Can you take Etoposide with Rituxan?

The riTUXimab in Rituxan 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.

The riTUXimab in Rituxan 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.

Etoposide has a major potential interaction with Bleeding Disorder.

Etoposide induces dose-related myelosuppression. Leukopenia, thrombocytopenia, and anemia have been reported during etoposide therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Therapy should be administered cautiously in patients whose bone marrow reserve may be severely depressed and should be withheld if an absolute neutrophil counts fall below 500/mm3 and/or platelet counts fall below 50,000/mm3. Clinical monitoring of hematopoetic function is recommended. Periodic complete blood counts should be done during the course of etoposide treatment and it should be performed prior to each cycle of therapy and at appropriate intervals during and after therapy. At least one determination should be done prior to each dose.

Etoposide has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Etoposide induces dose-related myelosuppression. Leukopenia, thrombocytopenia, and anemia have been reported during etoposide therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Therapy should be administered cautiously in patients whose bone marrow reserve may be severely depressed and should be withheld if an absolute neutrophil counts fall below 500/mm3 and/or platelet counts fall below 50,000/mm3. Clinical monitoring of hematopoetic function is recommended. Periodic complete blood counts should be done during the course of etoposide treatment and it should be performed prior to each cycle of therapy and at appropriate intervals during and after therapy. At least one determination should be done prior to each dose.

The riTUXimab in Rituxan 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.

Etoposide has a major potential interaction with Fever.

Etoposide induces dose-related myelosuppression. Leukopenia, thrombocytopenia, and anemia have been reported during etoposide therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Therapy should be administered cautiously in patients whose bone marrow reserve may be severely depressed and should be withheld if an absolute neutrophil counts fall below 500/mm3 and/or platelet counts fall below 50,000/mm3. Clinical monitoring of hematopoetic function is recommended. Periodic complete blood counts should be done during the course of etoposide treatment and it should be performed prior to each cycle of therapy and at appropriate intervals during and after therapy. At least one determination should be done prior to each dose.

Etoposide 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.

The riTUXimab in Rituxan 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.

The riTUXimab in Rituxan 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.

The riTUXimab in Rituxan 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.

The riTUXimab in Rituxan 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.

The riTUXimab in Rituxan 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.

Etoposide has a moderate potential interaction with Renal Dysfunction.

Etoposide is primarily eliminated by the kidney. Less than 50% is eliminated as unchanged drug in the urine. Reduced clearance, increased AUC, and decreased volume of distribution have been noted in patients with impaired renal function. Therapy should be administered cautiously and dosages reduced in patients with compromised renal function. Patients with a creatinine clearance between 15 to 50 mL/min should receive 75% of the recommended dosage of etoposide. Data are not available in patients with creatinine clearances <15 mL/min and further dosage reductions are recommended. Clinical monitoring of renal function is recommended.

The riTUXimab in Rituxan 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.

The riTUXimab in Rituxan 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.