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Interactions between Erleada and Magnesium hydroxide

1 drug interaction and 12 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

magnesium hydroxide apalutamide

Applies to: magnesium hydroxide and Erleada (apalutamide)
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Bowel cleansing as well as overuse of certain laxatives may cause electrolyte loss and increase the risk of torsade de pointes ventricular arrhythmia in patients treated with drugs that prolong the QT interval. Electrolyte disturbances including hypokalemia and hypomagnesemia have been reported with laxative abuse and are known risk factors for torsade de pointes associated with QT interval prolongation.

Management

Patients treated with drugs that prolong the QT interval should exercise caution when self-medicating with laxatives. The recommended dosage and duration of use should not be exceeded. Patients treated with lactulose for more than six months should be monitored periodically for electrolyte imbalance. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

References (4)
  1. Chin RL (1998) "Laxative-induced hypokalemia." Ann Emerg Med, 32, p. 517-8
  2. Muller-Lissner SA (1993) "Adverse effects of laxatives: fact and fiction." Pharmacology, 47, p. 138-45
  3. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
  4. Schaefer DC, Cheskin LJ (1998) "Constipation in the elderly." Am Fam Physician, 58, p. 907-14

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

12 potential interactions Applies to: 11 conditions, including High Blood Pressure, High Cholesterol, Seizures, Inflammatory Bowel Disease, and Diabetes Mellitus.

Diabetes Mellitus

Moderate:

Erleada

The apalutamide in Erleada has a moderate potential interaction with Diabetes Mellitus.

Ischemic cardiovascular events, including events leading to death, occurred in patients receiving apalutamide. It is recommended to monitor for signs and symptoms of ischemic heart disease and to consider discontinuation of treatment for Grade 3 and 4 events. Care should be exercised when prescribing this agent in patients at risk of an ischemic cardiovascular event, such as in those patients with hypertension, diabetes, or dyslipidemia.

Gastrointestinal Obstruction

Major:

magnesium hydroxide

Magnesium hydroxide has a major potential interaction with Gastrointestinal Obstruction.

The use of laxatives is contraindicated in patients with intestinal obstruction disorders. Patients with intestinal obstruction disorders may need their underlying condition treated to correct the constipation. Some laxatives require reduction in the colon to their active form to be effective which may be a problem in patients with intestinal obstruction.

High Blood Pressure

Moderate:

Erleada

The apalutamide in Erleada has a moderate potential interaction with High Blood Pressure.

Ischemic cardiovascular events, including events leading to death, occurred in patients receiving apalutamide. It is recommended to monitor for signs and symptoms of ischemic heart disease and to consider discontinuation of treatment for Grade 3 and 4 events. Care should be exercised when prescribing this agent in patients at risk of an ischemic cardiovascular event, such as in those patients with hypertension, diabetes, or dyslipidemia.

High Cholesterol

Moderate:

Erleada

The apalutamide in Erleada has a moderate potential interaction with High Cholesterol.

Ischemic cardiovascular events, including events leading to death, occurred in patients receiving apalutamide. It is recommended to monitor for signs and symptoms of ischemic heart disease and to consider discontinuation of treatment for Grade 3 and 4 events. Care should be exercised when prescribing this agent in patients at risk of an ischemic cardiovascular event, such as in those patients with hypertension, diabetes, or dyslipidemia.

Inflammatory Bowel Disease

Major:

magnesium hydroxide

Magnesium hydroxide has a major potential interaction with Inflammatory Bowel Disease.

The use of laxatives is contraindicated in patients with inflammatory bowel disease. Patients with inflammatory bowel disease may experience colonic perforation with use of stimulant laxatives.

Ischemic Heart Disease

Moderate:

Erleada

The apalutamide in Erleada has a moderate potential interaction with Ischemic Heart Disease.

Ischemic cardiovascular events, including events leading to death, occurred in patients receiving apalutamide. It is recommended to monitor for signs and symptoms of ischemic heart disease and to consider discontinuation of treatment for Grade 3 and 4 events. Care should be exercised when prescribing this agent in patients at risk of an ischemic cardiovascular event, such as in those patients with hypertension, diabetes, or dyslipidemia.

Liver Disease

Moderate:

Erleada

The apalutamide in Erleada has a moderate potential interaction with Liver Disease.

No clinically significant differences in the pharmacokinetics of apalutamide or its major metabolite were observed in patients with mild (Child-Pugh A) to moderate (Child-Pugh B) hepatic impairment. The effect on patients with severe hepatic impairment (Child-Pugh C) on apalutamide pharmacokinetics is unknown. Close monitoring of liver function is recommended in these patients.

Metabolic Bone Disorders

Moderate:

Erleada

The apalutamide in Erleada has a moderate potential interaction with Metabolic Bone Disorders.

Falls and fractures have occurred in patients receiving apalutamide. Care should be exercised when apalutamide is used in patients at risk for fractures or falls and in those patients with osteoporosis. It is recommended to evaluate patients for fracture and fall risk and to consider the use of bone-targeted agents as medically necessary.

Metabolic Disorders

Moderate:

Erleada

The apalutamide in Erleada has a moderate potential interaction with Metabolic Disorders.

Falls and fractures have occurred in patients receiving apalutamide. Care should be exercised when apalutamide is used in patients at risk for fractures or falls and in those patients with osteoporosis. It is recommended to evaluate patients for fracture and fall risk and to consider the use of bone-targeted agents as medically necessary.

Renal Dysfunction

Major:

magnesium hydroxide

Magnesium hydroxide has a major potential interaction with Renal Dysfunction.

Magnesium is eliminated by the kidney. The serum concentration of magnesium is increased in patients with renal impairment. Magnesium toxicity includes CNS depression, muscular paralysis, respiratory depression, hypotension and prolonged cardiac conduction time. Disappearance of the patellar reflex is a useful clinical sign of magnesium intoxication. Therapy with magnesium should be administered cautiously and dosages should be modified in patients with compromised renal function. Clinical monitoring of serum magnesium levels is recommended.

Moderate:

Erleada

The apalutamide in Erleada has a moderate potential interaction with Renal Dysfunction.

No clinically significant differences in the pharmacokinetics of apalutamide or its major metabolite were observed in patients with mild to moderate renal impairment. The effect on patients with severe renal impairment or end-stage renal disease on apalutamide pharmacokinetics is unknown. Close monitoring of renal function is recommended in these patients.

Seizures

Moderate:

Erleada

The apalutamide in Erleada has a moderate potential interaction with Seizures.

The use of apalutamide may cause seizures. It is recommended to discontinue this agent in patients who develop a seizure while on treatment. Care should be exercised when using apalutamide in patients at risk or with a history of seizure disorder.

More resources

Erleada

A total of 674 drugs are known to interact with Erleada.

magnesium hydroxide

A total of 439 drugs are known to interact with magnesium hydroxide.

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.