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Drug Interactions between fosphenytoin and vincristine

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

vinCRIStine fosphenytoin

Applies to: vincristine and fosphenytoin

GENERALLY AVOID: Coadministration with potent inducers of CYP450 3A4 and/or P-glycoprotein such as phenytoin may significantly decrease the plasma concentrations of vinca alkaloids, which are substrates of both the hepatic microsomal isoenzyme and intracellular efflux transporter. Pharmacokinetic data are not available.

MONITOR: Cases have been reported in which patients receiving chemotherapy have experienced markedly reduced plasma phenytoin concentrations and seizures. The mechanism of this interaction has not been clearly established. One study showed that the absorption of phenytoin decreased significantly during chemotherapy. Intravenous phenytoin may be less likely to interact.

MANAGEMENT: The use of vinca alkaloids in combination with potent CYP450 3A4 and/or P-glycoprotein inducers such as phenytoin should generally be avoided.

References (9)
  1. Jarosinski PF, Moscow JA, Alexander MS, et al. (1988) "Altered phenytoin clearance during intensive chemotherapy for acute lymphoblastic leukemia." J Pediatr, 112, p. 996-9
  2. Bollini P, Riva R, Albani F, Ida, et al. (1983) "Decreased phenytoin level during antineoplastic therapy: a case report." Epilepsia, 24, p. 75-8
  3. Dofferhoff AS, Berendsen HH (1990) "Decreased phenytoin level after carboplatin treatment." Am J Med, 89, p. 247
  4. Fincham RW, Schottelius DD (1979) "Decreased phenytoin levels in antineoplastic therapy." Ther Drug Monit, 1, p. 277-83
  5. Sylvester RK, Lewis FB, Caldwell KC, Lobell M, Perri R, Sawchuk RA (1984) "Impaired phenytoin bioavailability secondary to cisplantin, vinblastine, and bleomycin." Ther Drug Monit, 6, p. 302-5
  6. Neef C, de Voogd-van der Straaten (1988) "An interaction between cytostatic and anticonvulsant drugs." Clin Pharmacol Ther, 43, p. 372-5
  7. Grossman SA, Sheidler VR, Gilbert MR (1989) "Decreased phenytoin levels in patients receiving chemotherapy." Am J Med, 87, p. 505-10
  8. (2001) "Product Information. Oncovin (vincristine)." Lilly, Eli and Company
  9. "Product Information. Marqibo (vinCRIStine liposome)." Talon Therapeutics Inc

Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

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.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor 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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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