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Interactions between Denosumab and Novantrone

1 drug interaction and 13 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

mitoXANTRONE denosumab

Applies to: Novantrone (mitoxantrone) and denosumab
Monitor

Concomitant use of immunosuppressive or myelosuppressive agents with denosumab may increase the risk of serious infections. Denosumab binds to and inhibits the receptor activator of nuclear factor kappa-B ligand (RANKL), which is expressed on activated T and B lymphocytes and in lymph nodes. Thus, denosumab alone may increase the risk of infections. In a clinical trial of over 7800 women with postmenopausal osteoporosis, the incidence of nonfatal serious infections was 3.3% in the placebo group and 4.0% in the denosumab group. Specifically, hospitalizations due to skin infections including erysipelas and cellulitis (<0.1% placebo vs. 0.4% denosumab) and serious infections in the abdomen (0.7% placebo vs. 0.9% denosumab), urinary tract (0.5% placebo vs. 0.7% denosumab), and ear (0.0% placebo vs. 0.1% denosumab) were reported. Endocarditis was reported in no placebo patients and 3 denosumab-treated patients. There was no difference in the incidence of opportunistic infections or infections resulting in death between the placebo and denosumab groups. The overall incidence of infections was also similar between the two groups.

Management

Caution is advised if denosumab must be used in combination with immuno- or myelosuppressive agents. Patients should be advised to contact their physician if they develop signs and symptoms of infection such as fever, chills, diarrhea, sore throat, muscle aches, shortness of breath, blood in phlegm, weight loss, red or inflamed skin, body sores, and pain or burning during urination. The need for continued denosumab therapy should be assessed when serious infections occur during treatment.

References (1)
  1. (2010) "Product Information. Prolia (denosumab)." Amgen Inc

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

13 potential interactions Applies to: 12 conditions, including Fever, Heart Disease, Hypocalcemia, Hypoparathyroidism, and Thyroid Disease.

Bleeding Disorder

Major:

Novantrone

The mitoXANTRONE in Novantrone has a major potential interaction with Bleeding Disorder.

Mitoxantrone induces myelosuppression when administered at therapeutic doses indicated for treatment of leukemia. Leukopenia is the most profound hematologic side-effect. Thrombocytopenia is rare, but can be severe and erythrocytes do not appear to be significantly affected. Therapy with mitoxantrone should be withheld in patients whose bone marrow function is severely depressed by prior irradiation or chemotherapy or whose marrow function is recovering from previous cytotoxic therapy. If the need outweighs the risk, extreme caution should be exercised in administering mitoxantrone. 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 monitory of hematopoietic function is recommended.

Bone Marrow Depression/Low Blood Counts

Major:

Novantrone

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

Mitoxantrone induces myelosuppression when administered at therapeutic doses indicated for treatment of leukemia. Leukopenia is the most profound hematologic side-effect. Thrombocytopenia is rare, but can be severe and erythrocytes do not appear to be significantly affected. Therapy with mitoxantrone should be withheld in patients whose bone marrow function is severely depressed by prior irradiation or chemotherapy or whose marrow function is recovering from previous cytotoxic therapy. If the need outweighs the risk, extreme caution should be exercised in administering mitoxantrone. 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 monitory of hematopoietic function is recommended.

Fever

Major:

Novantrone

The mitoXANTRONE in Novantrone has a major potential interaction with Fever.

Mitoxantrone induces myelosuppression when administered at therapeutic doses indicated for treatment of leukemia. Leukopenia is the most profound hematologic side-effect. Thrombocytopenia is rare, but can be severe and erythrocytes do not appear to be significantly affected. Therapy with mitoxantrone should be withheld in patients whose bone marrow function is severely depressed by prior irradiation or chemotherapy or whose marrow function is recovering from previous cytotoxic therapy. If the need outweighs the risk, extreme caution should be exercised in administering mitoxantrone. 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 monitory of hematopoietic function is recommended.

Heart Disease

Major:

Novantrone

The mitoXANTRONE in Novantrone has a major potential interaction with Heart Disease.

Mitoxantrone can cause myocardial toxicity leading to congestive heart failure (CHF). Patients with preexisting heart disease, prior irradiation, previous therapy with related compounds such as daunorubicin, idarubicin or doxorubicin, or of advanced age are at increased risk of cardiotoxicity at a lower cumulative dose. The incidence of drug-induced congestive heart failure in adults is increased when the total cumulative dose of mitoxantrone exceeds 140 mg/m2. Close clinical monitoring of cardiac function, such as determination of left ventricular ejection fraction, prior to each course of therapy is recommended.

Hyperuricemia Secondary to Chemotherapy

Moderate:

Novantrone

The mitoXANTRONE in Novantrone has a moderate potential interaction with Hyperuricemia Secondary to Chemotherapy.

Treatment with mitoxantrone may cause hyperuricemia as a result of rapid lysis of tumor cells. Levels of serum uric acid should be monitored and appropriate therapy should be initiated before starting therapy.

Hypocalcemia

Major:

denosumab

Denosumab has a major potential interaction with Hypocalcemia.

Preexisting hypocalcemia must be corrected prior to initiating treatment with denosumab. Caution should be exercised in patients predisposed to hypocalcemia and any disturbances of mineral metabolism, such as history of hypoparathyroidism, thyroid or parathyroid surgery, malabsorption syndromes, excision of small intestine, severe renal impairment or dialysis. Clinical monitoring of calcium and mineral levels (phosphorus and magnesium) are highly recommended within 14 days of denosumab injection. It is important to maintain calcium levels with adequate calcium and vitamin D supplementation.

Hypoparathyroidism

Major:

denosumab

Denosumab has a major potential interaction with Hypoparathyroidism.

Preexisting hypocalcemia must be corrected prior to initiating treatment with denosumab. Caution should be exercised in patients predisposed to hypocalcemia and any disturbances of mineral metabolism, such as history of hypoparathyroidism, thyroid or parathyroid surgery, malabsorption syndromes, excision of small intestine, severe renal impairment or dialysis. Clinical monitoring of calcium and mineral levels (phosphorus and magnesium) are highly recommended within 14 days of denosumab injection. It is important to maintain calcium levels with adequate calcium and vitamin D supplementation.

Immunodeficiency

Moderate:

denosumab

Denosumab has a moderate potential interaction with Immunodeficiency.

Denosumab should be used with caution in patients with impaired immune systems or taking concomitant immunosuppressant agents as they may be at increased risk for serious infections.

Infection

Major:

Novantrone

The mitoXANTRONE in Novantrone 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.

Major:

Novantrone

The mitoXANTRONE in Novantrone has a major potential interaction with Infection.

Mitoxantrone induces myelosuppression when administered at therapeutic doses indicated for treatment of leukemia. Leukopenia is the most profound hematologic side-effect. Thrombocytopenia is rare, but can be severe and erythrocytes do not appear to be significantly affected. Therapy with mitoxantrone should be withheld in patients whose bone marrow function is severely depressed by prior irradiation or chemotherapy or whose marrow function is recovering from previous cytotoxic therapy. If the need outweighs the risk, extreme caution should be exercised in administering mitoxantrone. 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 monitory of hematopoietic function is recommended.

Liver Disease

Major:

Novantrone

The mitoXANTRONE in Novantrone has a major potential interaction with Liver Disease.

Hepatic impairment reduces mitoxantrone clearance. Patients with severe hepatic dysfunction (bilirubin > 3.4 mg/dL) have an AUC more than three times greater than that of patients with normal hepatic function receiving the same dose. Therapy with mitoxantrone should be administered cautiously to patients with significantly compromised hepatic function.

Renal Dysfunction

Major:

denosumab

Denosumab has a major potential interaction with Renal Dysfunction.

Preexisting hypocalcemia must be corrected prior to initiating treatment with denosumab. Caution should be exercised in patients predisposed to hypocalcemia and any disturbances of mineral metabolism, such as history of hypoparathyroidism, thyroid or parathyroid surgery, malabsorption syndromes, excision of small intestine, severe renal impairment or dialysis. Clinical monitoring of calcium and mineral levels (phosphorus and magnesium) are highly recommended within 14 days of denosumab injection. It is important to maintain calcium levels with adequate calcium and vitamin D supplementation.

Thyroid Disease

Major:

denosumab

Denosumab has a major potential interaction with Thyroid Disease.

Preexisting hypocalcemia must be corrected prior to initiating treatment with denosumab. Caution should be exercised in patients predisposed to hypocalcemia and any disturbances of mineral metabolism, such as history of hypoparathyroidism, thyroid or parathyroid surgery, malabsorption syndromes, excision of small intestine, severe renal impairment or dialysis. Clinical monitoring of calcium and mineral levels (phosphorus and magnesium) are highly recommended within 14 days of denosumab injection. It is important to maintain calcium levels with adequate calcium and vitamin D supplementation.

More resources

denosumab

A total of 324 drugs are known to interact with denosumab.

Novantrone

A total of 385 drugs are known to interact with Novantrone.

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.