Drug Interaction Report

Bosutinib has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

Thrombocytopenia, aplastic anemia, agranulocytosis, and neutropenia occur with BCR-ABL tyrosine kinase inhibitors. Therapy with these drugs should be administered cautiously in patients with preexisting bone marrow suppression. A complete blood count should be performed every 1 to 2 weeks for the first month of therapy and then monthly thereafter, or as clinically indicated. To manage myelosuppression, withhold, reduce dose, or discontinue therapy as necessary.

Bosutinib has a moderate potential interaction with Cardiovascular Conditions and Disorders.

Cardiovascular events (including arterial vascular occlusive events, peripheral arterial occlusive disease, and ischemic cerebrovascular events) have been reported in patients receiving BCR-ABL tyrosine kinase inhibitors. Patients should seek immediate medical attention if acute signs or symptoms of cardiovascular events occur. Cardiovascular status should be evaluated, and cardiovascular risk factors should be monitored and actively managed during treatment.

Bosutinib has a moderate potential interaction with Dehydration.

Adequate hydration might be necessary during therapy with bosutinib as diarrhea, nausea, vomiting, and abdominal pain occur with treatment. Monitor and manage patients using standards of care, including antidiarrheals, antiemetics, and fluid replacement. To manage gastrointestinal toxicity, withhold, dose reduce, or discontinue bosutinib as necessary.

Bosutinib has a moderate potential interaction with Diarrhea.

Adequate hydration might be necessary during therapy with bosutinib as diarrhea, nausea, vomiting, and abdominal pain occur with treatment. Monitor and manage patients using standards of care, including antidiarrheals, antiemetics, and fluid replacement. To manage gastrointestinal toxicity, withhold, dose reduce, or discontinue bosutinib as necessary.

Bosutinib has a moderate potential interaction with Fluid Retention.

Fluid retention occurs with BCR-ABL tyrosine kinase inhibitors therapy and may manifest as pericardial effusion, pleural effusion, pulmonary edema, and/or peripheral edema. Caution should be taken when using these drugs in patients with preexisting fluid retention or congestive heart failure. Monitor and manage patients using standards of care. Interrupt, reduce dose or discontinue therapy as necessary.

Bosutinib has a moderate potential interaction with Heart Failure.

Fluid retention occurs with BCR-ABL tyrosine kinase inhibitors therapy and may manifest as pericardial effusion, pleural effusion, pulmonary edema, and/or peripheral edema. Caution should be taken when using these drugs in patients with preexisting fluid retention or congestive heart failure. Monitor and manage patients using standards of care. Interrupt, reduce dose or discontinue therapy as necessary.

The duvelisib in Copiktra has a major potential interaction with Infection.

Any infection should be treated prior to initiation of treatment with duvelisib. Serious, including fatal infections have occurred in patients receiving treatment with this drug. The most common serious infections were pneumonia (including fatal pneumocystis jirovecii pneumonia, PJP), sepsis, and lower respiratory infections. Advise patients to report any new or worsening signs and symptoms of infection. In some cases, treatment might need to be suspended while the infection is treated. Prophylaxis for PJP should be provided during treatment, and in some cases also prophylactic antivirals should be considered in patients with history of CMV infection to avoid CMV reactivation.

Bosutinib has a moderate potential interaction with Liver Disease.

Bosutinib is primarily metabolized by the CYP 450 3A4. Therapy with bosutinib should be administered cautiously in patients with hepatic impairment and the starting dose should be 200 mg daily in patients with baseline hepatic impairment. The manufacturer recommends performing hepatic enzyme tests monthly for the first three months of bosutinib treatment and as clinically indicated. In patients with transaminase elevations, monitor liver enzymes more frequently. Withhold, reduce dose, or discontinue bosutinib as necessary.

The duvelisib in Copiktra has a moderate potential interaction with Liver Disease.

Bilirubin and ALT and/or AST elevation has been reported in patients receiving duvelisib. Monitor hepatic function in all patients during treatment with duvelisib. Caution and close monitoring is advised in patients with hepatic impairment.

The duvelisib in Copiktra has a moderate potential interaction with Neutropenia.

Caution and close monitoring is advised when starting treatment in patients with neutropenia. Grade 3 or 4 neutropenia has been reported in 42% of patients receiving treatment. Monitor neutrophil counts at least every 2 weeks for the first 2 months of duvelisib therapy, and at least weekly in patients with neutrophil counts < 1.0 Gi/L (Grade 3-4). Withhold treatment with duvelisib in patients presenting with neutrophil counts < 0.5 Gi/L (Grade 4). Monitor until ANC is > 0.5 Gi/L, and then resume duvelisib at same dose for the first occurrence or a reduced dose for subsequent occurrence.

The duvelisib in Copiktra has a major potential interaction with Noninfectious Colitis.

Serious, including fatal diarrhea or colitis has been reported in 18% of patients receiving treatment with duvelisib. Patients with history of colitis should be monitored closely for any signs or symptoms. Advise patients to report any new or worsening diarrhea. Patients presenting with abdominal pain, stool with mucus or blood, change in bowel habits, peritoneal signs, or with diarrhea that is noninfectious should be followed closely and supportive therapy should be initiated based on severity (antidiarrheal agents, to enteric acting or systemic steroids if needed). A diagnostic work- up to determine etiology, including colonoscopy, should be performed. Monitor at least weekly. Upon resolution of the diarrhea or colitis, treatment can be restarted at a reduced dose. Treatment should be discontinued for recurrent Grade 3 diarrhea or recurrent colitis of any grade.

Bosutinib has a moderate potential interaction with Pleural Effusion.

Fluid retention occurs with BCR-ABL tyrosine kinase inhibitors therapy and may manifest as pericardial effusion, pleural effusion, pulmonary edema, and/or peripheral edema. Caution should be taken when using these drugs in patients with preexisting fluid retention or congestive heart failure. Monitor and manage patients using standards of care. Interrupt, reduce dose or discontinue therapy as necessary.

Bosutinib has a moderate potential interaction with Renal Dysfunction.

An on-treatment decline in estimated glomerular filtration rate (eGFR) has occurred in patients treated with bosutinib. The manufacturer recommends reducing the bosutinib starting dose in patients with severe (CrCl) less than 30 mL/min) or moderate (CrCl 30 to 50 mL/min) renal impairment at baseline. Consider dose adjustment in patients with baseline and treatment emergent renal impairment. It is recommended to monitor patients for renal function at baseline and during therapy with bosutinib, with particular attention to those patients who have preexisting renal impairment or risk factors for renal dysfunction.

Bosutinib has a moderate potential interaction with Vomiting.

Adequate hydration might be necessary during therapy with bosutinib as diarrhea, nausea, vomiting, and abdominal pain occur with treatment. Monitor and manage patients using standards of care, including antidiarrheals, antiemetics, and fluid replacement. To manage gastrointestinal toxicity, withhold, dose reduce, or discontinue bosutinib as necessary.