Can you take Interferon alfa-2b with Tocilizumab?

Interferon alfa-2b has a major potential interaction with Arrhythmia.

Hypertension, arrhythmias, angina, myocardial infarction, cardiomyopathy, and congestive heart failure have been reported during interferon therapy. Therapy with interferons should be administered with caution in patients with compromised cardiac function.

Interferon alfa-2b has a major potential interaction with Autoimmune Disorders.

Antiviral interferons may exacerbate autoimmune disorders such as myositis, thyroiditis, systemic lupus erythematosus, rheumatoid arthritis, psoriasis, or autoimmune hepatitis. Therapy should be avoided or administered with extreme caution in patients with autoimmune disorders.

Interferon alfa-2b has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

Interferons (alfa and gamma) induce a dose-dependent, generally mild, myelosuppression. Leukopenia is the primary manifestation. Thrombocytopenia and anemia occur less frequently. Therapy with interferons (alfa and gamma) should be administered cautiously to patients with bone marrow suppression. Clinical monitoring of hematopoietic function is recommended.

Interferon alfa-2b has a major potential interaction with Cardiovascular Conditions and Disorders.

Hypertension, arrhythmias, angina, myocardial infarction, cardiomyopathy, and congestive heart failure have been reported during interferon therapy. Therapy with interferons should be administered with caution in patients with compromised cardiac function.

Interferon alfa-2b has a major potential interaction with Depression.

Interferons (alfa or beta) can induce depression and suicidal behavior. Suicidal attempts and suicides have been reported. Therapy with interferons (alfa or beta) should be administered cautiously to patients with or predisposed to mental depression. Clinical monitoring of psychological status is recommended.

Interferon alfa-2b has a moderate potential interaction with Diabetes Mellitus.

Flu-like symptoms frequently associated with interferon-alfa therapy can precipitate ketoacidosis in diabetic patients. Therapy with interferon alfa should be administered cautiously in patients with diabetes mellitus. Clinical monitoring of blood glucose concentrations and anti-diabetic therapy is recommended.

Tocilizumab has a moderate potential interaction with Diverticulitis.

The use of tocilizumab may cause gastrointestinal (GI) perforation. Tocilizumab should be used with caution in patients who may be at increased risk for GI perforation. Patients with new onset abdominal symptoms should be evaluated promptly for early detection of GI perforation.

Tocilizumab has a moderate potential interaction with Gastrointestinal Perforation.

The use of tocilizumab may cause gastrointestinal (GI) perforation. Tocilizumab should be used with caution in patients who may be at increased risk for GI perforation. Patients with new onset abdominal symptoms should be evaluated promptly for early detection of GI perforation.

Interferon alfa-2b has a major potential interaction with Heart Failure.

Hypertension, arrhythmias, angina, myocardial infarction, cardiomyopathy, and congestive heart failure have been reported during interferon therapy. Therapy with interferons should be administered with caution in patients with compromised cardiac function.

Tocilizumab has a moderate potential interaction with High Cholesterol.

Tocilizumab treatment was associated with increases in lipid parameters (e.g., total cholesterol, triglycerides, low-density lipoprotein [LDL] cholesterol, and/or high-density lipoprotein [HDL] cholesterol). Lipid parameters should be assessed about 4 to 8 weeks after initiation of therapy. Patients should be managed according to clinical guidelines for the management of hyperlipidemia.

Tocilizumab has a major potential interaction with History, Tuberculosis.

Tocilizumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting tocilizumab and during therapy; testing for latent infection is not necessary before starting tocilizumab in patients with coronavirus disease 2019 (COVID-19). If positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting tocilizumab. Anti-TB therapy should be considered prior to starting tocilizumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in the treatment of TB is recommended to aid in the decision about whether initiating anti-TB therapy is appropriate for an individual patient. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

Interferon alfa-2b has a major potential interaction with Hyperthyroidism.

Thyroid abnormalities, hypothyroidism or hyperthyroidism, have been reported in patients administered interferons. Therapy with interferons should be administered cautiously to patients with thyroid dysfunction. If thyroid control cannot be maintained within normal limits with medication, interferon-alfa should be discontinued. Clinical monitoring of thyroid function is recommended.

Tocilizumab has a major potential interaction with Infection.

Serious and sometimes fatal infections due to bacterial, mycobacterial, invasive fungal, viral, or other opportunistic pathogens have been reported in patients receiving tocilizumab; the most common serious infections reported included pneumonia, urinary tract infection, cellulitis, herpes zoster, gastroenteritis, diverticulitis, sepsis, and bacterial arthritis. Tocilizumab should not be administered in patients with an active infection, including localized infections. The risks and benefits of treatment should be considered before starting tocilizumab in patients: with chronic/recurrent infection, who have been exposed to tuberculosis, with history of serious/opportunistic infection, who have resided/traveled in areas of endemic tuberculosis/mycoses, or with underlying conditions that may predispose them to infection. Patients should be closely monitored for signs/symptoms of infection during and after tocilizumab treatment as signs/symptoms of acute inflammation may be reduced due to suppression of acute phase reactants. If a serious infection, an opportunistic infection, or sepsis develops, tocilizumab should be interrupted until the infection is controlled. A patient who develops a new infection during treatment with tocilizumab should undergo a prompt and complete diagnostic workup appropriate for an immunocompromised patient; appropriate antimicrobial therapy should be started, and the patient should be monitored closely.

Patients with coronavirus disease 2019 (COVID-19) should be monitored for signs/symptoms of new infections during and after tocilizumab treatment. The risks and benefits of tocilizumab in COVID-19 patients with other concomitant infections should be considered.

Interferon alfa-2b has a major potential interaction with Ischemic Heart Disease.

Hypertension, arrhythmias, angina, myocardial infarction, cardiomyopathy, and congestive heart failure have been reported during interferon therapy. Therapy with interferons should be administered with caution in patients with compromised cardiac function.

Interferon alfa-2b has a major potential interaction with Liver Disease.

Hepatotoxicity, including fatal cases, has been reported in patients treated with interferon alpha. Additionally, the risk of hepatic decompensation and death is increased in patients with cirrhosis. Any patient developing liver function abnormalities during treatment should be monitored closely and treatment should be discontinued if appropriate. Interferon-alfa is contraindicated in patients with autoimmune hepatitis and decompensated liver disease.

Tocilizumab has a moderate potential interaction with Liver Disease.

The safety and efficacy of tocilizumab have not been studied in patients with liver dysfunction, including patients with positive HBV and HCV serology. Treatment with tocilizumab is not recommended in patients with active liver disease or liver dysfunction.

Treatment with tocilizumab was associated with a higher incidence of transaminase elevations. For patients with rheumatoid arthritis (RA), giant cell arteritis (GCA), or systemic sclerosis-associated interstitial lung disease (SSc-ILD), a liver test panel (serum ALT, AST, alkaline phosphatase, total bilirubin) should be obtained before starting tocilizumab, every 4 to 8 weeks for the first 6 months of therapy, and every 3 months thereafter. Tocilizumab should not be started in patients with RA, GCA, or SSc-ILD with elevated ALT or AST greater than 1.5 times the upper limit of normal (1.5 x ULN) and should be discontinued in those who develop elevated ALT or AST greater than 5 x ULN. Modifications should be based on increased transaminases. A similar pattern of liver enzyme elevation was seen with tocilizumab in patients with polyarticular juvenile idiopathic arthritis (PJIA) or systemic juvenile idiopathic arthritis (SJIA); liver test panel should be monitored at the second dose and thereafter every 4 to 8 weeks for PJIA and every 2 to 4 weeks for SJIA.

Patients hospitalized with coronavirus disease 2019 (COVID-19) may have elevated ALT or AST levels; multi-organ failure with liver involvement is a complication of severe COVID-19. The decision to use tocilizumab should balance the potential benefit of treating COVID-19 against the potential risks of acute therapy. Tocilizumab should not be started in patients with COVID-19 who have elevated ALT or AST greater than 10 x ULN. ALT and AST should be monitored during treatment.

Tocilizumab has a moderate potential interaction with Multiple Sclerosis.

Clinical studies have reported that tocilizumab may have an effect on demyelinating disorders such as multiple sclerosis and chronic inflammatory demyelinating polyneuropathy. Patients should be monitored for signs/symptoms potentially indicative of demyelinating disorders. Caution should be exercised when considering the use of tocilizumab in patients with preexisting or recent onset demyelinating disorders.

Tocilizumab has a moderate potential interaction with Neutropenia.

Tocilizumab treatment was associated with a higher incidence of neutropenia and a reduction in platelet counts. Tocilizumab should not be started in patients with rheumatoid arthritis (RA), giant cell arteritis (GCA), or systemic sclerosis-associated interstitial lung disease (SSc-ILD) who have a low neutrophil count (i.e., absolute neutrophil count [ANC] less than 2000 cells/mm3) or a platelet count less than 100,000 cells/mm3. Tocilizumab is not recommended in patients with RA, GCA, or SSc-ILD who develop an ANC less than 500 cells/mm3 or a platelet count less than 50,000 cells/mm3. Neutrophils and platelets should be monitored in these patients 4 to 8 weeks after the start of therapy and every 3 months thereafter; modifications should be based on ANC results and platelet counts. A similar pattern of low neutrophil and platelet counts was seen with tocilizumab in patients with polyarticular juvenile idiopathic arthritis (PJIA) or systemic juvenile idiopathic arthritis (SJIA); neutrophils and platelets should be monitored at the second dose and thereafter every 4 to 8 weeks for PJIA and every 2 to 4 weeks for SJIA. Tocilizumab should not be started in patients with coronavirus disease 2019 (COVID-19) who have an ANC less than 1000 cells/mm3 or a platelet count less than 50,000 cells/mm3; neutrophils and platelets should be monitored in these patients.

Interferon alfa-2b has a major potential interaction with Parkinsonism.

Reversible CNS effects such as seizures, mental status changes, manic behavior or psychotic reactions, gait disturbances, and dizziness have occurred in patients receiving interferons. Therapy with interferons should be administered cautiously in patients with or predisposed to seizures, psychiatric disorders, or conditions affecting posture or gait.

Interferon alfa-2b has a moderate potential interaction with Peripheral Neuropathy.

Paresthesia and numbness have been reported during interferon therapy. Therapy with interferons should be administered cautiously in patients with or predisposed to peripheral neuropathy.

Interferon alfa-2b has a major potential interaction with Psychosis.

Reversible CNS effects such as seizures, mental status changes, manic behavior or psychotic reactions, gait disturbances, and dizziness have occurred in patients receiving interferons. Therapy with interferons should be administered cautiously in patients with or predisposed to seizures, psychiatric disorders, or conditions affecting posture or gait.

Interferon alfa-2b has a major potential interaction with Renal Dysfunction.

Proteinuria (rare), not associated with a decrease in serum protein, is the most common renal toxicity observed with interferon- alfa therapy. Increased BUN and serum creatinine levels, hematuria, acute renal failure and nephrotic syndrome have also been reported. Therapy with interferon alfa should be administered cautiously to patients with severe renal dysfunction. Renal function should be evaluated in all patients before initiation of interferon- alfa therapy. In addition, patients with any degree of renal impairment should be carefully monitored for laboratory abnormalities and decreased creatinine clearance. A reduced dose of medication is recommended in patients with low CrCl (less than 50 mL/min - 30 mL/min).

Tocilizumab has a moderate potential interaction with Renal Dysfunction.

Tocilizumab has not been studied in patients with severe renal dysfunction; caution is recommended when using tocilizumab in these patients. No dose adjustment is required in patients with mild or moderate renal dysfunction.

Interferon alfa-2b has a major potential interaction with Seizures.

Reversible CNS effects such as seizures, mental status changes, manic behavior or psychotic reactions, gait disturbances, and dizziness have occurred in patients receiving interferons. Therapy with interferons should be administered cautiously in patients with or predisposed to seizures, psychiatric disorders, or conditions affecting posture or gait.

Tocilizumab has a moderate potential interaction with Thrombocytopenia.

Tocilizumab treatment was associated with a higher incidence of neutropenia and a reduction in platelet counts. Tocilizumab should not be started in patients with rheumatoid arthritis (RA), giant cell arteritis (GCA), or systemic sclerosis-associated interstitial lung disease (SSc-ILD) who have a low neutrophil count (i.e., absolute neutrophil count [ANC] less than 2000 cells/mm3) or a platelet count less than 100,000 cells/mm3. Tocilizumab is not recommended in patients with RA, GCA, or SSc-ILD who develop an ANC less than 500 cells/mm3 or a platelet count less than 50,000 cells/mm3. Neutrophils and platelets should be monitored in these patients 4 to 8 weeks after the start of therapy and every 3 months thereafter; modifications should be based on ANC results and platelet counts. A similar pattern of low neutrophil and platelet counts was seen with tocilizumab in patients with polyarticular juvenile idiopathic arthritis (PJIA) or systemic juvenile idiopathic arthritis (SJIA); neutrophils and platelets should be monitored at the second dose and thereafter every 4 to 8 weeks for PJIA and every 2 to 4 weeks for SJIA. Tocilizumab should not be started in patients with coronavirus disease 2019 (COVID-19) who have an ANC less than 1000 cells/mm3 or a platelet count less than 50,000 cells/mm3; neutrophils and platelets should be monitored in these patients.

Tocilizumab has a major potential interaction with Tuberculosis, Active.

Tocilizumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting tocilizumab and during therapy; testing for latent infection is not necessary before starting tocilizumab in patients with coronavirus disease 2019 (COVID-19). If positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting tocilizumab. Anti-TB therapy should be considered prior to starting tocilizumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in the treatment of TB is recommended to aid in the decision about whether initiating anti-TB therapy is appropriate for an individual patient. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

Tocilizumab has a major potential interaction with Tuberculosis, Latent.

Tocilizumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting tocilizumab and during therapy; testing for latent infection is not necessary before starting tocilizumab in patients with coronavirus disease 2019 (COVID-19). If positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting tocilizumab. Anti-TB therapy should be considered prior to starting tocilizumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in the treatment of TB is recommended to aid in the decision about whether initiating anti-TB therapy is appropriate for an individual patient. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

Interferon alfa-2b has a moderate potential interaction with Ulcerative Colitis.

Fatal and nonfatal ulcerative or hemorrhagic/ischemic colitis have been observed within 12 weeks of the start of alpha interferon treatment. Abdominal pain, bloody diarrhea, and fever are the typical manifestations. Treatment should be discontinued immediately in patients who develop these signs and symptoms. The colitis usually resolves within 1 to 3 weeks of discontinuation of alpha interferons.

Interferon alfa-2b has a major potential interaction with Underactive Thyroid.

Thyroid abnormalities, hypothyroidism or hyperthyroidism, have been reported in patients administered interferons. Therapy with interferons should be administered cautiously to patients with thyroid dysfunction. If thyroid control cannot be maintained within normal limits with medication, interferon-alfa should be discontinued. Clinical monitoring of thyroid function is recommended.