Interactions between Flavalta and Sarilumab

The EPINEPHrine in Flavalta has a moderate potential interaction with Acidosis.

Acidosis, hypoxia, and hypercapnia may reduce the effectiveness of sympathomimetic amines in raising blood pressure. These conditions should be corrected before initiating therapy with sympathomimetic amines, if possible. Monitoring the patients acid-base balance, carbon dioxide levels, and oxygen saturation is recommended.

The EPINEPHrine in Flavalta has a major potential interaction with Cardiovascular Conditions and Disorders.

Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

The EPINEPHrine in Flavalta has a major potential interaction with Dehydration.

The use of sympathomimetic amines has been infrequently associated with significant hypotension especially in dehydrated patients secondary to the drug's beta-2 mediated vasodilation. Hypovolemia should be corrected, if possible, before administering sympathomimetic amines. Blood pressure and ECG should be monitored at regular intervals. Monitoring of cardiac output and pulmonary wedge pressure may also be desired.

The EPINEPHrine in Flavalta has a moderate potential interaction with Diabetes Mellitus.

Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.

Sarilumab has a moderate potential interaction with Gastrointestinal Diverticula.

Gastrointestinal (GI) perforations have been reported with the use of sarilumab. GI perforation risk may be increased with concurrent diverticulitis or concomitant use of NSAIDs or corticosteroids. Assess patients for gastrointestinal complications prior to beginning therapy and promptly evaluate patients presenting with new onset abdominal symptoms.

Sarilumab has a moderate potential interaction with Gastrointestinal Obstruction.

Gastrointestinal (GI) perforations have been reported with the use of sarilumab. GI perforation risk may be increased with concurrent diverticulitis or concomitant use of NSAIDs or corticosteroids. Assess patients for gastrointestinal complications prior to beginning therapy and promptly evaluate patients presenting with new onset abdominal symptoms.

The lidocaine in Flavalta has a major potential interaction with Heart Block.

The use of lidocaine is contraindicated in patients with Stokes-Adam syndrome, Wolff-Parkinson White syndrome, or second- or third-degree AV block in the absence of a functional artificial pacemaker, or congenital QT prolongation.

The lidocaine in Flavalta has a major potential interaction with Heart Failure.

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

Sarilumab has a moderate potential interaction with High Cholesterol.

The use of sarilumab is associate with increases in lipid parameters such as LDL cholesterol, HDL cholesterol and/or triglycerides. Care should be exercised when using this agent in patients with lipid abnormalities. It is recommended to assess lipid parameters at baseline and parameters approximately 4 to 8 weeks following initiation of treatment, then at approximately 6 months intervals.

Sarilumab has a major potential interaction with History, Tuberculosis.

Sarilumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting sarilumab and during therapy; if positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting sarilumab. Anti-TB therapy should be considered prior to starting sarilumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in TB may be appropriate when considering anti-TB therapy. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

Sarilumab has a moderate potential interaction with History of Blood Dyscrasias.

The use of sarilumab is associate with higher incidence of decrease in absolute neutrophil count (ANC), including neutropenia and thrombocytopenia. It is recommended to assess neutrophil count and platelet count prior to initiation of therapy and monitor these levels 4 to 8 weeks after start of therapy and every 3 months thereafter. Dose modification may be necessary based on the pharmacodynamics of the changes in ANC. Care is recommended when using this agent in patients with blood disorders.

The lidocaine in Flavalta has a moderate potential interaction with Hyperkalemia.

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

The EPINEPHrine in Flavalta has a major potential interaction with Hyperthyroidism.

Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

The lidocaine in Flavalta has a moderate potential interaction with Hypokalemia.

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

The lidocaine in Flavalta has a major potential interaction with Hypotension.

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

Sarilumab has a major potential interaction with Infection.

Serious and sometimes fatal infections due to bacterial, mycobacterial, invasive fungal, viral, or other opportunistic pathogens have been reported in rheumatoid arthritis patients receiving sarilumab; the most common serious infections reported included pneumonia and cellulitis. Use of sarilumab should be avoided in patients with an active infection, including localized infections. The risks and benefits of treatment should be considered before starting sarilumab in patients: with chronic/recurrent infection, who have been exposed to tuberculosis, with history of serious/opportunistic infection, who have resided/traveled in areas of endemic tuberculosis/mycoses, or with underlying conditions that may predispose them to infection. Patients should be closely monitored for signs/symptoms of infection during sarilumab treatment as signs/symptoms of acute inflammation may be reduced due to suppression of acute phase reactants. If a serious infection or an opportunistic infection develops, sarilumab should be interrupted until the infection is controlled. A patient who develops a new infection during treatment with sarilumab should undergo prompt and complete diagnostic testing appropriate for an immunocompromised patient; appropriate antimicrobial therapy should be started, and the patient should be monitored closely.

The lidocaine in Flavalta has a major potential interaction with Liver Disease.

Lidocaine is rapidly and extensively metabolized by the liver. Less than 10% is eliminated unchanged in the urine. Several inactive and two active forms (MEGX and GX) have been identified. MEGX and GX exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. The pharmacokinetic disposition of lidocaine is altered by changes in hepatic function, including hepatic blood flow. Therapy with lidocaine should be administered cautiously and dosing modifications for repeated or loading and maintenance doses may be necessary. Clinical monitoring of cardiac (continuous ECG) is required and serum metabolite concentrations and monitoring hepatic function are recommended.

Sarilumab has a moderate potential interaction with Liver Disease.

The use of sarilumab is associate with transaminase elevations; therefore, treatment with sarilumab is not recommended in patients with active hepatic disease or hepatic impairment. It is recommended to assess ALT/AST levels prior to initiation of treatment and monitor ALT and AST levels 4 to 8 weeks after start of therapy and every 3 months thereafter. When clinically indicated, consider other liver function tests such as bilirubin. Dose modification based on transaminase elevations might be warranted. The safety and efficacy or sarilumab have not been conducted in patients with hepatic impairment, including patients with positive HBV or HCV serology.

The lidocaine in Flavalta has a moderate potential interaction with Magnesium Imbalance.

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

The EPINEPHrine in Flavalta has a moderate potential interaction with Neurological Disorders.

Epinephrine should be administered with caution to patients with Parkinson's disease as these patients may experience psychomotor agitation or notice a temporary worsening of symptoms.

Sarilumab has a moderate potential interaction with Neutropenia.

The use of sarilumab is associate with higher incidence of decrease in absolute neutrophil count (ANC), including neutropenia and thrombocytopenia. It is recommended to assess neutrophil count and platelet count prior to initiation of therapy and monitor these levels 4 to 8 weeks after start of therapy and every 3 months thereafter. Dose modification may be necessary based on the pharmacodynamics of the changes in ANC. Care is recommended when using this agent in patients with blood disorders.

The EPINEPHrine in Flavalta has a moderate potential interaction with Parkinsonism.

Epinephrine should be administered with caution to patients with Parkinson's disease as these patients may experience psychomotor agitation or notice a temporary worsening of symptoms.

The EPINEPHrine in Flavalta has a major potential interaction with Pheochromocytoma.

Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

The lidocaine in Flavalta has a major potential interaction with Renal Dysfunction.

Lidocaine is primarily eliminated by the kidney. Less than 10% is eliminated unchanged in the urine. Two active metabolites (MEGX and GX) have been identified that exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. Serum concentrations of lidocaine and the active metabolites are increased and the half-life prolonged in patients with renal impairment. Therapy with lidocaine should be administered cautiously and dosing modified for repeated or maintenance doses in patients with compromised renal function. Clinical monitoring of cardiac function (continual ECG) is required and serum metabolite concentrations and monitoring renal function are recommended.

Sarilumab has a moderate potential interaction with Renal Dysfunction.

Monoclonal antibodies, including sarilumab, are not eliminated via renal pathway. No dose adjustment is required in patients with mild to moderate renal impairment. The use of sarilumab has not been evaluated in patients with severe renal impairment. Care should be exercised.

The lidocaine in Flavalta has a major potential interaction with Seizures.

Seizures have occurred during lidocaine therapy and have been associated with the rapid administration of a large intravenous doses or accumulation of active metabolites with maintenance therapy. Therapy with lidocaine should be administered cautiously to patients with or predisposed to seizure disorders. Clinical monitoring of cardiac (continuous ECG) is required, and serum metabolite concentrations are recommended.

Sarilumab has a moderate potential interaction with Thrombocytopenia.

The use of sarilumab is associate with higher incidence of decrease in absolute neutrophil count (ANC), including neutropenia and thrombocytopenia. It is recommended to assess neutrophil count and platelet count prior to initiation of therapy and monitor these levels 4 to 8 weeks after start of therapy and every 3 months thereafter. Dose modification may be necessary based on the pharmacodynamics of the changes in ANC. Care is recommended when using this agent in patients with blood disorders.

Sarilumab has a major potential interaction with Tuberculosis, Active.

Sarilumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting sarilumab and during therapy; if positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting sarilumab. Anti-TB therapy should be considered prior to starting sarilumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in TB may be appropriate when considering anti-TB therapy. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

Sarilumab has a major potential interaction with Tuberculosis, Latent.

Sarilumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting sarilumab and during therapy; if positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting sarilumab. Anti-TB therapy should be considered prior to starting sarilumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in TB may be appropriate when considering anti-TB therapy. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.