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Drug Interactions between imatinib and lactobacillus rhamnosus gg

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

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Interactions between your drugs

Moderate

imatinib lactobacillus rhamnosus GG

Applies to: imatinib and lactobacillus rhamnosus gg

MONITOR: Probiotic use during immunosuppressant or intense antineoplastic therapy may theoretically increase the risk of infections from the live microorganisms contained in probiotic products. Patients may be immunosuppressed if they have recently received or are receiving alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents, or long-term topical or inhaled corticosteroids. Although probiotics are generally considered safe, with minimal to low pathogenicity, infections such as bacteremia and endocarditis with various strains commonly found in probiotics (e.g., lactobacilli, bifidobacteria, Bacillus subtilis) have been rarely reported, primarily in critically ill patients or patients with significant underlying medical conditions such as malignancy, organ transplantation, AIDS, valvular heart disease, diabetes mellitus, recent surgery, or compromised immune system. Lactobacillus bacteremia has also been reported following endoscopy. In addition, cases of lactobacillus pneumonia and liver abscess, as well as Saccharomyces fungemia, pneumonia, liver abscess, peritonitis and vaginitis, have been described in the medical literature.

MANAGEMENT: Caution is advised when probiotics are used during immunosuppressant or intense antineoplastic therapy. It may be advisable to avoid using probiotics, particularly products containing saccharomyces boulardii, in patients who are significantly immunosuppressed unless benefits are anticipated to outweigh the potential risk of infection.

References

  1. Salminen MK, Rautelin H, Tynkkynen S, et al. (2004) "Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG." Clin Infect Dis, 38, p. 62-9
  2. Salminen MK, Tynkkynen S, Rautelin H, et al. (2002) "Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland." Clin Infect Dis, 35, p. 1155-60
  3. Rautio M, Jousimies-Somer H, Kauma H, et al. (1999) "Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG." Clin Infect Dis, 28, p. 1159-60
  4. Schlegel L, Lemerle S, Geslin P (1998) "Lactobacillus species as opportunistic pathogens in immunocompromised patients." Eur J Clin Microbiol Infect Dis, 17, p. 887-8
  5. Saxelin M, Chuang NH, Chassy B, et al. (1996) "Lactobacilli and bacteremia in southern Finland, 1989-1992" Clin Infect Dis, 22, p. 564-6
  6. Husni RN, Gordon SM, Washington JA, Longworth DL (1997) "Lactobacillus bacteremia and endocarditis: review of 45 cases." Clin Infect Dis, 25, p. 1048-55
  7. Oggioni MR, Pozzi G, Valensin PE, Galieni P, Bigazzi C (1998) "Recurrent septicemia in an immunocompromised patient due to probiotic strains of Bacillus subtilis." J Clin Microbiol, 36, p. 325-6
  8. Mackay AD, Taylor MB, Kibbler CC, Hamilton-Miller JM (1999) "Lactobacillus endocarditis caused by a probiotic organism." Clin Microbiol Infect, 5, p. 290-2
  9. Borriello SP, Hammes WP, Holzapfel W, et al. (2003) "Safety of probiotics that contain lactobacilli or bifidobacteria." Clin Infect Dis, 36, p. 775-80
  10. Lolis N, Veldekis D, Moraitou H, et al. (2008) "Saccharomyces boulardii fungaemia in an intensive care unit patient treated with caspofungin." Crit Care, 12, epub
  11. Boyle RJ, Robins-Browne RM, Tang ML (2006) "Probiotic use in clinical practice: what are the risks?" Am J Clin Nutr, 83, p. 1256-64
  12. Pruccoli G, Silvestro E, Napoleone CP, Aidala E, Garazzino S, Scolfaro C (2024) Are probiotics safe? Bifidobacterium bacteremia in a child with severe heart failure. https://www.researchgate.net/publication/333853508_Are_probiotics_safe_Bifidobacterium_bacteremia_in_a_child_with_severe_heart_failure
View all 12 references

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Drug and food interactions

Moderate

imatinib food

Applies to: imatinib

GENERALLY AVOID: Coadministration of imatinib with strong CYP450 3A4 inhibitors such as grapefruit juice, may significantly increase the plasma concentrations of imatinib, a known substrate of CYP450 3A4. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of imatinib by certain compounds present in grapefruits. Because grapefruit juice inhibits primarily intestinal rather than hepatic CYP450 3A4, the magnitude of interaction is greatest for those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability). In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict. In a single-dose study, coadministration of imatinib with ketoconazole (a strong CYP450 3A4 inhibitor) increased imatinib peak plasma concentration (Cmax) and systemic exposure (AUC) by 26% and 40%, respectively.

MANAGEMENT: Patients treated with imatinib should preferably avoid the consumption of grapefruit or grapefruit juice. If coadministration is unavoidable, monitor for prolonged and/or increased pharmacologic effects of imatinib, including edema, hematologic toxicity and immunosuppression.

References

  1. (2022) "Product Information. Gleevec (imatinib)." Novartis Pharmaceuticals
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."

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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

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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

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