Can you take Panamax with Vemurafenib?

The acetaminophen in Panamax has a major potential interaction with Alcoholism.

Chronic alcohol abusers may be at increased risk of hepatotoxicity during treatment with acetaminophen (APAP). Severe liver injury, including cases of acute liver failure resulting in liver transplant and death, has been reported in patients using acetaminophen. Therapy with acetaminophen should be administered cautiously, if at all, in patients who consume three or more alcoholic drinks a day. In general, patients should avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure. They should also be advised to seek medical attention if they experience signs and symptoms of liver injury such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.

Vemurafenib has a moderate potential interaction with Arrhythmia.

Vemurafenib can cause dose dependent QT prolongation which may lead to an increased risk for ventricular arrhythmias, including Torsade de Pointes. It is recommended not to start treatment in patients with uncorrectable electrolyte abnormalities, QTc > 500 ms, or long QT syndrome, or in patients who are taking medicinal products known to prolong the QT interval. Evaluate patients prior to and following treatment initiation or after dose modification for QTc prolongation, evaluate ECG and electrolytes (including potassium, magnesium, and calcium) periodically, and thereafter as clinically indicated. Vemurafenib should be withhold in patients who develop QTc > 500 ms. Upon recovery to QTc <= 500 ms, restart at a reduced dose and it should be permanently discontinued if the QTc interval remains > 500 ms and increased > 60 ms from pre-treatment values after controlling cardiac risk factors for QT prolongation (e.g., electrolyte abnormalities, congestive heart failure, and bradyarrhythmias).

The acetaminophen in Panamax has a major potential interaction with Dehydration.

Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.

Vemurafenib has a moderate potential interaction with Dermatitis, Drug-Induced.

Severe dermatologic reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and mild to severe photosensitivity can occur in patients treated with vemurafenib. Consider dose modifications for intolerable >= Grade 2 photosensitivity. It is recommended to advise patients to avoid sun exposure, wear protective clothing and use a broad-spectrum UVA/UVB sunscreen and a suitable lip balm when outdoors while on vemurafenib treatment. Permanently discontinue vemurafenib in patients who experience a severe dermatologic reaction.

Vemurafenib has a moderate potential interaction with Electrolyte Abnormalities.

Vemurafenib can cause dose dependent QT prolongation which may lead to an increased risk for ventricular arrhythmias, including Torsade de Pointes. It is recommended not to start treatment in patients with uncorrectable electrolyte abnormalities, QTc > 500 ms, or long QT syndrome, or in patients who are taking medicinal products known to prolong the QT interval. Evaluate patients prior to and following treatment initiation or after dose modification for QTc prolongation, evaluate ECG and electrolytes (including potassium, magnesium, and calcium) periodically, and thereafter as clinically indicated. Vemurafenib should be withhold in patients who develop QTc > 500 ms. Upon recovery to QTc <= 500 ms, restart at a reduced dose and it should be permanently discontinued if the QTc interval remains > 500 ms and increased > 60 ms from pre-treatment values after controlling cardiac risk factors for QT prolongation (e.g., electrolyte abnormalities, congestive heart failure, and bradyarrhythmias).

Vemurafenib has a moderate potential interaction with History, Skin Cancer.

Cutaneous squamous cell carcinoma, keratoacanthoma, and melanoma occurred at a higher incidence in patients receiving vemurafenib. Potential risk factors associated included age (> 65 years), prior skin cancer, and chronic sun exposure. It is recommended to perform dermatologic evaluations prior to initiation of therapy and periodically thereafter as clinically indicated. Consider dermatologic monitoring for 6 months following discontinuation of vemurafenib.

Vemurafenib has a moderate potential interaction with Interstitial Lung Disease.

The use of certain multikinase inhibitors has been associated with pulmonary toxicity. Serious cases of interstitial lung disease (ILD), including fatal cases and interstitial pneumonitis or pulmonary fibrosis have been reported. Caution is recommended when using these agents in patients with a history of interstitial pneumonitis or pulmonary fibrosis or those patients presenting with acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever pending diagnostic evaluation. If ILD is confirmed, these agents should be permanently discontinued and appropriate measures should be instituted. Treatment should be immediately withheld in patients diagnosed with ILD/pneumonitis and permanently discontinued if no other potential causes of ILD/pneumonitis have been identified.

The acetaminophen in Panamax has a major potential interaction with Liver Disease.

Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.

Vemurafenib has a moderate potential interaction with Liver Disease.

Liver injury leading to functional hepatic impairment, including coagulopathy or other organ dysfunction may occur with the use of vemurafenib. Based on a population pharmacokinetic analysis to evaluate the effect of hepatic impairment, no dose adjustment is recommended for patients with mild and moderate hepatic impairment. The appropriate dose of vemurafenib has not been established in patients with severe hepatic impairment. It is recommended to monitor transaminases, alkaline phosphatase, and bilirubin before initiation of treatment and monthly during treatment, or as clinically indicated; and to manage laboratory abnormalities with dose reduction, treatment interruption, or treatment discontinuation as appropriate.

The acetaminophen in Panamax has a major potential interaction with Malnourishment.

Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.

The acetaminophen in Panamax has a moderate potential interaction with Phenylketonuria.

Several oral acetaminophen and acetaminophen-combination products, particularly flavored chewable tablets, contain the artificial sweetener, aspartame (NutraSweet). Aspartame is converted to phenylalanine in the gastrointestinal tract following ingestion. Chewable and effervescent formulations of acetaminophen products may also contain phenylalanine. The aspartame/phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

Vemurafenib has a moderate potential interaction with Pulmonary Impairment.

The use of certain multikinase inhibitors has been associated with pulmonary toxicity. Serious cases of interstitial lung disease (ILD), including fatal cases and interstitial pneumonitis or pulmonary fibrosis have been reported. Caution is recommended when using these agents in patients with a history of interstitial pneumonitis or pulmonary fibrosis or those patients presenting with acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever pending diagnostic evaluation. If ILD is confirmed, these agents should be permanently discontinued and appropriate measures should be instituted. Treatment should be immediately withheld in patients diagnosed with ILD/pneumonitis and permanently discontinued if no other potential causes of ILD/pneumonitis have been identified.

Vemurafenib has a moderate potential interaction with Renal Dysfunction.

Renal failure, including acute interstitial nephritis and acute tubular necrosis may occur with the use of vemurafenib. Based on a population pharmacokinetic analysis, no dose adjustment is recommended for patients with mild and moderate renal impairment. The appropriate dose of vemurafenib has not been established in patients with severe renal impairment. It is recommended to measure serum creatinine before initiation of therapy and periodically during treatment.

Vemurafenib has a moderate potential interaction with Skin Cancer.

Cutaneous squamous cell carcinoma, keratoacanthoma, and melanoma occurred at a higher incidence in patients receiving vemurafenib. Potential risk factors associated included age (> 65 years), prior skin cancer, and chronic sun exposure. It is recommended to perform dermatologic evaluations prior to initiation of therapy and periodically thereafter as clinically indicated. Consider dermatologic monitoring for 6 months following discontinuation of vemurafenib.

Vemurafenib has a moderate potential interaction with Visual Defect/Disturbance.

Uveitis, blurry vision, and photophobia can occur in patients treated with vemurafenib. Monitor patients for signs and symptoms of uveitis. Care must be exercised when using this agent in patients with ophthalmological complications.