Drug Interaction Report

MONITOR: The concomitant or sequential administration of multiple antineoplastic agents may result in additive toxicities, particularly in the bone marrow, gastrointestinal tract and heart.

MANAGEMENT: Close clinical and laboratory monitoring for hematologic and nonhematologic toxicities are recommended when antineoplastic agents are administered concurrently or during close intervals. Dosing adjustments may be necessary. The manufacturers' recommendations and institutional protocols for dosage, treatment regimens, monitoring, and management of toxicities should be consulted.

MONITOR: Gadobenate dimeglumine may compete with other substrates of the canalicular multispecific organic anion transporter, also known as cMOAT or MRP2, which is an endogenous transporter protein that works in coordination with the conjugation process to facilitate drug excretion. In solid tumor cells, overexpression of MRP2 confers resistance to a wide variety of anticancer chemotherapeutic agents. Substrates of MRP2 include anthracyclines, protease inhibitors, taxanes, vinca alkaloids, cisplatin, etoposide, methotrexate, and tamoxifen. Theoretically, competition for MRP2 transport may interfere with the clearance of these drugs and/or gadobenate dimeglumine. In patients with tumor cell lines that express MRP2, the interaction may also result in enhanced pharmacologic response to some chemotherapeutic agents.

MANAGEMENT: Caution is advised during concomitant use of gadobenate dimeglumine and other substrates of MRP2. Patients should be monitored for potentially increased pharmacologic effects of gadobenate dimeglumine as well as the coadministered drug(s).