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Drug Interaction Report

2 potential interactions and/or warnings found for the following 2 drugs:

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Interactions between your drugs

Minor

ifosfamide sparfloxacin

Applies to: Ifex/Mesnex (ifosfamide / mesna), Zagam (sparfloxacin)

Limited data suggest that chemotherapy with antineoplastic agents may reduce the plasma concentrations of oral quinolone antibiotics. The proposed mechanism is decreased quinolone absorption secondary to alteration of intestinal mucosa by cancer chemotherapy. In six patients with newly diagnosed hematologic malignancy, treatment with various antineoplastic agents (cyclophosphamide, cytarabine, daunorubicin, doxorubicin, mitoxantrone, prednisolone, vincristine) decreased the mean peak serum concentration (Cmax) and area under the concentration-time curve (AUC 0 to 4 hours) of ciprofloxacin by approximately 46% each. Data are not available for other quinolone antibiotics.

References

  1. Johnson EJ, MacGowan AP, Potter MN, et al. (1990) "Reduced absorption of oral ciprofloxacin after chemotherapy for haematological malignancy." J Antimicrob Chemother, 25, p. 837-42

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Drug and food interactions

Moderate

ifosfamide food

Applies to: Ifex/Mesnex (ifosfamide / mesna)

GENERALLY AVOID: Grapefruit and/or grapefruit juice may reduce the efficacy of ifosfamide, whose anticancer effect is dependent on its activation to the 4-hydroxyifosfamide metabolite via CYP450 3A4. The proposed mechanism is inhibition of CYP450 3A4 metabolism by certain compounds present in grapefruit. There are no data available about the effects of grapefruit on ifosfamide. However, in a small study, 8 patients with incurable malignancies received ifosfamide 3 g/m2 by infusion with the potent CYP450 3A4 inhibitor ketoconazole 200 mg orally twice daily for 4 days starting 1 day before the ifosfamide infusion. Ketoconazole decreased the clearance of ifosfamide by 11%, decreased systemic exposure (AUC) of the active metabolite 4-hydroxyifosfamide by 30%, and increased the AUC of the inactive but potentially neurotoxic metabolite 2-dechloroethylifosfamide by 23%, as compared to control. Because pharmacokinetic interactions involving grapefruit juice are often subject to a high degree of interpatient variability, the extent to which a given patient may be affected is difficult to predict.

GENERALLY AVOID: Alcohol may potentiate the neurotoxic effects of ifosfamide. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills. In addition, ifosfamide therapy may cause gastrointestinal disorders and alcohol consumption may increase nausea and vomiting.

MANAGEMENT: Given the potential for reduced efficacy of ifosfamide and increased risk of neurotoxicity and nephrotoxicity it may be advisable for patients to avoid consumption of grapefruit, grapefruit juice, or supplements that contain grapefruit during treatment with ifosfamide. In addition, patients receiving ifosfamide should be warned of the increased risk of neurotoxicity, nausea and vomiting when used in combination with alcohol. Patients should avoid or limit the consumption of alcohol during treatment with ifosfamide.

References

  1. (2019) "Product Information. Ifosfamide (ifosfamide)." Hikma USA (formerly West-Ward Pharmaceutical Corporation)
  2. Kerbusch T, jansen rlh, mathot raa, huitema adr, Jansen RNM, Rijswijk REN, Beijen JH (2001) "Modulation of the cytochrome P450-mediated metabolism of ifosfamide by ketoconazole and rifampin" Clin Pharmacol and Therapeutic, 70, p. 132-141
  3. (2018) "Product Information. Ifex (ifosfamide)." Baxter Pharmaceutical Products, Inc
  4. (2018) "Product Information. Holoxan (iFOSFamide)." Baxter Healthcare Pty Ltd
  5. (2022) "Product Information. Ifosfamide (ifosfamide)." Baxter Healthcare Ltd
  6. (2018) "Product Information. Ifex (ifosfamide)." Baxter Corporation
View all 6 references

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Therapeutic duplication warnings

No duplication warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.


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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.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.