Can you take Erlotinib with Panamax?
1 drug interaction and 18 additional warnings found for the following 2 drugs:
- erlotinib
- Panamax (acetaminophen)
Drug interactions
Moderate drug interactions
Moderate:
acetaminophen erlotinib
Applies to: Panamax (acetaminophen) and erlotinib
Both acetaminophen and erlotinib can affect the liver, and combining them may increase the risk of liver damage.
Talk to your doctor before using these medications together, particularly if you have other risk factors for liver problems. Do not use more than the recommended dose of acetaminophen or take more than one medication containing acetaminophen at the same time.
Contact your doctor if you experience increased side effects or symptoms that concern you.
It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Food/lifestyle interactions
Major food/lifestyle interactions
Major:
acetaminophen Food/Lifestyle
Applies to: Panamax (acetaminophen)
Acetaminophen may cause liver damage and taking it with alcohol may increase that risk.
You should avoid or limit the use of alcohol while being treated with acetaminophen.
Call your doctor immediately if you have:
- fever
- chills
- joint pain or swelling
- excessive tiredness or weakness
- unusual bleeding or bruising
- skin rash or itching
- loss of appetite
- nausea
- vomiting
- dark colored urine
- yellowing of the skin or the whites of your eyes
These may be symptoms of liver damage.
It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Moderate food/lifestyle interactions
Moderate:
erlotinib Food/Lifestyle
Applies to: erlotinib
Erlotinib should be taken on an empty stomach at least 1 hour before or 2 hours after a meal and at the same time each day unless otherwise directed by your doctor.
You should also avoid grapefruit and grapefruit juice while taking erlotinib. Food and grapefruit juice can increase the absorption of erlotinib from the gastrointestinal tract, which may lead to higher blood levels of the medication and possibly increased side effects.
If you are a smoker, you should try to quit as soon as you can. Cigarette smoking can reduce the blood levels of erlotinib, which may make the medication less effective in treating your cancer. It is best to avoid smoking during erlotinib therapy.
Talk to a healthcare professional if you have any questions or concerns.
If you start smoking or undergo smoking cessation, your doctor may need to adjust your dose of erlotinib.
It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Disease interactions
16 potential interactions Applies to: 14 conditions, including Fever, Diverticulitis, Eye Conditions, Liver Disease, and Dehydration.
Alcoholism
Major:
Panamax
The acetaminophen in Panamax 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.
Dehydration
Major:
erlotinib
Erlotinib has a major potential interaction with Dehydration.
The use of erlotinib has been associated with hepatotoxicity with or without hepatic impairment including hepatic failure and hepatorenal syndrome, in some cases with fatal outcomes. Patients with hepatic impairment (total bilirubin > upper limit of normal (ULN) or Child-Pugh A, B and C) should be closely monitored during therapy with erlotinib. Treatment with erlotinib should be used with extra caution in patients with total bilirubin > 3 x ULN. Clinical monitoring of hepatic function (transaminases, bilirubin, and alkaline phosphatase) is recommended during treatment and increase frequency of monitoring is required for patients with preexisting-existing hepatic impairment or biliary obstruction. In patients with preexisting-existing hepatic impairment or biliary obstruction with doubling of bilirubin or tripling of transaminases values over baseline, erlotinib therapy should be withhold and therapy should be discontinued in patients whose abnormal liver tests meeting the above criteria do not improve significantly or resolve within three weeks. Withhold erlotinib in patients developing severe renal impairment until renal toxicity is resolved. Monitor renal function and electrolytes, particularly in patients at risk of dehydration. Withhold erlotinib for severe renal toxicity.
Major:
Panamax
The acetaminophen in Panamax 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.
Dermatitis, Drug-Induced
Major:
erlotinib
Erlotinib has a major potential interaction with Dermatitis, Drug-Induced.
Cutaneous reactions, in some cases severe, have been reported with the use of EGFR inhibitors. Monitor patients who develop dermatologic or soft tissue toxicities while receiving these agents for the development of inflammatory or infectious sequelae. It is recommended to withhold treatment, and appropriate measures should be instituted as appropriate or discontinue the use of these agents for dermatologic or soft tissue toxicity associated with severe or life-threatening inflammatory or infectious complications. Advise patients to wear sunscreen and hats and limit sun exposure while receiving therapy with these agents as exposure to sunlight can exacerbate dermatologic toxicities.
Diverticulitis
Major:
erlotinib
Erlotinib has a major potential interaction with Diverticulitis.
The use of some EGFR inhibitors may be associated with gastrointestinal perforation and fatal cases have been reported. Patients receiving concomitant anti-angiogenic agents, corticosteroids, NSAIDs, or taxane-based chemotherapy, or who have prior history of peptic ulceration or diverticular disease may be at increased risk of perforation. Permanently discontinue these agents in patients who develop gastrointestinal perforation.
Eye Conditions
Major:
erlotinib
Erlotinib has a major potential interaction with Eye Conditions.
Some epidermal growth factor receptor (EGFR) inhibitors should be administered cautiously in patients with ocular disorders such as primary keratitis, ulcerative keratitis, or conjunctivitis. It is recommended to interrupt or discontinue treatment with these agents if patients present with acute or worsening ocular disorders.
Fever
Major:
erlotinib
Erlotinib has a major potential interaction with Fever.
The use of certain EGFR inhibitors has been associated with pulmonary toxicity. Serious cases of interstitial lung disease (ILD), including fatal cases and interstitial pneumonitis or pulmonary fibrosis have been reported. Caution is recommended when using these agents in patients with a history of interstitial pneumonitis or pulmonary fibrosis or those patients presenting with acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever pending diagnostic evaluation. If ILD is confirmed, permanently discontinue these agents and institute appropriate measures.
Gastrointestinal Perforation
Major:
erlotinib
Erlotinib has a major potential interaction with Gastrointestinal Perforation.
The use of some EGFR inhibitors may be associated with gastrointestinal perforation and fatal cases have been reported. Patients receiving concomitant anti-angiogenic agents, corticosteroids, NSAIDs, or taxane-based chemotherapy, or who have prior history of peptic ulceration or diverticular disease may be at increased risk of perforation. Permanently discontinue these agents in patients who develop gastrointestinal perforation.
History, Peptic Ulcer
Major:
erlotinib
Erlotinib has a major potential interaction with History, Peptic Ulcer.
The use of some EGFR inhibitors may be associated with gastrointestinal perforation and fatal cases have been reported. Patients receiving concomitant anti-angiogenic agents, corticosteroids, NSAIDs, or taxane-based chemotherapy, or who have prior history of peptic ulceration or diverticular disease may be at increased risk of perforation. Permanently discontinue these agents in patients who develop gastrointestinal perforation.
Hyperkinetic Syndrome of Childhood
Major:
erlotinib
Erlotinib has a major potential interaction with Hyperkinetic Syndrome of Childhood.
The use of erlotinib has been associated with hepatotoxicity with or without hepatic impairment including hepatic failure and hepatorenal syndrome, in some cases with fatal outcomes. Patients with hepatic impairment (total bilirubin > upper limit of normal (ULN) or Child-Pugh A, B and C) should be closely monitored during therapy with erlotinib. Treatment with erlotinib should be used with extra caution in patients with total bilirubin > 3 x ULN. Clinical monitoring of hepatic function (transaminases, bilirubin, and alkaline phosphatase) is recommended during treatment and increase frequency of monitoring is required for patients with preexisting-existing hepatic impairment or biliary obstruction. In patients with preexisting-existing hepatic impairment or biliary obstruction with doubling of bilirubin or tripling of transaminases values over baseline, erlotinib therapy should be withhold and therapy should be discontinued in patients whose abnormal liver tests meeting the above criteria do not improve significantly or resolve within three weeks. Withhold erlotinib in patients developing severe renal impairment until renal toxicity is resolved. Monitor renal function and electrolytes, particularly in patients at risk of dehydration. Withhold erlotinib for severe renal toxicity.
Liver Disease
Major:
erlotinib
Erlotinib has a major potential interaction with Liver Disease.
The use of erlotinib has been associated with hepatotoxicity with or without hepatic impairment including hepatic failure and hepatorenal syndrome, in some cases with fatal outcomes. Patients with hepatic impairment (total bilirubin > upper limit of normal (ULN) or Child-Pugh A, B and C) should be closely monitored during therapy with erlotinib. Treatment with erlotinib should be used with extra caution in patients with total bilirubin > 3 x ULN. Clinical monitoring of hepatic function (transaminases, bilirubin, and alkaline phosphatase) is recommended during treatment and increase frequency of monitoring is required for patients with preexisting-existing hepatic impairment or biliary obstruction. In patients with preexisting-existing hepatic impairment or biliary obstruction with doubling of bilirubin or tripling of transaminases values over baseline, erlotinib therapy should be withhold and therapy should be discontinued in patients whose abnormal liver tests meeting the above criteria do not improve significantly or resolve within three weeks. Withhold erlotinib in patients developing severe renal impairment until renal toxicity is resolved. Monitor renal function and electrolytes, particularly in patients at risk of dehydration. Withhold erlotinib for severe renal toxicity.
Major:
Panamax
The acetaminophen in Panamax 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:
Panamax
The acetaminophen in Panamax 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.
Phenylketonuria
Moderate:
Panamax
The acetaminophen in Panamax 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).
Pulmonary Impairment
Major:
erlotinib
Erlotinib has a major potential interaction with Pulmonary Impairment.
The use of certain EGFR inhibitors has been associated with pulmonary toxicity. Serious cases of interstitial lung disease (ILD), including fatal cases and interstitial pneumonitis or pulmonary fibrosis have been reported. Caution is recommended when using these agents in patients with a history of interstitial pneumonitis or pulmonary fibrosis or those patients presenting with acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever pending diagnostic evaluation. If ILD is confirmed, permanently discontinue these agents and institute appropriate measures.
Renal Dysfunction
Major:
erlotinib
Erlotinib has a major potential interaction with Renal Dysfunction.
The use of erlotinib has been associated with hepatotoxicity with or without hepatic impairment including hepatic failure and hepatorenal syndrome, in some cases with fatal outcomes. Patients with hepatic impairment (total bilirubin > upper limit of normal (ULN) or Child-Pugh A, B and C) should be closely monitored during therapy with erlotinib. Treatment with erlotinib should be used with extra caution in patients with total bilirubin > 3 x ULN. Clinical monitoring of hepatic function (transaminases, bilirubin, and alkaline phosphatase) is recommended during treatment and increase frequency of monitoring is required for patients with preexisting-existing hepatic impairment or biliary obstruction. In patients with preexisting-existing hepatic impairment or biliary obstruction with doubling of bilirubin or tripling of transaminases values over baseline, erlotinib therapy should be withhold and therapy should be discontinued in patients whose abnormal liver tests meeting the above criteria do not improve significantly or resolve within three weeks. Withhold erlotinib in patients developing severe renal impairment until renal toxicity is resolved. Monitor renal function and electrolytes, particularly in patients at risk of dehydration. Withhold erlotinib for severe renal toxicity.
More resources
erlotinib
A total of 319 drugs are known to interact with erlotinib.
- Erlotinib is in the drug class EGFR inhibitors.
- Erlotinib is used to treat the following conditions:
Panamax
A total of 540 drugs are known to interact with Panamax.
- Panamax is in the drug class miscellaneous analgesics.
- Panamax 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
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