Interactions between Dostarlimab and Liquiprin
1 drug interaction and 9 additional warnings found for the following 2 drugs:
- dostarlimab
- Liquiprin (acetaminophen)
Drug interactions
Moderate drug interactions
Moderate:
acetaminophen dostarlimab
Applies to: Liquiprin (acetaminophen) and dostarlimab
Monitor
Acetaminophen may reduce the efficacy of immune checkpoint inhibitors (ICIs) such as anti-cytotoxic T-lymphocyte-associated protein (CTLA)-4 monoclonal antibodies and/or inhibitors of programmed cell death-1 (PD-1)/programmed death ligand-1 (PD-L1). The mechanism of this interaction has not been fully elucidated, but may involve the ability of acetaminophen to impair proliferation of immune cells and T-cell mediated antitumor immunity, which has been observed in some studies. In the CheckMate 025 trial, patients with advanced renal cell carcinoma (n=297) and detectable serum levels of acetaminophen or its metabolite acetaminophen glucuronide were observed to have significantly poorer overall survival (OS) than patients without detectable acetaminophen levels at treatment onset. Similarly, it was noted during an analysis of plasma samples from patients (n=34) in a separate study who were treated with anti-PD-L1 therapies, with or without anti-CTLA-4 antibodies, that those with a detectable serum acetaminophen level had a significantly lower objective response rate than those without a detectable acetaminophen level (0% vs. 29.4%, respectively). Although OS was numerically shorter for patients with detectable acetaminophen levels compared to those without, this difference was not statistically significant in this study. Likewise, an analysis of plasma samples from patients enrolled in the PREMIS study (n=297) treated with anti-PD-L1 therapies, with or without anti-CTLA-4 antibodies, found that the presence of detectable acetaminophen levels was associated with significantly worse progression-free survival (PFS, median 2.63 months vs. 50.3 months) and OS (median 8.43 months vs. 14.93 months) when compared to those without detectable acetaminophen levels. Similarly, a retrospective single-center study in patients (n=225) with stage IV non-small cell lung cancer (NSCLC) who underwent first-line therapy with pembrolizumab (alone or in combination with platinum-based chemotherapy) or second-line therapy with pembrolizumab, nivolumab, or atezolizumab noted that patients who were exposed to high intensity acetaminophen (defined as therapeutic intake lasting >24 hours or a total intake >60 doses of 1000 mg) between 30 days before to 90 days after the first ICI infusion had an increased risk of treatment failure and a shorter duration of median PFS and OS. Multivariate analyses confirmed that high exposure to acetaminophen was independently associated with a reduction in both PFS and OS. Data are not available for every ICI in combination with acetaminophen in every clinical situation.
Management
Until more information is available, caution and clinical monitoring for reduced efficacy of immune checkpoint inhibitors (ICIs) may be advisable if they are administered with acetaminophen. One study suggests that only a pronounced and/or prolonged intake of acetaminophen is able to reduce the immune response to anti-PD-1/PD-L1 agents in patients with advanced NSCLC and suggests a more restrained and discontinuous intake of acetaminophen (<4 doses of 1000 mg/week) may help avoid worsening patient outcomes in this patient population.
References (3)
- Bessede A, Marabelle A, Guegan JP, et al. (2022) "Impact of acetaminophen on the efficacy of immunotherapy in cancer patients." Ann Oncol, 33, p. 909-15
- Nelli F, Virtuoso A, giannarelli d, et al. (2023) "Effects of acetaminophen exposure on outcomes of patients receiving immune checkpoint inhibitors for advanced non-small-cell lung cancer: a propensity score-matched analysis." Curr Oncol, 30, p. 8117-33
- Najeebullah, ali ma, Naveed R, Khatri G, Priya, hasan mm (2022) "Acetaminophen: a hazard to immunotherapy." Ann Med Surg (Lond), 80, p. 104272
Food/lifestyle interactions
Major food/lifestyle interactions
Major:
acetaminophen Food/Lifestyle
Applies to: Liquiprin (acetaminophen)
Generally avoid
Chronic, excessive consumption of alcohol may increase the risk of acetaminophen-induced hepatotoxicity, which has included rare cases of fatal hepatitis and frank hepatic failure requiring liver transplantation. The proposed mechanism is induction of hepatic microsomal enzymes during chronic alcohol use, which may result in accelerated metabolism of acetaminophen and increased production of potentially hepatotoxic metabolites.
Management
In general, chronic alcoholics should avoid regular or excessive use of acetaminophen. Alternative analgesic/antipyretic therapy may be appropriate in patients who consume three or more alcoholic drinks per day.
References (1)
- (2022) "Product Information. Acetaminophen (acetaminophen)." Camber Pharmaceuticals, Inc
Disease interactions
8 potential interactions Applies to: 8 conditions, including Autoimmune Disorders, Liver Disease, Dehydration, Alcoholism, and Organ Transplant.
Alcoholism
Major:
Liquiprin
The acetaminophen in Liquiprin has a major potential interaction with Alcoholism.
Chronic alcohol abusers may be at increased risk of hepatotoxicity during treatment with acetaminophen (APAP). Severe liver injury, including cases of acute liver failure resulting in liver transplant and death, has been reported in patients using acetaminophen. Therapy with acetaminophen should be administered cautiously, if at all, in patients who consume three or more alcoholic drinks a day. In general, patients should avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure. They should also be advised to seek medical attention if they experience signs and symptoms of liver injury such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.
Autoimmune Disorders
Moderate:
dostarlimab
Dostarlimab has a moderate potential interaction with Autoimmune Disorders.
Programmed death receptor-1/ligand-1 (PD-1/PD-L1) blocking antibodies can cause immune-mediated adverse reactions, which may be severe or fatal. Immune-mediated adverse reactions can occur in any organ system or tissue at any time after starting therapy. This may be considered when using PD-1/PD-L1 blocking antibodies in patients with immune system disorders (e.g., ulcerative colitis, Crohn's disease, lupus) or with conditions affecting the nervous system (e.g., myasthenia gravis, Guillain-Barre syndrome). It is recommended to monitor patients closely for signs/symptoms that may be clinical manifestations of underlying immune-mediated adverse reactions.
Bone Marrow Transplantation
Moderate:
dostarlimab
Dostarlimab has a moderate potential interaction with Bone Marrow Transplantation.
Fatal and other serious complications can occur in patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after being treated with a programmed death receptor-1/ligand-1 (PD-1/PD-L1) blocking antibody. Transplant-related complications include hyperacute graft-versus-host disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease after reduced intensity conditioning, and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between PD-1/PD-L1 blockade and allogeneic HSCT. It is recommended to follow patients closely for evidence of transplant-related complications and intervene promptly. The benefit versus risks of treatment with a PD-1/PD-L1 blocking antibody before or after an allogeneic HSCT should be considered.
Dehydration
Major:
Liquiprin
The acetaminophen in Liquiprin has a major potential interaction with Dehydration.
Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.
Liver Disease
Major:
Liquiprin
The acetaminophen in Liquiprin has a major potential interaction with Liver Disease.
Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.
Malnourishment
Major:
Liquiprin
The acetaminophen in Liquiprin has a major potential interaction with Malnourishment.
Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.
Organ Transplant
Moderate:
dostarlimab
Dostarlimab has a moderate potential interaction with Organ Transplant.
Solid organ transplant rejection and other transplant (including corneal graft) rejection have been reported with the use of programmed death receptor-1/ligand-1 (PD-1/PD-L1) blocking antibodies. This may be considered when using PD-1/PD-L1 blocking antibodies in patients who have received a solid organ or other transplant.
Phenylketonuria
Moderate:
Liquiprin
The acetaminophen in Liquiprin has a moderate potential interaction with Phenylketonuria.
Several oral acetaminophen and acetaminophen-combination products, particularly flavored chewable tablets, contain the artificial sweetener, aspartame (NutraSweet). Aspartame is converted to phenylalanine in the gastrointestinal tract following ingestion. Chewable and effervescent formulations of acetaminophen products may also contain phenylalanine. The aspartame/phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).
More resources
dostarlimab
A total of 613 drugs are known to interact with dostarlimab.
- Dostarlimab is in the drug class Immune checkpoint inhibitors (PD-1 and PD-L1 inhibitors).
- Dostarlimab is used to treat the following conditions:
Liquiprin
A total of 540 drugs are known to interact with Liquiprin.
- Liquiprin is in the drug class miscellaneous analgesics.
- Liquiprin 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.