Can you take Nelarabine with Radium 223 dichloride?

The radium Ra 223 dichloride in radium 223 dichloride has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

A randomized clinical trial reported that 2% of the patients receiving radium Ra 223 experienced bone marrow failure or ongoing pancytopenia, including 2 deaths due to bone marrow failure. Myelosuppression including thrombocytopenia, neutropenia, pancytopenia, and leukopenia have been reported in patients receiving this agent. Patients should have a baseline hematologic evaluation, as well as another evaluation prior to every dose. The absolute neutrophil count (ANC) prior to the first administration should be >= 1.5 x 10^9/L, the platelet count should be >= 100 x 10^9/L, and hemoglobin should be >= 10 g/dL; and before subsequent administrations, the ANC should be >= 1 x 10^9/L and the platelet count >= 50 x 10^9/L. Discontinue treatment if after the last administration there is no recovery of these values within 6 to 8 weeks, despite supporting care and in those patients experiencing life-threatening complications. Caution is advised in patients with preexisting hematologic issues.

Nelarabine has a major potential interaction with History, Radiation Therapy.

Severe neurologic adverse reactions have been reported with the use of nelarabine. Neurotoxicity is the dose-limiting toxicity of nelarabine. Patients treated previously or concurrently with intrathecal chemotherapy or previously with craniospinal irradiation may be at increased risk for neurologic adverse events. Close monitoring for neurologic adverse reactions is strongly recommended, when using nelarabine and therapy should be discontinued for neurologic adverse reactions of NCI Common Toxicity Criteria Grade 2 or greater.

Nelarabine has a moderate potential interaction with Hyperuricemia Secondary to Chemotherapy.

Patients receiving nelarabine should receive intravenous hydration according to standard medical practice for the management of hyperuricemia in patients at risk for tumor lysis syndrome. Consideration should be given to the use of allopurinol in patients at risk of hyperuricemia.

Nelarabine has a moderate potential interaction with Liver Disease.

The influence of hepatic impairment on the pharmacokinetics of nelarabine has not been evaluated. Because the risk of adverse reactions to this drug may be greater in patients with severe hepatic impairment (total bilirubin greater than 3 times upper limit of normal), it is recommended to closely monitor patients with severe liver dysfunction when treated with nelarabine.

The radium Ra 223 dichloride in radium 223 dichloride has a moderate potential interaction with Liver Disease.

No dedicated hepatic or renal impairment studies have been conducted for radium Ra 223. Subgroup analyses in the randomized controlled trials have concluded that no dose adjustment is needed in patients with mild to moderate renal impairment, and mild hepatic impairment. No dose adjustment can be recommended for patients with severe renal impairment or moderate to severe hepatic impairment. Caution is advised if used in these patients.

Nelarabine has a major potential interaction with Neurological Disorders.

Severe neurologic adverse reactions have been reported with the use of nelarabine. Neurotoxicity is the dose-limiting toxicity of nelarabine. Patients treated previously or concurrently with intrathecal chemotherapy or previously with craniospinal irradiation may be at increased risk for neurologic adverse events. Close monitoring for neurologic adverse reactions is strongly recommended, when using nelarabine and therapy should be discontinued for neurologic adverse reactions of NCI Common Toxicity Criteria Grade 2 or greater.

Nelarabine has a moderate potential interaction with Renal Dysfunction.

Nelarabine has not been studied in patients with renal dysfunction. There are insufficient data to support a dose recommendation for patients with a CrCl less than 50 mL/min. Because the risk of adverse reactions to this drug may be greater in patients with moderate (CrCl 30 to 50 mL/min) or severe (CrCl less than 30 mL/min) renal impairment, these patients should be closely monitored for toxicities if treated with this drug.

The radium Ra 223 dichloride in radium 223 dichloride has a moderate potential interaction with Renal Dysfunction.

No dedicated hepatic or renal impairment studies have been conducted for radium Ra 223. Subgroup analyses in the randomized controlled trials have concluded that no dose adjustment is needed in patients with mild to moderate renal impairment, and mild hepatic impairment. No dose adjustment can be recommended for patients with severe renal impairment or moderate to severe hepatic impairment. Caution is advised if used in these patients.

Nelarabine has a moderate potential interaction with Tumor Lysis Syndrome.

Patients receiving nelarabine should receive intravenous hydration according to standard medical practice for the management of hyperuricemia in patients at risk for tumor lysis syndrome. Consideration should be given to the use of allopurinol in patients at risk of hyperuricemia.

Nelarabine has a major potential interaction with Vaccination.

Immunocompromised patients receiving nelarabine should avoid receiving live vaccines.