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Drug Interactions between irinotecan liposomal and Zytiga

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

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Interactions between your drugs

Moderate

abiraterone irinotecan liposomal

Applies to: Zytiga (abiraterone) and irinotecan liposomal

MONITOR: Coadministration with inhibitors of CYP450 3A4 and/or UGT1A1 may increase the plasma concentrations of irinotecan and its active metabolite, SN-38. CYP450 3A4 and UGT1A1 are the isoenzymes responsible for the metabolic conversion of irinotecan to its inactive metabolite, APC. Inhibition of APC formation results in more irinotecan metabolism to SN-38, an active and toxic metabolite. High plasma levels of irinotecan and SN-38 may increase the risk of potentially fatal toxicities such as severe diarrhea, neutropenia, sepsis, and thromboembolism. In cancer patients receiving irinotecan, coadministration of ketoconazole, a potent CYP450 3A4 and UGT1A1 inhibitor, resulted in a 100% increase in the relative exposure to SN-38 and an 87% reduction in the exposure to APC. In HIV patients with Kaposi's sarcoma, coadministration of irinotecan with lopinavir-ritonavir decreased the clearance of irinotecan by 47%, increased the AUC of SN-38 by 204%, and decreased the AUC of APC by 81%.

MANAGEMENT: Caution is advised when irinotecan is prescribed with CYP450 3A4 or UGT1A1 inhibitors. Patients should be monitored for toxicities such as diarrhea, myelosuppression, thromboembolism, and interstitial lung disease, and the irinotecan dosage adjusted accordingly or treatment discontinued as necessary.

References

  1. (2001) "Product Information. Camptosar (irinotecan)." Pharmacia and Upjohn
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
  4. Corona G, Vaccher E, Sandron S, et al. (2008) "Lopinavir-ritonavir dramatically affects the pharmacokinetics of irinotecan in HIV patients with Kaposi's sarcoma." Clin Pharmacol Ther, 83, p. 601-6
  5. Cerner Multum, Inc. "Australian Product Information."
  6. Phansalker S, Desai AA, Bell D, et al. (2012) "High-priority drug-drug interactions for use in electronic health records." J Am Med Inform Assoc, 19, p. 735-43
  7. (2015) "Product Information. Onivyde (irinotecan liposomal)." Merrimack Pharmaceuticals
View all 7 references

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Drug and food interactions

Moderate

abiraterone food

Applies to: Zytiga (abiraterone)

ADJUST DOSING INTERVAL: Food may significantly increase the oral bioavailability of some formulations of abiraterone acetate. Compared to administration in the fasted state, abiraterone peak plasma concentration (Cmax) and systemic exposure (AUC) were approximately 7- and 5-fold higher, respectively, when a single dose of abiraterone acetate was administered with a low-fat meal (7% fat; 300 calories) and approximately 17- and 10-fold higher, respectively, when it was administered with a high-fat meal (57% fat; 825 calories). Given the normal variation in the content and composition of meals, taking abiraterone acetate with meals has the potential to result in increased and highly variable exposures. The safety of these increased exposures during multiple dosing has not been assessed. However, the abiraterone acetate 125 mg tablet, commonly marketed as Yonsa, was found to have an approximately 6.5-fold higher Cmax and 4.4-fold higher AUC when a single dose of 500 mg (4 tablets) was administered with a high-fat meal (56% - 60% fat, 900 - 1000 calories) compared to overnight fasting in healthy volunteers. These differences were not considered clinically significant for this formulation.

MANAGEMENT: Some formulations of abiraterone acetate must be taken on an empty stomach. No food should be consumed for at least two hours before and one hour after the abiraterone acetate dose. However, the abiraterone acetate 125 mg tablet, commonly marketed as Yonsa, can be taken with or without food. The manufacturer's product labeling should be consulted for specific guidance.

References

  1. (2011) "Product Information. Zytiga (abiraterone)." Centocor Inc
  2. (2023) "Product Information. Akeega (abiraterone-niraparib)." Janssen Biotech, Inc.
  3. (2023) "Product Information. Akeega (abiraterone-niraparib)." Janssen Inc
  4. (2021) "Product Information. Zytiga (abiraterone)." Janssen Biotech, Inc.
  5. (2022) "Product Information. Yonsa (abiraterone)." Sun Pharmaceutical Industries
  6. (2023) "Product Information. Apo-Abiraterone (abiraterone)." Apotex Inc
  7. (2021) "Product Information. Zytiga (abiraterone)." Janssen-Cilag Pty Ltd
  8. (2023) "Product Information. Abiraterone (abiraterone)." Wockhardt UK Ltd
  9. (2023) "Product Information. Yonsa Mpred (abiraterone-methylprednisolone)." Sun Pharma ANZ Pty Ltd
View all 9 references

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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.