Interactions between Fingolimod and Ultane

Fingolimod has a moderate potential interaction with Central Nervous System Disorders.

Rare cases of posterior reversible encephalopathy syndrome (PRES) have been reported in patients receiving a sphingosine 1-phosphate receptor modulator. It is recommended to promptly schedule a complete physical and neurological examination and should consider an MRI, if a patient develops any unexpected neurological or psychiatric symptoms/signs, any symptom/sign suggestive of an increase of intracranial pressure, or accelerated neurological deterioration. Delay in diagnosis and treatment may lead to permanent neurological sequelae. Exercise care when using this agent in patients with a history of ischemic stroke or cerebral hemorrhage. Treatment should be discontinued if PRES is suspected.

Fingolimod has a major potential interaction with Cerebrovascular Insufficiency.

Fingolimod is contraindicated in patients who have had a recent myocardial infarction, those with unstable angina, stroke, transient ischemic attack, decompensated heart failure with hospitalization, or Class III/IV heart failure, a history of Mobitz Type II 2nd degree or 3rd degree AV block or sick sinus syndrome, unless the patient has a pacemaker, baseline QTc interval of >= to 500 msec., or those patients being treated with Class Ia or Class III anti-arrhythmic drugs.

Fingolimod has a moderate potential interaction with Diabetes Mellitus.

Fingolimod increases the risk of macular edema. Patients with a history of uveitis, and those with diabetes mellitus are at increased risk of macular edema. It is recommended to perform an examination of the fundus including the macula in all patients before starting treatment, again 3-4 months after starting treatment, and again at any time after a patient reports visual disturbances. A decision on whether or not to discontinue therapy should include an assessment of the potential benefits and risks.

Fingolimod has a major potential interaction with Heart Disease.

Fingolimod is contraindicated in patients who have had a recent myocardial infarction, those with unstable angina, stroke, transient ischemic attack, decompensated heart failure with hospitalization, or Class III/IV heart failure, a history of Mobitz Type II 2nd degree or 3rd degree AV block or sick sinus syndrome, unless the patient has a pacemaker, baseline QTc interval of >= to 500 msec., or those patients being treated with Class Ia or Class III anti-arrhythmic drugs.

Fingolimod has a moderate potential interaction with High Blood Pressure.

Hypertension was reported as an adverse reaction in patients on fingolimod. Blood pressure should be monitored during treatment with this agent as it can increase the blood pressure of patients with hypertension.

The sevoflurane in Ultane has a moderate potential interaction with Hyperkalemia.

The use of inhaled anesthetic agents has been associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias and death in pediatric patients during the postoperative period. Patients with latent as well as overt neuromuscular disease, particularly Duchenne muscular dystrophy, appear to be most vulnerable. Early and aggressive intervention to treat the hyperkalemia and resistant arrhythmias is recommended; as is subsequent evaluation for latent neuromuscular disease. Caution and close monitoring is recommended when using this agent in these patients.

Fingolimod has a moderate potential interaction with Infection.

Fingolimod may increase the risk of infections, and some serious infections with opportunistic pathogens including viruses have been reported. Prior to treatment, a recent CBC (i.e., within 6 months or after discontinuation of prior therapy) should be available. Consider withholding treatment if a patient develops a serious infection, and reassess the benefits and risks prior to reinitiation of therapy.

Fingolimod has a moderate potential interaction with Liver Disease.

Cases of liver injury with hepatocellular and/or cholestatic hepatitis have been reported with fingolimod in the postmarketing setting. Patients with preexisting liver disease may be at increased risk of developing elevated liver enzymes when taking fingolimod. It is recommended to obtain liver enzyme results before initiation of therapy. No dose adjustment is needed in patients with mild or moderate hepatic impairment. Closely monitor patients with severe hepatic impairment as this agent exposure is doubled in these patients and the risk of adverse reactions is greater. Discontinue if significant liver injury occurs.

The sevoflurane in Ultane has a moderate potential interaction with Liver Disease.

In a multicenter study to compare the safety of sevoflurane and isoflurane in patients with mild to moderate hepatic impairment, sevoflurane patients had prolonged terminal disposition of fluoride, as evidenced by longer inorganic fluoride half-life than patients with normal hepatic function. Results of evaluations of laboratory parameters (e.g., ALT, AST, alkaline phosphatase, and total bilirubin, etc.), as well as investigator-reported incidence of adverse events relating to liver function, demonstrate that sevoflurane can be administered to patients with normal or mild-to-moderately impaired hepatic function. The use of this agent in patients with severe hepatic dysfunction has not been investigated. Clinical judgment should be exercised when sevoflurane is used in patients with underlying hepatic conditions or under treatment with drugs known to cause hepatic dysfunction.

The sevoflurane in Ultane has a major potential interaction with Malignant Hyperthermia.

The use of sevoflurane is contraindicated in patients with known or suspected susceptibility to malignant hyperthermia.

Fingolimod has a moderate potential interaction with Multiple Myeloma.

Rare cases of severe exacerbation of multiple sclerosis (MS), including disease rebound, have been reported after discontinuation of sphingosine 1-phosphate receptor modulator in MS treated patients. The possibility of severe exacerbation of disease should be considered after stopping treatment with these agents. Patients should be observed for a severe increase in disability upon discontinuation and appropriate treatment should be instituted, as required.

The sevoflurane in Ultane has a moderate potential interaction with Pseudotumor Cerebri.

Studies comparing sevoflurane to isoflurane for maintenance of anesthesia during neurosurgical procedures found no difference between sevoflurane and isoflurane with regard to recovery from anesthesia. In patients at risk for elevations of intracranial pressure (ICP), sevoflurane should be administered cautiously in conjunction with ICP-reducing maneuvers such as hyperventilation.

Fingolimod has a moderate potential interaction with Pulmonary Impairment.

Cases of dyspnea in patients using fingolimod have been reported during clinical trials. Dose-dependent reductions in forced expiratory volume over 1 second (FEV1) and diffusion lung capacity for carbon monoxide (DLCO) were observed in patients treated with fingolimod as early as 1 month after treatment initiation. Caution with patients at risk of dyspnea and spirometric evaluation of respiratory function and evaluation of DLCO should be performed during therapy if clinically indicated.

The sevoflurane in Ultane has a moderate potential interaction with Renal Dysfunction.

Limited data are available on the use of oral sevoflurane in patients with renal insufficiency. Sevoflurane may be associated with glycosuria and proteinuria when used for long procedures at low flow rates. Caution is advised when using sevoflurane in these patients as the safety has not been fully established.

The sevoflurane in Ultane has a moderate potential interaction with Seizures.

The use of sevoflurane has been associated with seizures. The majority of cases were in children and young adults, most of whom had no medical history of seizures. Seizures have occurred during, or soon after sevoflurane induction, during emergence, and during post-operative recovery up to a day following anesthesia. Caution and clinical judgment should be exercised when using sevoflurane in patients who may be at risk for seizures.

Fingolimod has a moderate potential interaction with Skin Cancer.

Cases of malignancies, including skin malignancies have been reported in patients treated with some sphingosine -1-receptor (S1P) receptor modulators. Skin examinations are recommended prior and during treatment in all patients, particularly in those with risk factors for skin cancer. Suspicious skin lesions should be promptly evaluated, and patients at increased risk should wear protective clothing and use sunscreen with high protection factor.

Fingolimod has a moderate potential interaction with Uveitis.

Fingolimod increases the risk of macular edema. Patients with a history of uveitis, and those with diabetes mellitus are at increased risk of macular edema. It is recommended to perform an examination of the fundus including the macula in all patients before starting treatment, again 3-4 months after starting treatment, and again at any time after a patient reports visual disturbances. A decision on whether or not to discontinue therapy should include an assessment of the potential benefits and risks.