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Drug Interactions between interferon alfa-n1 and Promacta

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

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Interactions between your drugs

Major

interferon alfa-n1 eltrombopag

Applies to: interferon alfa-n1 and Promacta (eltrombopag)

MONITOR CLOSELY: In chronic hepatitis C patients with advanced liver disease, coadministration of eltrombopag with interferon-based therapy may increase the risk of adverse reactions including potentially fatal hepatic decompensation and thromboembolic events. In two controlled clinical trials of thrombocytopenic patients with chronic hepatitis C, adverse events related to hepatic decompensation such as ascites, hepatic encephalopathy, variceal hemorrhage, and spontaneous bacterial peritonitis occurred more frequently in the group receiving antiviral treatment with eltrombopag than the group receiving placebo concomitantly (11% vs. 6%). Patients with albumin levels <=3.5 g/dL or Model for End-Stage Liver Disease (MELD) score >=10 at baseline had a three-fold greater risk of hepatic decompensation and increased risk of a fatal adverse event compared to those with less advanced liver disease. Furthermore, the proportion of these patients who achieved a sustained virologic response compared with placebo were modest relative to the group overall.

MANAGEMENT: In chronic hepatitis C patients with poor liver function (albumin levels <=3.5 g/L or MELD score >=10) at baseline, eltrombopag should only be administered with interferon-based therapy after careful consideration of the potential benefits versus associated risks, and patients should be monitored closely for signs and symptoms of hepatic decompensation. Eltrombopag should be discontinued if antiviral therapy is withdrawn for hepatic decompensation.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. "Product Information. Promacta (eltrombopag)." GlaxoSmithKline (2008):
View all 4 references

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Drug and food interactions

Moderate

eltrombopag food

Applies to: Promacta (eltrombopag)

ADJUST DOSING INTERVAL: Food may reduce the oral bioavailability of eltrombopag. In healthy volunteers, a standard high-fat breakfast significantly decreased plasma eltrombopag peak plasma concentration (Cmax) by 65% and systemic exposure (AUC) by 59% and delayed Tmax by one hour. The calcium content of this meal may have also contributed to this decrease in exposure. In another study, adult subjects administered a single 25 mg dose of eltrombopag for oral suspension with a high-calcium, moderate-fat, moderate-calorie meal exhibited a 79% decrease in Cmax and 75% decrease in AUC of eltrombopag. Administration of eltrombopag 2 hours after the high-calcium meal decreased eltrombopag Cmax by 48% and AUC by 47%, while administration 2 hours before the high-calcium meal decreased eltrombopag Cmax by 14% and AUC by 20%.

ADJUST DOSING INTERVAL: Polyvalent cations such as aluminum, calcium, iron, magnesium, and zinc can significantly reduce the gastrointestinal absorption of eltrombopag due to chelation. In one clinical trial, administration of a single 75 mg dose of eltrombopag with an antacid containing 1524 mg aluminum hydroxide and 1425 mg magnesium carbonate resulted in an approximately 70% decrease in eltrombopag Cmax and AUC.

MANAGEMENT: Eltrombopag should be taken on an empty stomach one hour before or two hours after a meal. Additionally, eltrombopag should be taken at least 2 hours before or 4 hours after any products that contain polyvalent cations such as antacids, mineral supplements, dairy products, and fortified juices.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. "Product Information. Promacta (eltrombopag)." GlaxoSmithKline (2008):

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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.

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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