Drug Interactions between hexaminolevulinate and Tice BCG Vaccine

CONTRAINDICATED: Inflammation of bladder resulting from the use of BCG immunotherapy or intravesical chemotherapy may interfere with the diagnostic utility of hexaminolevulinate, which is an ester of the heme precursor, aminolevulinic acid. Following intravesical instillation of hexaminolevulinate, photoactive porphyrins are formed and accumulate intracellularly in bladder wall lesions. In humans, a higher degree of accumulation of porphyrins has been demonstrated in neoplastic or inflamed cells compared to normal bladder urothelium. As such, inflammation may lead to increased porphyrin buildup and higher risk of local toxicity upon illumination as well as false-positive fluorescence.

MANAGEMENT: The use of hexaminolevulinate is considered contraindicated in patients given BCG immunotherapy or intravesical chemotherapy within the past 90 days due to a high risk of bladder inflammation in these patients. Widespread inflammation of the bladder should be excluded by cystoscopy before hexaminolevulinate is administered. If a widespread inflammation in the bladder becomes evident during white light inspection, the blue light inspection should be avoided.