil counts < 1500/mm3 and/or platelet counts < 100,000/mm3. Subsequent courses of topotecan should be withheld until neutrophil counts exceed 1000/mm3, platelet counts exceed 100,000/mm3, and/or hemoglobin levels are at least 9 g/dl.

The duvelisib in Copiktra has a major potential interaction with Infection.

Any infection should be treated prior to initiation of treatment with duvelisib. Serious, including fatal infections have occurred in patients receiving treatment with this drug. The most common serious infections were pneumonia (including fatal pneumocystis jirovecii pneumonia, PJP), sepsis, and lower respiratory infections. Advise patients to report any new or worsening signs and symptoms of infection. In some cases, treatment might need to be suspended while the infection is treated. Prophylaxis for PJP should be provided during treatment, and in some cases also prophylactic antivirals should be considered in patients with history of CMV infection to avoid CMV reactivation.

Topotecan 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.

The duvelisib in Copiktra has a moderate potential interaction with Liver Disease.

Bilirubin and ALT and/or AST elevation has been reported in patients receiving duvelisib. Monitor hepatic function in all patients during treatment with duvelisib. Caution and close monitoring is advised in patients with hepatic impairment.

The duvelisib in Copiktra has a moderate potential interaction with Neutropenia.

Caution and close monitoring is advised when starting treatment in patients with neutropenia. Grade 3 or 4 neutropenia has been reported in 42% of patients receiving treatment. Monitor neutrophil counts at least every 2 weeks for the first 2 months of duvelisib therapy, and at least weekly in patients with neutrophil counts < 1.0 Gi/L (Grade 3-4). Withhold treatment with duvelisib in patients presenting with neutrophil counts < 0.5 Gi/L (Grade 4). Monitor until ANC is > 0.5 Gi/L, and then resume duvelisib at same dose for the first occurrence or a reduced dose for subsequent occurrence.

The duvelisib in Copiktra has a major potential interaction with Noninfectious Colitis.

Serious, including fatal diarrhea or colitis has been reported in 18% of patients receiving treatment with duvelisib. Patients with history of colitis should be monitored closely for any signs or symptoms. Advise patients to report any new or worsening diarrhea. Patients presenting with abdominal pain, stool with mucus or blood, change in bowel habits, peritoneal signs, or with diarrhea that is noninfectious should be followed closely and supportive therapy should be initiated based on severity (antidiarrheal agents, to enteric acting or systemic steroids if needed). A diagnostic work- up to determine etiology, including colonoscopy, should be performed. Monitor at least weekly. Upon resolution of the diarrhea or colitis, treatment can be restarted at a reduced dose. Treatment should be discontinued for recurrent Grade 3 diarrhea or recurrent colitis of any grade.

Topotecan has a moderate potential interaction with Pulmonary Impairment.

Fatal cases of interstitial lung disease (ILD) have occurred with the use of topotecan. Risk factors include a history of ILD, pulmonary fibrosis, lung cancer, thoracic radiation, and use of pneumotoxic drugs and/or colony stimulating factors. It is recommended to monitor patients for pulmonary symptoms indicative of ILD and permanently discontinue treatment for confirmed ILD.

Topotecan has a major potential interaction with Renal Dysfunction.

Topotecan is partially eliminated by the kidney. Approximately 30% of topotecan is excreted in the urine. Plasma clearance of topotecan was reduced 33% in patients with mild renal impairment (creatinine clearance of 40 to 60 mL/min) and 66% in patients with moderate renal impairment (creatinine clearance of 20 to 40 mL/min). Therapy with topotecan should be administered cautiously and at a reduced dosage in patients with moderate to severe renal dysfunction.