Drug Interaction Report

Alemtuzumab has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Severe, including fatal, autoimmune anemia and thrombocytopenia, and prolonged myelosuppression have been reported in patients receiving alemtuzumab. It is recommended to withhold therapy for severe cytopenias and to discontinue therapy for autoimmune cytopenias or recurrent/persistent severe cytopenias (except lymphopenia). It is recommended to monitor complete blood counts (CBC) at weekly intervals during therapy and more frequently if worsening anemia, neutropenia, or thrombocytopenia occurs and to assess CD4+ counts after treatment until recovery to >= 200 cells/µL.

PEMEtrexed has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Pemetrexed can cause severe myelosuppression resulting in the need for transfusion and which may lead to neutropenic infection. The risk of myelosuppression is increased in patients who do not receive vitamin supplementation (including oral folic acid and IM vitamin B12). Patients with myelosuppression should be monitored carefully. A CBC should be obtained at the beginning of each cycle and as needed. Treatment should not be initiated unless the absolute neutrophil count is at least 1500 cells/mm3 and platelet count is at least 100,000 cells/mm3.

Alemtuzumab has a moderate potential interaction with Heart Disease.

The use of alemtuzumab can cause severe infusion reactions, including pyrexia, chills/rigors, nausea, hypotension, urticaria, dyspnea, rash, emesis, and bronchospasm. Caution should be taken in patients with a history of pulmonary disease, heart disease as they may require dose-escalation and additional pre-infusion medications to manage complications as appropriate.

PEMEtrexed has a moderate potential interaction with History, Radiation Therapy.

Radiation recall can occur with pemetrexed in patients who have received radiation weeks to years previously. Patients should be monitored for inflammation/blistering in areas of previous radiation treatment; they should be advised to immediately contact their health care provider if inflammation/blisters develop in a previously irradiated area. Pemetrexed should be permanently discontinued for signs of radiation recall.

Alemtuzumab has a moderate potential interaction with Infection.

Alemtuzumab should be used with caution in patients at risk of opportunistic infections, as therapy could result in severe and prolonged lymphopenia. It is recommended to administer prophylaxis against Pneumocystis jiroveci pneumonia (PCP) and herpes viral during and for a minimum of 2 months after completion of therapy or until the CD4+ count is >=200 cells/µL. Routinely monitor patients for CMV infection during therapy and withhold therapy for serious infections and during antiviral treatment for CMV infection or confirmed CMV viremia.

PEMEtrexed has a moderate potential interaction with Liver Disease.

No formal studies have been conducted to examine pemetrexed in patients with liver dysfunction. Caution is advised.

PEMEtrexed has a major potential interaction with Pulmonary Impairment.

Serious interstitial pneumonitis (including fatal case) can occur with pemetrexed. Care should be exercised when using pemetrexed in patients with preexisting pulmonary impairment. Pemetrexed should be withheld for acute onset of new/progressive unexplained pulmonary symptoms; if pneumonitis is confirmed, pemetrexed should be permanently discontinued.

Alemtuzumab has a moderate potential interaction with Pulmonary Impairment.

The use of alemtuzumab can cause severe infusion reactions, including pyrexia, chills/rigors, nausea, hypotension, urticaria, dyspnea, rash, emesis, and bronchospasm. Caution should be taken in patients with a history of pulmonary disease, heart disease as they may require dose-escalation and additional pre-infusion medications to manage complications as appropriate.

PEMEtrexed has a major potential interaction with Renal Dysfunction.

Pemetrexed can cause severe (and sometimes fatal) renal toxicity. Pemetrexed is primarily eliminated by the kidneys; decreased renal function results in decreased clearance and increased pemetrexed exposure compared with normal renal function. No dose is recommended for patients with CrCl less than 45 mL/min. CrCl should be determined before each dose and renal function should be monitored periodically during therapy. Pemetrexed should be withheld in patients with renal toxicity until CrCl is 45 mL/min or greater.