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Drug Interactions between naloxegol and pegvaliase

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

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Interactions between your drugs

Moderate

naloxegol pegvaliase

Applies to: naloxegol and pegvaliase

MONITOR: Coadministration of pegvaliase with other PEGylated products may increase the risk of hypersensitivity reactions, including anaphylaxis. In a single-dose study of pegvaliase in adults with phenylketonuria, two patients experienced hypersensitivity reactions during concomitant injections of medroxyprogesterone acetate suspension, a formulation containing PEG 3350. The first patient experienced a hypersensitivity reaction on day 15 after a single 0.67 mg dose of pegvaliase within 15 minutes following medroxyprogesterone acetate injection, and subsequently experienced anaphylaxis on day 89 within 30 minutes after the next dose of medroxyprogesterone acetate injection. The second patient experienced a hypersensitivity reaction on day 40 after a single 0.08 mg dose of pegvaliase within 10 minutes following medroxyprogesterone acetate injection. Both patients had high anti-PEG IgG antibody titers at or around the time of the hypersensitivity reactions. In clinical trials, the majority of patients developed anti-PEG IgM and IgG antibodies after treatment with pegvaliase. The clinical effects of concomitant treatment with different PEGylated products is unknown.

MANAGEMENT: Close monitoring for anaphylaxis and other hypersensitivity reactions is recommended during concomitant use of pegvaliase with other PEGylated products or products that contain polyethylene glycol (e.g., certolizumab pegol; doxorubicin liposomal; eflapegrastim; epoetin beta-methoxy polyethylene glycol; irinotecan liposomal; medroxyprogesterone acetate suspension; naloxegol; pegademase bovine; pegaptanib; pegaspargase; pegfilgrastim; peginesatide; peginterferons; pegloticase; pegvisomant; certain formulations of recombinant antihemophilic factor and coagulation factor IX).

References (1)
  1. (2018) "Product Information. Palynziq (pegvaliase)." BioMarin Pharmaceutical Inc

Drug and food interactions

Major

naloxegol food

Applies to: naloxegol

GENERALLY AVOID: Grapefruit juice may significantly increase the plasma concentrations of naloxegol. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. In pharmacokinetic studies, naloxegol systemic exposure (AUC) was increased approximately 3.5-fold by the moderate CYP450 3A4 inhibitor diltiazem and nearly 13-fold by the potent inhibitor ketoconazole. The interaction has not been studied with grapefruit juice. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Increased exposure to naloxegol may precipitate opioid withdrawal symptoms such as hyperhidrosis, lacrimation, rhinorrhea, chills, diarrhea, abdominal pain, anxiety, insomnia, irritability, restlessness, and yawning.

ADJUST DOSING INTERVAL: Food may increase the rate and extent of naloxegol absorption. When administered with a high-fat meal, naloxegol peak plasma concentration (Cmax) and systemic exposure (AUC) increased by approximately 30% and 45%, respectively. In clinical trials, naloxegol was given on an empty stomach approximately 1 hour prior to the first meal in the morning.

MANAGEMENT: Patients treated with naloxegol should avoid consumption of grapefruit and grapefruit juice. Naloxegol should be taken on an empty stomach at least 1 hour prior to the first meal of the day or 2 hours after the meal.

References (1)
  1. (2014) "Product Information. Movantik (naloxegol)." Astra-Zeneca Pharmaceuticals

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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