Drug Interactions between fingolimod and Purixan
This report displays the potential drug interactions for the following 2 drugs:
- fingolimod
- Purixan (mercaptopurine)
Interactions between your drugs
mercaptopurine fingolimod
Applies to: Purixan (mercaptopurine) and fingolimod
MONITOR CLOSELY: Coadministration of fingolimod with antineoplastic, immunosuppressive, or other immune-modulating therapies is expected to increase the risk of immunosuppression and infection. Life-threatening and sometimes fatal infections have been reported. Fingolimod causes reversible sequestration of lymphocytes in lymphoid tissues. When administered daily, fingolimod produces a dose-dependent reduction in peripheral lymphocyte count to 20-30% of baseline values, which may increase the risk of infections. In Phase III clinical trials, short courses of corticosteroids (up to 5 days) to treat relapses did not increase the overall rate of infection and so is generally considered acceptable during treatment with fingolimod. A small study of 12 subjects receiving fingolimod 0.5 mg daily found that the lymphocyte count decreased to approximately 60% of baseline within 4 to 6 hours after the first dose. The lymphocyte count continued to decrease over a 2-week period, reaching a nadir count of approximately 500 cells/mcL (30% of baseline). In a placebo-controlled study of 1272 multiple sclerosis (MS) patients, 18% of patients on fingolimod 0.5 mg daily (n = 425) reached a nadir of less than 200 cells/mcL on at least one occasion, compared to no patient on placebo (n = 418). Chronic fingolimod dosing leads to a mild decrease in the neutrophil count to approximately 80% of baseline but does not affect monocytes. Decreased lymphocyte counts persist during daily dosing, then generally return to baseline within 1 to 2 months after stopping the medication.
MANAGEMENT: The safety and efficacy of fingolimod in combination with antineoplastic, immunosuppressive, or immune-modulating agents have not been evaluated. Concomitant use is considered contraindicated by some authorities; however, short courses of corticosteroids (up to 5 days) are generally considered acceptable during treatment with fingolimod. A complete blood count is recommended prior to starting fingolimod if a recent one (i.e., within the last 6 months or after discontinuation of prior therapy) is not available. Treatment suspension should be considered in patients who develop a serious infection, and the benefits and risks reassessed prior to restarting treatment. Patients should be instructed to immediately report any signs or symptoms of an infection (e.g., fever, body aches, chills, nausea, vomiting, headache with neck stiffness or confusion) to their doctor. Because fingolimod remains in the blood for up to two months after the last dose, continued monitoring is recommended throughout this period, and initiating other drugs during this period warrants the same considerations needed for concomitant administration. Consult the manufacturer's product labeling for specific recommendations regarding the timing of use of fingolimod in relation to other agents used in the treatment of MS, including beta interferon, glatiramer acetate, dimethyl fumarate, alemtuzumab, teriflunomide, and mitoxantrone.
References
- "Product Information. Gilenya (fingolimod)." Novartis Pharmaceuticals (2010):
- "Product Information. Fingolimod (fingolimod)." Dr Reddy's Laboratories (UK) Ltd (2023):
- "Product Information. Fingolimod (Teva) (fingolimod)." Teva Pharma Australia Pty Ltd 1.0 (2023):
- "Product Information. Fingolimod (fingolimod)." Apotex Corporation (2023):
- "Product Information. Apo-Fingolimod (fingolimod)." Apotex Inc (2023):
Drug and food interactions
mercaptopurine food
Applies to: Purixan (mercaptopurine)
ADJUST DOSING INTERVAL: Limited data suggest that food may decrease the oral bioavailability of 6-mercaptopurine (6-MP). In one study, the pharmacokinetics of 6-MP were studied on two separate occasions in seven patients. A single dose of 6-MP was administered after an overnight fast on one occasion and 15 minutes after a standard breakfast on the other. The authors reported that peak plasma levels of 6-MP were lower and took longer to reach following administration in the fed state. In addition, plasma levels were undetectable (less than 20 ng/mL) in two patients.
MANAGEMENT: Until more information is available regarding the effect of food on 6-MP absorption, it may be advisable to take 6-MP on an empty stomach 1 hour before or 2 hours after a meal.
References
- Schmidt LE, Dalhoff K "Food-drug interactions." Drugs 62 (2002): 1481-502
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
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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