Can you take Diroximel fumarate with Rituximab?

riTUXimab has a major potential interaction with Arrhythmia.

Cardiotoxicity has been reported in a few patients receiving rituximab infusion during clinical studies. Patients with a history of angina or arrhythmias have experienced recurrences of these conditions during administration of rituximab. Therapy with rituximab should be administered cautiously in patients with preexisting arrhythmias or coronary artery or ischemic heart disease. Clinical monitoring of cardiac function throughout infusion and immediately post-infusion is recommended.

riTUXimab has a major potential interaction with Autoimmune Disorders.

JC virus infection resulting in Progressive Multifocal Leukoencephalopathy (PML) and death can occur in rituximab-treated patients with hematologic malignancies or with autoimmune diseases. Consider the diagnosis of PML in any patient presenting with new-onset neurologic manifestations. Discontinue rituximab and consider discontinuation or reduction of any concomitant chemotherapy or immunosuppressive therapy in patients who develop PML.

riTUXimab has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

Myelosuppression has been reported during administration of rituximab. Leukopenia and thrombocytopenia occur more frequently than anemia. Severe myelosuppression has been reported rarely. Therapy with rituximab should be administered cautiously in patients with severe bone marrow suppression. Clinical monitoring of hematopoietic function is recommended.

Diroximel fumarate has a moderate potential interaction with Immunodeficiency.

Progressive multifocal leukoencephalopathy (PML) has occurred in patients with multiple sclerosis (MS) treated with dimethyl fumarate (which has the same active metabolite as diroximel fumarate); PML is an opportunistic viral infection of the brain caused by the John Cunningham virus (JC virus) that generally only occurs in immunocompromised patients and usually leads to death or severe disability. Caution and monitoring is advised in patients with MS. Diroximel fumarate should be withheld at the first sign/symptom suggestive of PML and an appropriate diagnostic evaluation should be performed.

Diroximel fumarate has a moderate potential interaction with Infection.

Diroximel fumarate may decrease lymphocyte counts. Neither diroximel fumarate nor dimethyl fumarate (same active metabolite) have been studied in patients with preexisting low lymphocyte counts; caution is advised in these patients. CBC (including lymphocyte count) should be obtained before initiating treatment with diroximel fumarate, 6 months after starting treatment, every 6 to 12 months thereafter, and as clinically indicated. Interruption of therapy in patients with lymphocyte counts less than 0.5 x 10(9)/L persisting for more than 6 months and withholding treatment from patients with serious infections until resolution should be considered. Caution is recommended and decisions about whether or not to restart diroximel fumarate should be individualized based on clinical circumstances.

Diroximel fumarate has a moderate potential interaction with Infection.

Serious cases of herpes zoster have occurred in patients treated with dimethyl fumarate (which has the same active metabolite as diroximel fumarate); patients should be monitored for signs/symptoms of herpes zoster while on diroximel fumarate. Other serious opportunistic infections have occurred with dimethyl fumarate, including cases of serious viral, fungal, and bacterial infections. Patients with signs/symptoms consistent with any of these infections should undergo prompt diagnostic evaluation and receive appropriate treatment. Withholding diroximel fumarate treatment in patients with herpes zoster or other serious infections until the infection has resolved should be considered.

riTUXimab has a moderate potential interaction with Infection.

Rituximab can cause serious, including fatal, bacterial, fungal, and new or reactivated viral infections during and following the completion of rituximab-based therapy. Infections have been reported in some patients with prolonged hypogammaglobulinemia (defined as hypogammaglobulinemia >11 months after rituximab exposure). New or reactivated viral infections included cytomegalovirus, herpes simplex virus, parvovirus B19, varicella zoster virus, West Nile virus, and hepatitis B and C. The manufacturer recommends discontinuing rituximab for serious infections and institute appropriate anti-infective therapy.

riTUXimab has a major potential interaction with Infectious Hepatitis.

Rituximab, as other drugs classified as CD20-directed cytolytic antibodies can cause hepatitis B virus (HBV) reactivation, in some cases resulting in fulminant hepatitis, hepatic failure and death. Cases have been reported in patients who are hepatitis B surface antigen (HBsAg) positive and in patients who are HBsAg negative but are hepatitis B core antibody (anti-HBc) positive. Reactivation also has occurred in patients who appear to have resolved hepatitis B infection (i.e., HBsAg negative, anti-HBc positive and hepatitis B surface antibody [anti-HBs] positive). Screen all patients for HBV infection by measuring HBsAg and anti-HBc before initiating treatment with rituximab. Monitor patients with evidence of current or prior HBV infection for clinical and laboratory signs of hepatitis or HBV reactivation during and for several months following rituximab therapy. In patients who develop reactivation of HBV while on rituximab, immediately discontinue rituximab and any concomitant chemotherapy, and institute appropriate treatment.

riTUXimab has a major potential interaction with Ischemic Heart Disease.

Cardiotoxicity has been reported in a few patients receiving rituximab infusion during clinical studies. Patients with a history of angina or arrhythmias have experienced recurrences of these conditions during administration of rituximab. Therapy with rituximab should be administered cautiously in patients with preexisting arrhythmias or coronary artery or ischemic heart disease. Clinical monitoring of cardiac function throughout infusion and immediately post-infusion is recommended.

Diroximel fumarate has a moderate potential interaction with Liver Disease.

Therapy with diroximel fumarate should be administered cautiously in patients with liver dysfunction; no studies have been conducted in these patients. Clinically significant cases of liver injury have been reported in patients treated with dimethyl fumarate (which has the same active metabolite as diroximel fumarate) in the postmarketing setting. Signs/symptoms of liver injury, including elevation of serum aminotransferases to greater than 5-fold the upper limit of normal and elevation of total bilirubin to greater than 2-fold the upper limit of normal have been observed; these abnormalities resolved upon treatment discontinuation. Serum aminotransferase, alkaline phosphatase, and total bilirubin levels should be obtained prior to and during treatment with diroximel fumarate, as clinically indicated; therapy should be discontinued if clinically significant liver injury induced by diroximel fumarate is suspected.

Diroximel fumarate has a moderate potential interaction with Lymphocytopenia.

Diroximel fumarate may decrease lymphocyte counts. Neither diroximel fumarate nor dimethyl fumarate (same active metabolite) have been studied in patients with preexisting low lymphocyte counts; caution is advised in these patients. CBC (including lymphocyte count) should be obtained before initiating treatment with diroximel fumarate, 6 months after starting treatment, every 6 to 12 months thereafter, and as clinically indicated. Interruption of therapy in patients with lymphocyte counts less than 0.5 x 10(9)/L persisting for more than 6 months and withholding treatment from patients with serious infections until resolution should be considered. Caution is recommended and decisions about whether or not to restart diroximel fumarate should be individualized based on clinical circumstances.

riTUXimab has a major potential interaction with Lymphoma.

JC virus infection resulting in Progressive Multifocal Leukoencephalopathy (PML) and death can occur in rituximab-treated patients with hematologic malignancies or with autoimmune diseases. Consider the diagnosis of PML in any patient presenting with new-onset neurologic manifestations. Discontinue rituximab and consider discontinuation or reduction of any concomitant chemotherapy or immunosuppressive therapy in patients who develop PML.

riTUXimab has a major potential interaction with Myeloproliferative Disorders.

JC virus infection resulting in Progressive Multifocal Leukoencephalopathy (PML) and death can occur in rituximab-treated patients with hematologic malignancies or with autoimmune diseases. Consider the diagnosis of PML in any patient presenting with new-onset neurologic manifestations. Discontinue rituximab and consider discontinuation or reduction of any concomitant chemotherapy or immunosuppressive therapy in patients who develop PML.

Diroximel fumarate has a moderate potential interaction with Renal Dysfunction.

Due to an increase in the exposure of a major metabolite (2-hydroxyethyl succinimide [HES]), the use of diroximel fumarate is not recommended in patients with moderate or severe renal dysfunction.

riTUXimab has a moderate potential interaction with Renal Dysfunction.

Severe, including fatal, renal toxicity can occur after rituximab administration in patients with Non-Hodgkin's Lymphoma (NHL). Renal toxicity has occurred in patients who experience tumor lysis syndrome and in patients with NHL administered concomitant cisplatin therapy during clinical trials. The combination of cisplatin and rituximab is not an approved treatment regimen. Monitor closely for signs of renal failure and discontinue rituximab in patients with a rising serum creatinine or oliguria. No formal studies have been conducted to examine the effects of renal impairment on the pharmacokinetics of rituximab.

riTUXimab has a major potential interaction with Tumor Lysis Syndrome.

Acute renal failure, hyperkalemia, hypocalcemia, hyperuricemia, or hyperphosphatemia from tumor lysis, some fatal, can occur within 12-24 hours after the first infusion of rituximab in patients with Non-Hodgkin Lymphoma (NHL). Administer aggressive intravenous hydration and anti-hyperuricemic therapy in patients at high risk for Tumor Lysis Syndrome (TLS). Correct electrolyte abnormalities, monitor renal function and fluid balance, and administer supportive care, including dialysis as indicated.