Drug Interaction Report

MONITOR: Coadministration with blinatumomab may increase the plasma concentrations of drugs that are substrates of CYP450 isoenzymes. Initiation of blinatumomab treatment causes transient release of cytokines that may suppress CYP450 enzymes, although the potential for interaction has not been studied. Presumably, the highest drug-drug interaction risk would be during the first 9 days of the first cycle and the first 2 days of the second cycle.

MANAGEMENT: Caution is advised when blinatumomab is prescribed to patients receiving drugs that are metabolized by CYP450 isoenzymes, particularly those with a narrow therapeutic index such as carbamazepine, colchicine, cyclosporine, disopyramide, phenytoin, quinidine, theophylline, warfarin, macrolide immunosuppressants, vinca alkaloids, and some narcotic analgesics. Clinical and laboratory monitoring are recommended following the initiation of blinatumomab, and the individual dosage of the concomitant agents adjusted as needed.

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.