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Interactions between Irinotecan and Tyruko

1 drug interaction and 11 additional warnings found for the following 2 drugs:

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Drug interactions

Major drug interactions

Major:

irinotecan natalizumab

Applies to: irinotecan and Tyruko (natalizumab)
Generally avoid

Concomitant or recent use of immunosuppressant, immunomodulating, or antineoplastic agents in patients treated with natalizumab may increase the risk of infections including progressive multifocal leukoencephalopathy (PML), a severely disabling, potentially fatal opportunistic viral infection of the brain caused by John Cunningham Virus (JCV). In clinical trials, PML occurred in two of 1869 patients with multiple sclerosis treated with natalizumab for a median of 120 weeks and one of 1043 patients with Crohn's disease after eight doses of natalizumab. Both of the MS patients were receiving concomitant interferon beta therapy, and the third patient was immunocompromised due to recent treatment with azathioprine. In the postmarketing setting, additional cases of PML have been reported in patients who were receiving no concomitant immunomodulatory therapy. Longer treatment duration of natalizumab, especially beyond 2 years, and the presence of anti-JCV antibodies are additional risk factors for the development of PML. Other potentially serious or life-threatening infections that may occur include herpes encephalitis or meningitis and opportunistic infections such as pneumocystis carinii pneumonia, pulmonary mycobacterium avium intracellulare, bronchopulmonary aspergillosis, and Burkholderia cepacia.

Management

The safety and efficacy of natalizumab in combination with immunosuppressant, immunomodulating, antineoplastic, or other myelosuppressive agents have not been established. In general, patients receiving chronic therapy with such agents should not be treated with natalizumab due to potentially increased risk of PML and other serious infections. For patients with Crohn's disease who start natalizumab while on chronic corticosteroid therapy, begin steroid withdrawal as soon as a therapeutic benefit is achieved. Natalizumab should be discontinued if patient is unable to stop using systemic corticosteroids within six months. All patients treated with natalizumab should be monitored closely during and for at least six months following discontinuation of treatment. The drug should be discontinued immediately at the first sign or symptom suggestive of PML, although it is not known if early detection of PML and discontinuation of natalizumab will mitigate the disease. Typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body, clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. Due to the long half-life of natalizumab, immune effects are possible for up to 2 to 3 months following its discontinuation.

References (4)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
  4. (2023) "Product Information. Tysabri (natalizumab)." Biogen

Food/lifestyle interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Disease interactions

11 potential interactions Applies to: 9 conditions, including Fever, Liver Disease, Infection, Bleeding Disorder, and Immunodeficiency.

Bleeding Disorder

Major:

irinotecan

Irinotecan has a major potential interaction with Bleeding Disorder.

Irinotecan induces myelosuppression, causing leukopenia, thrombocytopenia and anemia. Deaths due to sepsis following severe neutropenia have been reported in patients treated with irinotecan. Hold irinotecan if neutropenic fever occurs or if the absolute neutrophil count drops <1000/mm3. After recovery to an absolute neutrophil count =1000/mm3, subsequent doses of irinotecan should be reduced. Therapy with irinotecan should be administered cautiously in patients who have received previous irradiation therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

Bone Marrow Depression/Low Blood Counts

Major:

irinotecan

Irinotecan has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Irinotecan induces myelosuppression, causing leukopenia, thrombocytopenia and anemia. Deaths due to sepsis following severe neutropenia have been reported in patients treated with irinotecan. Hold irinotecan if neutropenic fever occurs or if the absolute neutrophil count drops <1000/mm3. After recovery to an absolute neutrophil count =1000/mm3, subsequent doses of irinotecan should be reduced. Therapy with irinotecan should be administered cautiously in patients who have received previous irradiation therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

Fever

Major:

irinotecan

Irinotecan has a major potential interaction with Fever.

Irinotecan induces myelosuppression, causing leukopenia, thrombocytopenia and anemia. Deaths due to sepsis following severe neutropenia have been reported in patients treated with irinotecan. Hold irinotecan if neutropenic fever occurs or if the absolute neutrophil count drops <1000/mm3. After recovery to an absolute neutrophil count =1000/mm3, subsequent doses of irinotecan should be reduced. Therapy with irinotecan should be administered cautiously in patients who have received previous irradiation therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

Herpes Zoster Meningitis

Moderate:

Tyruko

The natalizumab in Tyruko has a moderate potential interaction with Herpes Zoster Meningitis.

Natalizumab increases the risk of developing encephalitis and meningitis caused by herpes simplex and varicella zoster viruses. It is recommended to monitor patients receiving natalizumab for signs and symptoms of meningitis and encephalitis. If herpes encephalitis or meningitis occurs, treatment should be discontinued, and appropriate treatment for herpes encephalitis/meningitis should be administered.

Immunodeficiency

Major:

Tyruko

The natalizumab in Tyruko has a major potential interaction with Immunodeficiency.

Immunosuppressive agents may increase the risk of progressive multifocal leukoencephalopathy (PML). Certain agents are contraindicated in patients who have or have had PML. Patients receiving chronic immunosuppressant or immunomodulatory therapy or who have systemic medical conditions resulting in significantly compromised immune system function should not be treated with these agents. Health care professionals should monitor patients for any new sign or symptom suggestive of PML. Therapy dosing should be withheld immediately and an appropriate diagnostic evaluation should be performed at the first sign or symptom suggestive of PML.

Infection

Major:

irinotecan

Irinotecan has a major potential interaction with Infection.

Irinotecan induces myelosuppression, causing leukopenia, thrombocytopenia and anemia. Deaths due to sepsis following severe neutropenia have been reported in patients treated with irinotecan. Hold irinotecan if neutropenic fever occurs or if the absolute neutrophil count drops <1000/mm3. After recovery to an absolute neutrophil count =1000/mm3, subsequent doses of irinotecan should be reduced. Therapy with irinotecan should be administered cautiously in patients who have received previous irradiation therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

Major:

Tyruko

The natalizumab in Tyruko has a major potential interaction with Infection.

Serious and sometimes fatal infections have been reported in patients receiving immunosuppressive agents. Patients receiving immunosuppressants are at increased risk of developing bacterial, viral, fungal, and protozoal infections, and new or reactivated viral infections including opportunistic infections. Caution should be exercised when considering their use in patients with severe or chronic infections. It is recommended to interrupt therapy in patients who develop a new infection while undergoing treatment and to monitor these patients closely for any sign or symptom indicative of infection.

Liver Disease

Moderate:

irinotecan

Irinotecan has a moderate potential interaction with Liver Disease.

Irinotecan clearance is diminished in patients with hepatic impairment. The magnitude of these effects is proportional to the degree of liver impairment as measured by elevations in total bilirubin and transaminase concentrations. However, the tolerability of irinotecan in patients with hepatic dysfunction (bilirubin greater than 2 mg/dl) has not been assessed sufficiently, and no recommendations for dosing are made by the manufacturers. Therapy with irinotecan should be administered cautiously to patients with or predisposed to compromised hepatic function. Clinical monitoring of hepatic function is recommended.

Moderate:

Tyruko

The natalizumab in Tyruko has a moderate potential interaction with Liver Disease.

Postmarketing reports have associated the use of natalizumab with severe hepatic toxicity, including acute liver failure requiring transplant. Natalizumab should be discontinued in patients with jaundice or other evidence of significant liver injury and appropriate therapy should be instituted according to clinical guidelines.

Pulmonary Impairment

Moderate:

irinotecan

Irinotecan has a moderate potential interaction with Pulmonary Impairment.

Irinotecan can cause severe and fatal interstitial pulmonary disease (IPD). Risk factors include preexisting-existing lung disease. It is recommended to withhold treatment with irinotecan in patients with new or progressive dyspnea, cough, and fever, pending diagnostic evaluation and to discontinue treatment in patients with a confirmed diagnosis of IPD. Exercise caution when using this agent in patients presenting symptoms of dyspnea and patients with pulmonary impairment.

Renal Dysfunction

Moderate:

irinotecan

Irinotecan has a moderate potential interaction with Renal Dysfunction.

The influence of renal impairment on the pharmacokinetics of irinotecan has not been evaluated. Therefore, caution should be undertaken in patients with impaired renal function. Irinotecan hydrochloride is not recommended for use in patients on dialysis.

More resources

irinotecan

A total of 472 drugs are known to interact with irinotecan.

Tyruko

A total of 434 drugs are known to interact with Tyruko.

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.