Can you take Gazyva with Radium 223 dichloride?

The obinutuzumab in Gazyva has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

Severe neutropenia, thrombocytopenia, and anemia have been documented with the use of anti-CD20 antibodies. Monitor complete blood counts during and after therapy according to clinical guidelines.

The radium Ra 223 dichloride in radium 223 dichloride has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

A randomized clinical trial reported that 2% of the patients receiving radium Ra 223 experienced bone marrow failure or ongoing pancytopenia, including 2 deaths due to bone marrow failure. Myelosuppression including thrombocytopenia, neutropenia, pancytopenia, and leukopenia have been reported in patients receiving this agent. Patients should have a baseline hematologic evaluation, as well as another evaluation prior to every dose. The absolute neutrophil count (ANC) prior to the first administration should be >= 1.5 x 10^9/L, the platelet count should be >= 100 x 10^9/L, and hemoglobin should be >= 10 g/dL; and before subsequent administrations, the ANC should be >= 1 x 10^9/L and the platelet count >= 50 x 10^9/L. Discontinue treatment if after the last administration there is no recovery of these values within 6 to 8 weeks, despite supporting care and in those patients experiencing life-threatening complications. Caution is advised in patients with preexisting hematologic issues.

The obinutuzumab in Gazyva has a major potential interaction with Infection.

Serious infections, including reactivation of viral infections, have been reported with the use of anti-CD20 antibodies. JC virus infections resulting in progressive multifocal leukoencephalopathy (PML) have been reported in patients treated with these agents. A diagnosis of PML should be considered in any patient presenting with new-onset neurological manifestations, and a consultation with a neurologist is recommended. Care should be exercised when giving these drugs to patients with a history of recurring or chronic infections as they are at an increased risk of infections. Do not start therapy in patients with an active infection.

The obinutuzumab in Gazyva has a major potential interaction with Infectious Hepatitis.

The use of anti-CD20 antibodies has caused reactivation of hepatitis B virus, in some cases with fatal outcomes. It is recommended to screen all patients for hepatitis B virus infection before initiating treatment. Monitor patients during, and after several months for hepatitis B virus infection according to clinical practice. Discontinue these agents immediately and institute appropriate treatment if patients develop reactivation of hepatitis B virus while on therapy.

The radium Ra 223 dichloride in radium 223 dichloride has a moderate potential interaction with Liver Disease.

No dedicated hepatic or renal impairment studies have been conducted for radium Ra 223. Subgroup analyses in the randomized controlled trials have concluded that no dose adjustment is needed in patients with mild to moderate renal impairment, and mild hepatic impairment. No dose adjustment can be recommended for patients with severe renal impairment or moderate to severe hepatic impairment. Caution is advised if used in these patients.

The obinutuzumab in Gazyva has a moderate potential interaction with Pulmonary Impairment.

Patients with a prior history of cardiac or pulmonary disease should be closely monitored during and after the infusion of anti-CD20 antibodies as they can increase the risk of presenting a severe and life-threatening infusion reaction. Therapy with these agents should be permanently discontinued in patients presenting any Grade 4 infusion reactions and for those presenting Grade 3, interrupt therapy and institute treatment according to clinical guidelines. The rate of infusion should be reduced for those patients presenting Grade 1, or 2 reactions.

The radium Ra 223 dichloride in radium 223 dichloride has a moderate potential interaction with Renal Dysfunction.

No dedicated hepatic or renal impairment studies have been conducted for radium Ra 223. Subgroup analyses in the randomized controlled trials have concluded that no dose adjustment is needed in patients with mild to moderate renal impairment, and mild hepatic impairment. No dose adjustment can be recommended for patients with severe renal impairment or moderate to severe hepatic impairment. Caution is advised if used in these patients.

The obinutuzumab in Gazyva has a major potential interaction with Tumor Lysis Syndrome.

Tumor lysis syndrome (TLS), which may be life-threatening or fatal, has occurred in patients receiving certain monoclonal antibodies. Patients with high tumor burden and/or high circulating lymphocyte counts (greater than 25 x 10[9]/L) are at greater risk for developing TLS. Tumor lysis prophylaxis with anti-hyperuricemics and hydration prior to infusion may be recommended or should be considered. Electrolyte abnormalities should be corrected, and renal function and fluid balance should be monitored in patients who develop TLS. It is recommended to monitor for signs/symptoms of TLS, and temporary interruption or discontinuation of therapy might be required.