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Interactions between Pegaspargase and Talquetamab

1 drug interaction and 9 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

pegaspargase talquetamab

Applies to: pegaspargase and talquetamab
Monitor

Concomitant use of asparaginase with other hepatotoxic agents may potentiate the risk of liver injury. Asparaginase-associated hepatotoxicity has been reported more commonly in adults than in children and has been strongly associated with obesity. Hepatomegaly, acute severe hepatotoxicity, and fatal liver failure have been reported with asparaginase treatment in adults. Also, asparaginase may increase the toxicity of drugs bound to plasma proteins or metabolized by the liver.

Management

The risk of additive hepatotoxicity should be considered when asparaginase is used with other hepatotoxic agents (e.g., alcohol, androgens, antituberculosis agents, azole antifungal agents, ACE inhibitors, macrolide antibiotics, nonsteroidal anti-inflammatory agents, nucleoside reverse transcriptase inhibitors, sulfonamides, thiazolidinediones, and statins). Liver function tests should be monitored at regular intervals during asparaginase treatment with or without other hepatotoxic drugs. Patients should be advised to seek medical attention if they experience potential symptoms of hepatotoxicity such as right upper quadrant pain, increasing abdominal size, fever, rash, itching, anorexia, nausea, vomiting, fatigue, malaise, dark urine, pale stools, and jaundice.

References (13)
  1. (2001) "Product Information. Oncaspar (pegaspargase)." Rhone Poulenc Rorer
  2. (2001) "Product Information. Elspar (asparaginase)." Merck & Co., Inc
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. Cerner Multum, Inc. "Australian Product Information."
  5. "Product Information. Erwinaze (asparaginase Erwinia chrysanthemi)." EUSA Pharma
  6. Cerner Multum, Inc (2015) "ANVISA Bulário Eletrônico."
  7. (2019) "Product Information. Asparlas (calaspargase pegol)." Servier
  8. Al-Nawakil C, Willems L, Mauprivez C, et al. (2014) "Successful treatment of l-asparaginase-induced severe acute hepatotoxicity using mitochondrial cofactors." Leuk Lymphoma, 55, p. 1670-4
  9. Christ TN, Stock W, Knoebel RW (2018) "Incidence of asparaginase-related hepatotoxicity, pancreatitis, and thrombotic events in adults with acute lymphoblastic leukemia treated with a pediatric-inspired regimen." J Oncol Pharm Pract, 24, p. 299-308
  10. Jenkins R, Perlin E (1987) "Severe hepatotoxicity from Escherichia coli L-asparaginase." J Natl Med Assoc, 79, p. 775-9
  11. Lu G, Karur V, Herrington JD, Walker MG (2016) "Successful treatment of pegaspargase-induced acute hepatotoxicity with vitamin B complex and L-carnitine" Proc (Bayl Univ Med Cent), 29, p. 46-7
  12. Bodmer M, Sulz M, Stadlmann S, Droll A, Terracciano L, Krahenbuhl S (2006) "Fatal liver failure in an adult patient with acute lymphoblastic leukemia following treatment with L-asparaginase." Digestion, 74, epub
  13. Burke PW, Aldoss I, Lunning MA, et al. (2013) "High-grade PEGylated asparaginase-related hepatotoxicity occurrence in a pediatric-inspired adult acute lymphoblastic leukemia regimen does not necessarily predict recurrent hepatotoxicity in subsequent cycles." Blood, 122, p. 2671

Food/lifestyle interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Disease interactions

9 potential interactions Applies to: 8 conditions, including Diabetes Mellitus, Thrombotic/Thromboembolic Disorder, Liver Disease, Pancreatitis, and Infection.

Bleeding Disorder

Major:

pegaspargase

Pegaspargase has a major potential interaction with Bleeding Disorder.

The use of pegaspargase is contraindicated in patients who developed significant bleeding with previous L-asparaginase therapy. Pegaspargase interferes with coagulation factors, and both thrombosis and hemorrhage have been observed. Therapy with pegaspargase should be administered with extreme caution to patients with or predisposed to coagulopathies. Patients should be instructed to immediately report any signs or symptoms of thrombosis or bleeding. Close clinical monitoring of hematopoetic function and coagulation profiles is recommended.

Diabetes Mellitus

Moderate:

pegaspargase

Pegaspargase has a moderate potential interaction with Diabetes Mellitus.

Hyperglycemia requiring insulin therapy has been reported during pegaspargase therapy. Therapy with pegaspargase should be administered cautiously to patients with diabetes mellitus.

History, Thrombotic/Thromboembolic Disorder

Major:

pegaspargase

Pegaspargase has a major potential interaction with History, Thrombotic/Thromboembolic Disorder.

The use of pegaspargase is contraindicated in patients who developed significant bleeding with previous L-asparaginase therapy. Pegaspargase interferes with coagulation factors, and both thrombosis and hemorrhage have been observed. Therapy with pegaspargase should be administered with extreme caution to patients with or predisposed to coagulopathies. Patients should be instructed to immediately report any signs or symptoms of thrombosis or bleeding. Close clinical monitoring of hematopoetic function and coagulation profiles is recommended.

Infection

Moderate:

talquetamab

Talquetamab has a moderate potential interaction with Infection.

Teclistamab and talquetamab can cause severe, life-threatening, or fatal infections. Patients should be monitored for signs and symptoms of infection prior to and during treatment. Any infection should be treated appropriately. Administer prophylactic antimicrobials according to clinical guidelines.

Liver Disease

Moderate:

pegaspargase

Pegaspargase has a moderate potential interaction with Liver Disease.

Reversible liver abnormalities such as elevated liver transaminase and bilirubin levels and decreased albumin synthesis have been reported during pegaspargase therapy. Fatty changes and liver failure have occurred. Patients should be instructed to immediately report any sign or symptoms of hepatic dysfunction such as jaundice, dark urine, right upper quadrant pain, or anorexia. Therapy with pegaspargase should be administered cautiously to patients with or predisposed to compromised hepatic function. Clinical monitoring of hepatic function is recommended.

Moderate:

talquetamab

Talquetamab has a moderate potential interaction with Liver Disease.

The effects of severe renal impairment (eGFR less than 30 mL/min) on the pharmacokinetics of teclistamab and talquetamab are unknown. Moderate to severe hepatic impairment (total bilirubin greater than 1.5 times ULN with any AST) on the pharmacokinetics of teclistamab are unknown. Severe hepatic impairment (total bilirubin greater than 3 times ULN with any AST) on the pharmacokinetics of talquetamab are unknown. Additionally, teclistamab and talquetamab have caused hepatotoxicity, including fatalities. Caution is advised in patients with renal and hepatic impairment. Monitor liver enzymes and bilirubin at baseline and during treatment as clinically indicated.

Pancreatitis

Major:

pegaspargase

Pegaspargase has a major potential interaction with Pancreatitis.

The use of pegaspargase is contraindicated in patients with or a history of pancreatitis. Pegaspargase can cause decreased insulin synthesis or inflammation and/or necrosis of cells of the pancreas. Fulminant and fatal pancreatitis has occurred. Clinical monitoring of pancreatic function, including serum amylase levels, is recommended.

Renal Dysfunction

Moderate:

talquetamab

Talquetamab has a moderate potential interaction with Renal Dysfunction.

The effects of severe renal impairment (eGFR less than 30 mL/min) on the pharmacokinetics of teclistamab and talquetamab are unknown. Moderate to severe hepatic impairment (total bilirubin greater than 1.5 times ULN with any AST) on the pharmacokinetics of teclistamab are unknown. Severe hepatic impairment (total bilirubin greater than 3 times ULN with any AST) on the pharmacokinetics of talquetamab are unknown. Additionally, teclistamab and talquetamab have caused hepatotoxicity, including fatalities. Caution is advised in patients with renal and hepatic impairment. Monitor liver enzymes and bilirubin at baseline and during treatment as clinically indicated.

Thrombotic/Thromboembolic Disorder

Major:

pegaspargase

Pegaspargase has a major potential interaction with Thrombotic/Thromboembolic Disorder.

The use of pegaspargase is contraindicated in patients who developed significant bleeding with previous L-asparaginase therapy. Pegaspargase interferes with coagulation factors, and both thrombosis and hemorrhage have been observed. Therapy with pegaspargase should be administered with extreme caution to patients with or predisposed to coagulopathies. Patients should be instructed to immediately report any signs or symptoms of thrombosis or bleeding. Close clinical monitoring of hematopoetic function and coagulation profiles is recommended.

More resources

pegaspargase

A total of 556 drugs are known to interact with pegaspargase.

talquetamab

A total of 483 drugs are known to interact with talquetamab.

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.