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Drug Interactions between palbociclib and Rethymic

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

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Interactions between your drugs

Major

palbociclib allogeneic processed thymus tissue

Applies to: palbociclib and Rethymic (allogeneic processed thymus tissue)

MONITOR CLOSELY: Prolonged use of immunosuppressants, particularly high-dose corticosteroids, after administration of allogenic thymocyte-depleted thymus tissue implant, may increase the risk of damage to the implant. However, Graft Versus Host Disease (GVHD) may be caused by or exacerbated by allogenic thymocyte-depleted thymus tissue implant in patients with congenital athymia and require treatment with systemic immunosuppressive therapy. In addition, patients with congenital athymia are at an increased risk of autologous GVHD (aGVHD), which may also require systemic immunosuppressive therapy, including treatment with corticosteroids such as methylprednisolone and prednisolone.

MANAGEMENT: The manufacturer advises that prolonged use of immunosuppressive therapies, including high-dose corticosteroids, should be avoided in patients who have received an allogenic thymocyte-depleted thymus tissue implant. Some authorities consider the use of high-dose corticosteroids in the period immediately after implant to be contraindicated and generally advise against the use of pulse corticosteroids (such as methylprednisolone 30 to 40 mg/kg/day for 3 days) post-implant due to the potential for permanent damage to the implant. If immunosuppressive therapy is required post-implant, patients should be closely monitored for signs of damage to the implant as well as adverse effects from the concomitant immunosuppressant(s). The concomitant immunosuppressant(s) should be weaned as soon as clinically possible.

References (2)
  1. (2021) "Product Information. Rethymic (allogeneic processed thymus tissue)." Enzyvant Therapeutics Inc., 1
  2. Gupton, S.E, McCarthy, E.A, Markert, M.L (2021) "Care of children with DiGeorge before and after cultured thymus tissue implantation" J Clin Immunol, 41, p. 896-905

Drug and food interactions

Moderate

palbociclib food

Applies to: palbociclib

GENERALLY AVOID: Grapefruit and/or grapefruit juice may increase the systemic exposure to palbociclib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Increased exposure to palbociclib may increase the risk of adverse effects such as infections, neutropenia, leukopenia, anemia, thrombocytopenia, anorexia, nausea, vomiting, diarrhea, stomatitis, alopecia, asthenia, peripheral neuropathy, and epistaxis.

ADJUST DOSING INTERVAL: Food may enhance the oral bioavailability of palbociclib capsules and reduce the intersubject variability of palbociclib exposure. According to the product labeling, absorption and exposure of palbociclib from its oral capsule formulation were very low in approximately 13% of the population when taken in the fasted state. Food intake increased the palbociclib exposure in this small subset of the population but did not alter exposure in the rest of the population to a clinically relevant extent. Compared to palbociclib capsules given under overnight fasted conditions, the population average palbociclib peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 38% and 21%, respectively, when given with high-fat, high-calorie food (approximately 800 to 1000 calories; 150, 250, and 500 to 600 calories from protein, carbohydrate and fat, respectively); by 27% and 12%, respectively, when given with low-fat, low-calorie food (approximately 400 to 500 calories; 120, 250, and 28 to 35 calories from protein, carbohydrate and fat, respectively); and by 24% and 13%, respectively, when given with moderate-fat, standard calorie food (approximately 500 to 700 calories; 75 to 105, 250 to 350 and 175 to 245 calories from protein, carbohydrate and fat, respectively) one hour before and two hours after palbociclib capsule dosing.

MANAGEMENT: Patients should avoid consumption of grapefruit or grapefruit juice while on treatment with palbociclib. To avoid variability in drug absorption between doses, palbociclib capsules should be taken with food. Palbociclib tablet formulations may be taken with or without food.

References (4)
  1. (2020) "Product Information. Ibrance (palbociclib)." Pfizer Australia Pty Ltd, pfpibrac10620
  2. (2021) "Product Information. Ibrance (palbociclib)." Pfizer Canada Inc
  3. (2023) "Product Information. Ibrance (palbociclib)." Pfizer Ltd
  4. (2022) "Product Information. Ibrance (palbociclib)." Pfizer U.S. Pharmaceuticals Group

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

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