Skip to main content

Drug Interactions between ifosfamide and Jynneos

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

ifosfamide smallpox and monkeypox vaccine

Applies to: ifosfamide and Jynneos (smallpox and mpox vaccine)

MONITOR: Administration of the smallpox and monkeypox vaccine, which contains a live, attenuated, non-replicating strain of orthopoxvirus, to immunosuppressed patients is generally safe but may be associated with a diminished or suboptimal immunologic response due to antibody inhibition. Such patients may include those who have recently received or are receiving immunosuppressive agents, antilymphocyte globulins, alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (e.g., greater than or equal to 2 mg/kg/day or 20 mg/day of prednisone or equivalent for 14 consecutive days or more), or long-term topical or inhaled corticosteroids.

MANAGEMENT: It is generally advisable to complete recommended vaccinations, including smallpox and monkeypox vaccine, before starting immunosuppressant or antineoplastic treatment. Clinicians should consult public health authorities and thoroughly assess risks versus benefits prior to administering the smallpox and monkeypox vaccine to immunosuppressed individuals. If the decision is made to vaccinate, titer testing by the Centers for Disease Control and Prevention (CDC) might be considered on a case-by-case basis. Because a correlate of protection has not been established and there is no known antibody titer level that will ensure protection, titer results should be interpreted with caution to avoid providing a false sense of security. Additionally, since immunosuppressed patients might be less likely to mount an effective vaccine response, infections may occur even after full vaccination and outcomes could be particularly severe in these patients, especially following exposure to more virulent orthopoxviruses. Therefore, vaccine recipients might consider avoiding high-risk exposures until after completion of immunosuppressive therapies. Regardless of vaccination status, all individuals who work with orthopoxviruses should wear appropriate personal protective equipment.

References (4)
  1. CDC Centers for Disease Control and Prevention (2019) General Best Practice Guidelines for Immunization: Altered Immunocompetence. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.pdf
  2. (2021) "Product Information. Jynneos (smallpox and monkeypox vaccine)." Bavarian Nordic, Inc.
  3. Rao AK, Petersen BW, Whitehill F, et al. (2022) "Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices--United States, 2022 ht"
  4. Anonymous. (2022) Updated ATAGI Clinical Guidance on Vaccination Against MPX (Monkeypox) https://www.health.gov.au/sites/default/files/documents/2022/08/atagi-clinical-guidance-on-vaccination-against-monkeypox.pdf

Drug and food interactions

Moderate

ifosfamide food

Applies to: ifosfamide

GENERALLY AVOID: Grapefruit and/or grapefruit juice may reduce the efficacy of ifosfamide, whose anticancer effect is dependent on its activation to the 4-hydroxyifosfamide metabolite via CYP450 3A4. The proposed mechanism is inhibition of CYP450 3A4 metabolism by certain compounds present in grapefruit. There are no data available about the effects of grapefruit on ifosfamide. However, in a small study, 8 patients with incurable malignancies received ifosfamide 3 g/m2 by infusion with the potent CYP450 3A4 inhibitor ketoconazole 200 mg orally twice daily for 4 days starting 1 day before the ifosfamide infusion. Ketoconazole decreased the clearance of ifosfamide by 11%, decreased systemic exposure (AUC) of the active metabolite 4-hydroxyifosfamide by 30%, and increased the AUC of the inactive but potentially neurotoxic metabolite 2-dechloroethylifosfamide by 23%, as compared to control. Because pharmacokinetic interactions involving grapefruit juice are often subject to a high degree of interpatient variability, the extent to which a given patient may be affected is difficult to predict.

GENERALLY AVOID: Alcohol may potentiate the neurotoxic effects of ifosfamide. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills. In addition, ifosfamide therapy may cause gastrointestinal disorders and alcohol consumption may increase nausea and vomiting.

MANAGEMENT: Given the potential for reduced efficacy of ifosfamide and increased risk of neurotoxicity and nephrotoxicity it may be advisable for patients to avoid consumption of grapefruit, grapefruit juice, or supplements that contain grapefruit during treatment with ifosfamide. In addition, patients receiving ifosfamide should be warned of the increased risk of neurotoxicity, nausea and vomiting when used in combination with alcohol. Patients should avoid or limit the consumption of alcohol during treatment with ifosfamide.

References (6)
  1. (2019) "Product Information. Ifosfamide (ifosfamide)." Hikma USA (formerly West-Ward Pharmaceutical Corporation)
  2. Kerbusch T, jansen rlh, mathot raa, huitema adr, Jansen RNM, Rijswijk REN, Beijen JH (2001) "Modulation of the cytochrome P450-mediated metabolism of ifosfamide by ketoconazole and rifampin" Clin Pharmacol and Therapeutic, 70, p. 132-141
  3. (2018) "Product Information. Ifex (ifosfamide)." Baxter Pharmaceutical Products, Inc
  4. (2018) "Product Information. Holoxan (iFOSFamide)." Baxter Healthcare Pty Ltd
  5. (2022) "Product Information. Ifosfamide (ifosfamide)." Baxter Healthcare Ltd
  6. (2018) "Product Information. Ifex (ifosfamide)." Baxter Corporation

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.

See also

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer