Drug Interactions between troleandomycin and vinblastine

Troleandomycin is primarily excreted by the liver and may accumulate in patients with impaired hepatic function. In addition, the use of troleandomycin has been associated with an allergic type of cholestatic hepatitis, particularly in patients receiving the drug for more than 2 weeks or given repeated courses. Therapy with troleandomycin should be administered cautiously in patients with liver and/or biliary disease. Liver function tests should be monitored during prolonged or repeated courses of therapy, and the drug discontinued if abnormalities develop.

The use of vinblastine is contraindicated in patients with significant granulocytopenia. Vinblastine induces dose-dependent leukopenia. Thrombocytopenia and anemia have been reported infrequently during vinblastine therapy. Therapy with vinblastine should be administered cautiously in patients whose bone marrow reserve may be severely depressed by prior chemotherapy or irradiation or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

The use of vinblastine is contraindicated in patients with significant granulocytopenia. Vinblastine induces dose-dependent leukopenia. Thrombocytopenia and anemia have been reported infrequently during vinblastine therapy. Therapy with vinblastine should be administered cautiously in patients whose bone marrow reserve may be severely depressed by prior chemotherapy or irradiation or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

The use of vinblastine is contraindicated in patients with significant granulocytopenia. Vinblastine induces dose-dependent leukopenia. Thrombocytopenia and anemia have been reported infrequently during vinblastine therapy. Therapy with vinblastine should be administered cautiously in patients whose bone marrow reserve may be severely depressed by prior chemotherapy or irradiation or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

The use of vinblastine is contraindicated in patients with known infectious diseases. Vinblastine can induce myelosuppression. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during therapy with vinblastine. Close clinical monitoring of hematopoietic function is recommended. Vinblastine should not be used in patients with neutrophil counts below 1000/mm3.

Troleandomycin is primarily excreted by the liver and may accumulate in patients with impaired hepatic function. In addition, the use of troleandomycin has been associated with an allergic type of cholestatic hepatitis, particularly in patients receiving the drug for more than 2 weeks or given repeated courses. Therapy with troleandomycin should be administered cautiously in patients with liver and/or biliary disease. Liver function tests should be monitored during prolonged or repeated courses of therapy, and the drug discontinued if abnormalities develop.

Acute shortness of breath and bronchospasm, some severe and life-threatening, have been reported with the use of vinca alkaloids. These reactions were observed most often during combination therapy with mitomycin C, occurring within minutes to several hours after administration of the vinca alkaloid or up to 2 weeks following the mitomycin dose. Therapy with vinca alkaloids should be administered cautiously in patients with preexisting pulmonary dysfunction. Aggressive treatment may be necessary, including use of supplemental oxygen, bronchodilators, and/or corticosteroids. In patients who develop progressive dyspnea requiring chronic therapy, vinca alkaloid should not be readministered.

Vinblastine is metabolized by the liver and eliminated primarily via biliary excretion. Patients with hepatic impairment may be at increased risk for toxicity associated with vinblastine therapy. Therapy with vinblastine should be administered cautiously in patients with compromised hepatic function.