Drug Interaction Report
1 drug interaction and 8 additional warnings found for the following 2 drugs:
- pemetrexed
- treosulfan
Drug interactions
Moderate drug interactions
Moderate:treosulfan PEMEtrexed
Applies to: treosulfan, pemetrexed
Using PEMEtrexed together with treosulfan or other chemotherapy drugs may increase the risk of side effects, especially those that affect the bone marrow or gastrointestinal tract.
You may experience a greater number or more severe side effects such as:
- nausea
- vomiting
- diarrhea
- loss of appetite
- mouth sores
- abdominal pain
- delayed wound healing
- impaired bone marrow function resulting in low numbers of different types of blood cells
You may also be more likely to develop anemia, bleeding problems, or infections due to low blood cell counts.
You should seek medical attention if you develop:
- paleness
- fatigue
- dizziness
- fainting
- unusual bruising or bleeding
- fever
- chills
- diarrhea
- sore throat
- muscle aches
- shortness of breath
- blood in phlegm
- weight loss
- red or inflamed skin
- body sores
- pain or burning during urination
You may need a dose adjustment or more frequent monitoring by your doctor to safely use these medications.
It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Food/lifestyle interactions
No alcohol/food interactions were found with the drugs in your list. However, this does not necessarily mean no food interactions exist. Always consult your healthcare provider.
Disease interactions
8 potential interactionsApplies to: 6 conditions, including Seizures, Liver Disease, Renal Dysfunction, History, Radiation Therapy, and Bone Marrow Depression/Low Blood Counts.
Bone Marrow Depression/Low Blood Counts
Major:pemetrexed
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.
History, Radiation Therapy
Moderate:pemetrexed
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.
Liver Disease
Moderate:pemetrexed
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.
Moderate:treosulfan
Treosulfan has a moderate potential interaction with Liver Disease.
Treosulfan has not been studied in patients with moderate or severe liver and renal dysfunction.
Pulmonary Impairment
Major:pemetrexed
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.
Renal Dysfunction
Major:pemetrexed
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.
Moderate:treosulfan
Treosulfan has a moderate potential interaction with Renal Dysfunction.
Treosulfan has not been studied in patients with moderate or severe liver and renal dysfunction.
Seizures
Moderate:treosulfan
Treosulfan has a moderate potential interaction with Seizures.
There have been reports of seizures in patients following treatment with treosulfan. Patients should be monitored for signs of neurological adverse reactions, and clonazepam prophylaxis may be considered for patients at higher risk for seizures, including infants.
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Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| 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.