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Interactions between Interferon beta-1b and Oxaliplatin

1 drug interaction and 22 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

interferon beta-1b oxaliplatin

Applies to: interferon beta-1b and oxaliplatin
Monitor

Coadministration of beta interferons with other agents known to induce hepatotoxicity may potentiate the risk of liver injury. Use of beta interferons has been associated with rare cases of liver injury, including autoimmune hepatitis and severe liver damage leading to hepatic failure, some of which required transplantation. In some cases, these events have occurred in the presence of other drugs that have been associated with hepatic injury. Symptoms of liver dysfunction typically began from 1 to 6 months following the initiation of therapy. Asymptomatic elevations of hepatic transaminases (particularly SGPT) have also been reported and are common with interferon therapy.

Management

The risk of hepatic injury should be considered when beta interferons are used with other potentially hepatotoxic agents (e.g., acetaminophen; alcohol; androgens and anabolic steroids; antituberculous agents; azole antifungal agents; ACE inhibitors; cyclosporine (high dosages); disulfiram; endothelin receptor antagonists; other interferons; ketolide and macrolide antibiotics; kinase inhibitors; minocycline; nonsteroidal anti-inflammatory agents; nucleoside reverse transcriptase inhibitors; proteasome inhibitors; retinoids; sulfonamides; tamoxifen; thiazolidinediones; tolvaptan; vincristine; zileuton; anticonvulsants such as carbamazepine, hydantoins, felbamate, and valproic acid; lipid-lowering medications such as fenofibrate, lomitapide, mipomersen, niacin, and statins; herbals and nutritional supplements such as black cohosh, chaparral, comfrey, DHEA, kava, pennyroyal oil, and red yeast rice). Liver function tests should be monitored at regular intervals and the interferon dosage reduced if SGPT rises above 5 times the upper limit of normal. The dosage may be gradually re-escalated when enzyme levels return to normal. Patients should be advised to seek medical attention if they experience potential signs and symptoms of hepatotoxicity such as fever, rash, itching, anorexia, nausea, vomiting, fatigue, malaise, right upper quadrant pain, dark urine, pale stools, and jaundice. If liver injury is suspected, interferon therapy should be promptly discontinued due to the potential for rapid progression to liver failure.

References (4)
  1. (2002) "Product Information. Betaseron (interferon beta-1b)." Berlex Laboratories
  2. (2001) "Product Information. Avonex (interferon beta-1a)." Biogen
  3. (2002) "Product Information. Rebif (interferon beta-1a)." Serono Laboratories Inc
  4. (2014) "Product Information. Plegridy (peginterferon beta-1a)." Biogen Idec Inc

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

interferon beta-1b Alcohol (Ethanol)

Applies to: interferon beta-1b
Monitor

Coadministration of beta interferons with other agents known to induce hepatotoxicity may potentiate the risk of liver injury. Use of beta interferons has been associated with rare cases of liver injury, including autoimmune hepatitis and severe liver damage leading to hepatic failure, some of which required transplantation. In some cases, these events have occurred in the presence of other drugs that have been associated with hepatic injury. Symptoms of liver dysfunction typically began from 1 to 6 months following the initiation of therapy. Asymptomatic elevations of hepatic transaminases (particularly SGPT) have also been reported and are common with interferon therapy.

Management

The risk of hepatic injury should be considered when beta interferons are used with other potentially hepatotoxic agents (e.g., acetaminophen; alcohol; androgens and anabolic steroids; antituberculous agents; azole antifungal agents; ACE inhibitors; cyclosporine (high dosages); disulfiram; endothelin receptor antagonists; other interferons; ketolide and macrolide antibiotics; kinase inhibitors; minocycline; nonsteroidal anti-inflammatory agents; nucleoside reverse transcriptase inhibitors; proteasome inhibitors; retinoids; sulfonamides; tamoxifen; thiazolidinediones; tolvaptan; vincristine; zileuton; anticonvulsants such as carbamazepine, hydantoins, felbamate, and valproic acid; lipid-lowering medications such as fenofibrate, lomitapide, mipomersen, niacin, and statins; herbals and nutritional supplements such as black cohosh, chaparral, comfrey, DHEA, kava, pennyroyal oil, and red yeast rice). Liver function tests should be monitored at regular intervals and the interferon dosage reduced if SGPT rises above 5 times the upper limit of normal. The dosage may be gradually re-escalated when enzyme levels return to normal. Patients should be advised to seek medical attention if they experience potential signs and symptoms of hepatotoxicity such as fever, rash, itching, anorexia, nausea, vomiting, fatigue, malaise, right upper quadrant pain, dark urine, pale stools, and jaundice. If liver injury is suspected, interferon therapy should be promptly discontinued due to the potential for rapid progression to liver failure.

References (4)
  1. (2002) "Product Information. Betaseron (interferon beta-1b)." Berlex Laboratories
  2. (2001) "Product Information. Avonex (interferon beta-1a)." Biogen
  3. (2002) "Product Information. Rebif (interferon beta-1a)." Serono Laboratories Inc
  4. (2014) "Product Information. Plegridy (peginterferon beta-1a)." Biogen Idec Inc

Disease interactions

21 potential interactions Applies to: 20 conditions, including Depression, Heart Failure, Seizures, Peripheral Neuropathy, and Arrhythmia.

Arrhythmia

Major:

interferon beta-1b

Interferon beta-1b 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.

Major:

oxaliplatin

Oxaliplatin has a major potential interaction with Arrhythmia.

The use of oxaliplatin has been associated with QT prolongation, and ventricular arrhythmias including fatal Torsade de Pointes. Therapy with oxaliplatin should be administered cautiously in patients with congestive heart failure, bradyarrhythmias, and electrolyte abnormalities. Correct hypokalemia or hypomagnesemia prior to initiating oxaliplatin and monitor these electrolytes periodically during therapy. Avoid oxaliplatin in patients with congenital long QT syndrome.

Bleeding Disorder

Moderate:

oxaliplatin

Oxaliplatin has a moderate potential interaction with Bleeding Disorder.

Thrombocytopenia was frequently reported with the combination of oxaliplatin and infusional 5-FU/LV. Therapy with oxaliplatin should be administered cautiously in patients whose bone marrow reserve may be severely depressed by prior chemotherapy or irradiation, whose marrow function is recovering from previous cytotoxic therapy, or in patients with compromised renal function. Patients should be instructed to immediately report any signs or symptoms suggesting bleeding such as petechia, purpura, epistaxis, hemoptysis, hematuria, and melena. Therapy with oxaliplatin should be administered cautiously in patients with compromised bone marrow reserve. Close clinical monitoring of hematopoietic function is recommended.

Bone Marrow Depression/Low Blood Counts

Moderate:

oxaliplatin

Oxaliplatin has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

Thrombocytopenia was frequently reported with the combination of oxaliplatin and infusional 5-FU/LV. Therapy with oxaliplatin should be administered cautiously in patients whose bone marrow reserve may be severely depressed by prior chemotherapy or irradiation, whose marrow function is recovering from previous cytotoxic therapy, or in patients with compromised renal function. Patients should be instructed to immediately report any signs or symptoms suggesting bleeding such as petechia, purpura, epistaxis, hemoptysis, hematuria, and melena. Therapy with oxaliplatin should be administered cautiously in patients with compromised bone marrow reserve. Close clinical monitoring of hematopoietic function is recommended.

Cardiovascular Conditions and Disorders

Major:

interferon beta-1b

Interferon beta-1b 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.

Depression

Major:

interferon beta-1b

Interferon beta-1b 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.

Electrolyte Abnormalities

Major:

oxaliplatin

Oxaliplatin has a major potential interaction with Electrolyte Abnormalities.

The use of oxaliplatin has been associated with QT prolongation, and ventricular arrhythmias including fatal Torsade de Pointes. Therapy with oxaliplatin should be administered cautiously in patients with congestive heart failure, bradyarrhythmias, and electrolyte abnormalities. Correct hypokalemia or hypomagnesemia prior to initiating oxaliplatin and monitor these electrolytes periodically during therapy. Avoid oxaliplatin in patients with congenital long QT syndrome.

Heart Failure

Major:

interferon beta-1b

Interferon beta-1b 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.

Infection

Moderate:

oxaliplatin

Oxaliplatin has a moderate potential interaction with Infection.

The use of oxaliplatin for injection and 5-fluorouracil/leucovorin has been associated with sepsis, neutropenic sepsis and septic shock with fatal outcomes. Therapy with oxaliplatin should be administered cautiously in patients predisposed to neutropenia. Patients should be warned to report any febrile illness.

Ischemic Heart Disease

Major:

interferon beta-1b

Interferon beta-1b 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.

Liver Disease

Major:

interferon beta-1b

Interferon beta-1b has a major potential interaction with Liver Disease.

Severe hepatic injury, including hepatitis, autoimmune hepatitis, cases of hepatic failure and asymptomatic transient increases in the concentrations of serum transaminases, have been reported in patients treated with beta interferons. In some cases, these events have occurred in the presence of other drugs that have been associated with hepatic injury. The potential risk of these agents used in combination with known hepatotoxic drugs or other products (e.g., alcohol) should be considered before starting therapy, or before starting hepatotoxic drugs. Patients should be monitored for signs of hepatic injury, including the regular monitoring of liver function tests, and discontinuation of therapy should be considered if serum transaminase levels significantly increase or if hepatic injury occurs.

Myoneural Disorder

Moderate:

oxaliplatin

Oxaliplatin has a moderate potential interaction with Myoneural Disorder.

Rhabdomyolysis, including fatal cases, has been reported during the administration of oxaliplatin. Therapy with oxaliplatin should be administered cautiously in patients with or predisposed to myopathy. Clinical monitoring is recommended during therapy with oxaliplatin and discontinuation of therapy if any signs or symptoms of rhabdomyolysis occur.

Myopathy

Moderate:

oxaliplatin

Oxaliplatin has a moderate potential interaction with Myopathy.

Rhabdomyolysis, including fatal cases, has been reported during the administration of oxaliplatin. Therapy with oxaliplatin should be administered cautiously in patients with or predisposed to myopathy. Clinical monitoring is recommended during therapy with oxaliplatin and discontinuation of therapy if any signs or symptoms of rhabdomyolysis occur.

Neurological Disorders

Moderate:

oxaliplatin

Oxaliplatin has a moderate potential interaction with Neurological Disorders.

Oxaliplatin for injection is associated with two types of neuropathy. An acute, reversible, primarily peripheral, sensory neuropathy that is of early onset, occurring within hours or one to two days of dosing, that resolves within 14 days, and that frequently recurs with further dosing and a persistent (>14 days), primarily peripheral, sensory neuropathy that is usually characterized by paresthesias, dysesthesias, hypoesthesias, but may also include deficits in proprioception that can interfere with daily activities (e.g., writing, buttoning, swallowing, and difficulty walking from impaired proprioception). Ice (mucositis prophylaxis) should be avoided during the infusion of oxaliplatin for Injection because cold temperature can exacerbate acute neurological symptoms. Therapy with oxaliplatin should be administered cautiously in patients with or predisposed to neurologic dysfunction.

Neutropenia

Moderate:

oxaliplatin

Oxaliplatin has a moderate potential interaction with Neutropenia.

The use of oxaliplatin for injection and 5-fluorouracil/leucovorin has been associated with sepsis, neutropenic sepsis and septic shock with fatal outcomes. Therapy with oxaliplatin should be administered cautiously in patients predisposed to neutropenia. Patients should be warned to report any febrile illness.

Parkinsonism

Major:

interferon beta-1b

Interferon beta-1b 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.

Peripheral Neuropathy

Moderate:

oxaliplatin

Oxaliplatin has a moderate potential interaction with Peripheral Neuropathy.

Oxaliplatin for injection is associated with two types of neuropathy. An acute, reversible, primarily peripheral, sensory neuropathy that is of early onset, occurring within hours or one to two days of dosing, that resolves within 14 days, and that frequently recurs with further dosing and a persistent (>14 days), primarily peripheral, sensory neuropathy that is usually characterized by paresthesias, dysesthesias, hypoesthesias, but may also include deficits in proprioception that can interfere with daily activities (e.g., writing, buttoning, swallowing, and difficulty walking from impaired proprioception). Ice (mucositis prophylaxis) should be avoided during the infusion of oxaliplatin for Injection because cold temperature can exacerbate acute neurological symptoms. Therapy with oxaliplatin should be administered cautiously in patients with or predisposed to neurologic dysfunction.

Psychosis

Major:

interferon beta-1b

Interferon beta-1b 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.

Pulmonary Impairment

Major:

oxaliplatin

Oxaliplatin has a major potential interaction with Pulmonary Impairment.

Oxaliplatin has been associated with pulmonary fibrosis (<1% of study patients), which may be fatal. Caution should be exercised when administering oxaliplatin in patients with compromised pulmonary function. Patients should be instructed to immediately report symptoms of unexplained respiratory symptoms such as non-productive cough, dyspnea, crackles, or radiological pulmonary infiltrates. Close clinical monitoring of pulmonary function is recommended and oxaliplatin should be discontinued until further pulmonary investigation excludes interstitial lung disease or pulmonary fibrosis.

Renal Dysfunction

Moderate:

oxaliplatin

Oxaliplatin has a moderate potential interaction with Renal Dysfunction.

The major route of platinum elimination is renal excretion. The exposure (AUC) of unbound platinum in plasma ultrafiltrate tends to increase in renally impaired patients. The starting dose of oxaliplatin should be reduced in patients with severe renal impairment (creatinine clearance < 30 mL/min). Caution and close monitoring should be exercised when oxaliplatin is administered to patients with renal impairment.

Seizures

Major:

interferon beta-1b

Interferon beta-1b 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.

More resources

interferon beta-1b

A total of 361 drugs are known to interact with interferon beta-1b.

oxaliplatin

A total of 662 drugs are known to interact with oxaliplatin.

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.