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Drug Interactions between Lunelle and tipiracil / trifluridine

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

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Interactions between your drugs

Moderate

medroxyPROGESTERone tipiracil

Applies to: Lunelle (estradiol / medroxyprogesterone) and tipiracil / trifluridine

ADDITIONAL CONTRACEPTION RECOMMENDED: Coadministration with tipiracil-trifluridine may reduce the efficacy of contraceptive hormones. The mechanism has not been established. Trifluridine is an antineoplastic agent and may cause fetal harm when administered during pregnancy. Data evaluating the interaction are not available.

MANAGEMENT: Because trifluridine may cause fetal harm, it is particularly important that patients not become pregnant during tipiracil-trifluridine treatment. Female patients of childbearing potential using hormonal contraceptives should be advised of the risk of breakthrough bleeding and unintended pregnancy during concomitant tipiracil-trifluridine treatment. The manufacturer recommends use of additional barrier contraceptive methods during and for up to 6 months after tipiracil-trifluridine therapy. No recommendations are available for women using hormone-release intrauterine systems or injectable progestin-only contraceptives. Input from a gynecologist or similar expert on adequate contraception, including emergency contraception, should be sought as needed.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0

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Moderate

estradiol tipiracil

Applies to: Lunelle (estradiol / medroxyprogesterone) and tipiracil / trifluridine

ADDITIONAL CONTRACEPTION RECOMMENDED: Coadministration with tipiracil-trifluridine may reduce the efficacy of contraceptive hormones. The mechanism has not been established. Trifluridine is an antineoplastic agent and may cause fetal harm when administered during pregnancy. Data evaluating the interaction are not available.

MANAGEMENT: Because trifluridine may cause fetal harm, it is particularly important that patients not become pregnant during tipiracil-trifluridine treatment. Female patients of childbearing potential using hormonal contraceptives should be advised of the risk of breakthrough bleeding and unintended pregnancy during concomitant tipiracil-trifluridine treatment. The manufacturer recommends use of additional barrier contraceptive methods during and for up to 6 months after tipiracil-trifluridine therapy. No recommendations are available for women using hormone-release intrauterine systems or injectable progestin-only contraceptives. Input from a gynecologist or similar expert on adequate contraception, including emergency contraception, should be sought as needed.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0

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Drug and food interactions

Moderate

trifluridine food

Applies to: tipiracil / trifluridine

ADJUST DOSING INTERVAL: Administration of trifluridine-tipiracil with a standardized high-fat, high-calorie meal has been shown to decrease trifluridine peak plasma concentration (Cmax) as well as tipiracil Cmax and systemic exposure (AUC) by approximately 40% compared to administration in a fasting state in patients with cancer given a single 35 mg/m2 dose. No change in trifluridine AUC was observed.

MANAGEMENT: Based on the observed correlation between increases in the Cmax of trifluridine and decreases in neutrophil counts, trifluridine-tipiracil should be taken within one hour after completion of the morning and evening meals.

References

  1. "Product Information. Lonsurf (tipiracil-trifluridine)." Taiho Oncology, Inc. (2015):

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Minor

estradiol food

Applies to: Lunelle (estradiol / medroxyprogesterone)

Coadministration with grapefruit juice may increase the bioavailability of oral estrogens. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits. In a small, randomized, crossover study, the administration of ethinyl estradiol with grapefruit juice (compared to herbal tea) increased peak plasma drug concentration (Cmax) by 37% and area under the concentration-time curve (AUC) by 28%. Based on these findings, grapefruit juice is unlikely to affect the overall safety profile of ethinyl estradiol. However, as with other drug interactions involving grapefruit juice, the pharmacokinetic alterations are subject to a high degree of interpatient variability. Also, the effect on other estrogens has not been studied.

References

  1. Weber A, Jager R, Borner A, et al. "Can grapefruit juice influence ethinyl estradiol bioavailability?" Contraception 53 (1996): 41-7
  2. Schubert W, Eriksson U, Edgar B, Cullberg G, Hedner T "Flavonoids in grapefruit juice inhibit the in vitro hepatic metabolism of 17B-estradiol." Eur J Drug Metab Pharmacokinet 20 (1995): 219-24

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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.

See also

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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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