Drug Interaction Report

MONITOR: Coadministration of alemtuzumab with drugs that have antiplatelet or anticoagulant effects, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may increase the risk of bleeding. Use of alemtuzumab alone has been associated with autoimmune and hemolytic anemia, thrombocytopenia, prolonged myelosuppression, bone marrow aplasia, hemophilia, and pancytopenia. The mechanism for this interaction has not been clearly delineated, but is presumably due to additive antiplatelet/anticoagulant effects.

MANAGEMENT: Caution is recommended if alemtuzumab is used concomitantly with NSAIDS. Patients should be monitored for increased anticoagulant effects and bleeding complications. Patients should be advised to promptly report any signs of unusual bleeding or bruising to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, red or brown urine, or red or black stools.

ADJUST DOSE: In-vivo studies have demonstrated that the absorption of bromfenac is greatly reduced if the drug is taken within three and one-half hours following a high fat meal. The concomitant administration of a high fat meal has led to a 75% reduction in peak plasma concentrations and a 60% reduction in total area under the curve. The mechanism has not been described.

MANAGEMENT: An increased dosage of bromfenac (from 25 to 50 mg) may be needed if a high fat meal is consumed. The clinician may want to warn the patient about subtherapeutic analgesic effects if high fat meals are regularly consumed.