Drug Interaction Report

The sibutramine in Meridia has a moderate potential interaction with Alcoholism.

Centrally-acting anorexiants are generally subject to habituation and abuse. While sibutramine does not appear to have a significant potential for abuse, clinical data are limited. Therapy with sibutramine should be administered cautiously in patients with a history of alcohol or substance abuse. Such patients should be observed carefully during therapy for signs of misuse of sibutramine.

The sibutramine in Meridia has a major potential interaction with Anorexia Nervosa.

The use of sibutramine is contraindicated in patients with anorexia nervosa. Sibutramine is an anorexiant used in the treatment of obesity.

Ibrutinib has a moderate potential interaction with Bleeding Associated with Coagulation Defect.

Cases of bleeding (including bruising, petechia, intracranial hemorrhage [including subdural hematoma], gastrointestinal bleeding, hematuria, and postprocedural hemorrhage), including fatal bleeding events, have been reported in patients treated with ibrutinib. Risk of major hemorrhage is increased in patients receiving antiplatelet or anticoagulant therapy; these patients should be monitored for signs/symptoms of bleeding. It is recommended to consider the benefit-risk of withholding ibrutinib for at least 3 to 7 days pre- and post-surgery depending upon the type of surgery and the risk of bleeding.

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

Cytopenias (including neutropenia, thrombocytopenia, and anemia) have been reported with use of ibrutinib. Care should be taken with patients at risk, and complete blood counts should be monitored monthly.

The sibutramine in Meridia has a major potential interaction with Cardiovascular Conditions and Disorders.

Sibutramine and its metabolites inhibit the reuptake of norepinephrine, serotonin, and dopamine and can induce substantial increases in heart rate and blood pressure in some patients. Sibutramine therapy should not be initiated in patients with uncontrolled or poorly controlled hypertension and/or a history of coronary artery disease, arrhythmias, congestive heart failure, stroke, or other severe cardiovascular or cerebrovascular disorders. All patients treated with sibutramine should have blood pressure and pulse measured prior to starting therapy and monitored at regular intervals thereafter. Sustained increases in blood pressure or pulse rate may require a dosage reduction or drug discontinuation.

The sibutramine in Meridia has a major potential interaction with Cerebral Vascular Disorder.

Sibutramine and its metabolites inhibit the reuptake of norepinephrine, serotonin, and dopamine and can induce substantial increases in heart rate and blood pressure in some patients. Sibutramine therapy should not be initiated in patients with uncontrolled or poorly controlled hypertension and/or a history of coronary artery disease, arrhythmias, congestive heart failure, stroke, or other severe cardiovascular or cerebrovascular disorders. All patients treated with sibutramine should have blood pressure and pulse measured prior to starting therapy and monitored at regular intervals thereafter. Sustained increases in blood pressure or pulse rate may require a dosage reduction or drug discontinuation.

Ibrutinib has a moderate potential interaction with Diabetes Mellitus.

Fatal and serious cardiac arrhythmias and cardiac failure have occurred with ibrutinib. These adverse reactions occurred in patients with and without preexisting hypertension or cardiac comorbidities; patients with cardiac comorbidities may be at greater risk of these events. Ventricular tachyarrhythmias, atrial fibrillation, and atrial flutter have occurred in patients treated with ibrutinib, especially in patients with acute infections or cardiac risk factors (including hypertension, diabetes mellitus, history of cardiac arrhythmia). Cardiac history and function should be evaluated at baseline, and patients should be monitored for cardiac arrhythmias and cardiac function. Further evaluation (e.g., ECG, echocardiogram) should be obtained as indicated for patients who develop symptoms of arrhythmia (e.g., palpitations, lightheadedness, syncope, chest pain), new onset dyspnea, or other cardiovascular concerns. Cardiac arrhythmias and cardiac failure should be managed appropriately, dosage modification guidelines should be followed, and the risks and benefits of continued ibrutinib treatment should be considered.

The sibutramine in Meridia has a moderate potential interaction with Drug Dependence.

Centrally-acting anorexiants are generally subject to habituation and abuse. While sibutramine does not appear to have a significant potential for abuse, clinical data are limited. Therapy with sibutramine should be administered cautiously in patients with a history of alcohol or substance abuse. Such patients should be observed carefully during therapy for signs of misuse of sibutramine.

The sibutramine in Meridia has a major potential interaction with Glaucoma, Narrow Angle.

Sibutramine and its metabolites inhibit the reuptake of norepinephrine, serotonin, and dopamine and can induce mydriasis. In patients with narrow angles, pupillary dilation can provoke an acute attack of angle-closure glaucoma. Therapy with sibutramine should be administered cautiously in patients with narrow-angle glaucoma or anatomically narrow angles.

Ibrutinib has a moderate potential interaction with Heart Disease.

Fatal and serious cardiac arrhythmias and cardiac failure have occurred with ibrutinib. These adverse reactions occurred in patients with and without preexisting hypertension or cardiac comorbidities; patients with cardiac comorbidities may be at greater risk of these events. Ventricular tachyarrhythmias, atrial fibrillation, and atrial flutter have occurred in patients treated with ibrutinib, especially in patients with acute infections or cardiac risk factors (including hypertension, diabetes mellitus, history of cardiac arrhythmia). Cardiac history and function should be evaluated at baseline, and patients should be monitored for cardiac arrhythmias and cardiac function. Further evaluation (e.g., ECG, echocardiogram) should be obtained as indicated for patients who develop symptoms of arrhythmia (e.g., palpitations, lightheadedness, syncope, chest pain), new onset dyspnea, or other cardiovascular concerns. Cardiac arrhythmias and cardiac failure should be managed appropriately, dosage modification guidelines should be followed, and the risks and benefits of continued ibrutinib treatment should be considered.

Ibrutinib has a moderate potential interaction with High Blood Pressure.

Fatal and serious cardiac arrhythmias and cardiac failure have occurred with ibrutinib. These adverse reactions occurred in patients with and without preexisting hypertension or cardiac comorbidities; patients with cardiac comorbidities may be at greater risk of these events. Ventricular tachyarrhythmias, atrial fibrillation, and atrial flutter have occurred in patients treated with ibrutinib, especially in patients with acute infections or cardiac risk factors (including hypertension, diabetes mellitus, history of cardiac arrhythmia). Cardiac history and function should be evaluated at baseline, and patients should be monitored for cardiac arrhythmias and cardiac function. Further evaluation (e.g., ECG, echocardiogram) should be obtained as indicated for patients who develop symptoms of arrhythmia (e.g., palpitations, lightheadedness, syncope, chest pain), new onset dyspnea, or other cardiovascular concerns. Cardiac arrhythmias and cardiac failure should be managed appropriately, dosage modification guidelines should be followed, and the risks and benefits of continued ibrutinib treatment should be considered.

Ibrutinib has a moderate potential interaction with High Blood Pressure.

The use of ibrutinib may cause hypertension. Blood pressure should be monitored in patients treated with this drug. Antihypertensive medication should be started or adjusted throughout ibrutinib treatment as appropriate, and the dosage modification guidelines should be followed for grade 3 or higher hypertension.

The sibutramine in Meridia has a major potential interaction with History, Thrombotic/Thromboembolic Disorder.

Sibutramine and its metabolites inhibit the reuptake of norepinephrine, serotonin, and dopamine and can induce substantial increases in heart rate and blood pressure in some patients. Sibutramine therapy should not be initiated in patients with uncontrolled or poorly controlled hypertension and/or a history of coronary artery disease, arrhythmias, congestive heart failure, stroke, or other severe cardiovascular or cerebrovascular disorders. All patients treated with sibutramine should have blood pressure and pulse measured prior to starting therapy and monitored at regular intervals thereafter. Sustained increases in blood pressure or pulse rate may require a dosage reduction or drug discontinuation.

Ibrutinib has a moderate potential interaction with History, Thrombotic/Thromboembolic Disorder.

Cases of bleeding (including bruising, petechia, intracranial hemorrhage [including subdural hematoma], gastrointestinal bleeding, hematuria, and postprocedural hemorrhage), including fatal bleeding events, have been reported in patients treated with ibrutinib. Risk of major hemorrhage is increased in patients receiving antiplatelet or anticoagulant therapy; these patients should be monitored for signs/symptoms of bleeding. It is recommended to consider the benefit-risk of withholding ibrutinib for at least 3 to 7 days pre- and post-surgery depending upon the type of surgery and the risk of bleeding.

The sibutramine in Meridia has a major potential interaction with History - Cerebrovascular Disease.

Sibutramine and its metabolites inhibit the reuptake of norepinephrine, serotonin, and dopamine and can induce substantial increases in heart rate and blood pressure in some patients. Sibutramine therapy should not be initiated in patients with uncontrolled or poorly controlled hypertension and/or a history of coronary artery disease, arrhythmias, congestive heart failure, stroke, or other severe cardiovascular or cerebrovascular disorders. All patients treated with sibutramine should have blood pressure and pulse measured prior to starting therapy and monitored at regular intervals thereafter. Sustained increases in blood pressure or pulse rate may require a dosage reduction or drug discontinuation.

The sibutramine in Meridia has a major potential interaction with History - Myocardial Infarction.

Sibutramine and its metabolites inhibit the reuptake of norepinephrine, serotonin, and dopamine and can induce substantial increases in heart rate and blood pressure in some patients. Sibutramine therapy should not be initiated in patients with uncontrolled or poorly controlled hypertension and/or a history of coronary artery disease, arrhythmias, congestive heart failure, stroke, or other severe cardiovascular or cerebrovascular disorders. All patients treated with sibutramine should have blood pressure and pulse measured prior to starting therapy and monitored at regular intervals thereafter. Sustained increases in blood pressure or pulse rate may require a dosage reduction or drug discontinuation.

Ibrutinib has a moderate potential interaction with Infection.

Fatal and nonfatal infections (including bacterial, viral, or fungal) have occurred with ibrutinib therapy. Cases of progressive multifocal leukoencephalopathy (PML) and Pneumocystis jirovecii pneumonia (PJP) have been reported in patients treated with ibrutinib. Prophylaxis (according to standard of care) should be considered in patients at increased risk for opportunistic infections. Patients should be monitored and evaluated for fever and infections and treated appropriately.

The sibutramine in Meridia has a major potential interaction with Liver Disease.

Sibutramine is converted by the liver to two active metabolites, which are further metabolized to inactive substances and subsequently eliminated by the kidney. Due to a lack of clinical data, the manufacturer does not recommend the use of sibutramine in patients with severe renal and/or hepatic impairment. Based on limited pharmacokinetic data, sibutramine may be administered in mild or moderate hepatic insufficiency at normally recommended dosages.

Ibrutinib has a moderate potential interaction with Liver Disease.

Ibrutinib is metabolized in the liver. In patients with B-cell malignancies, ibrutinib should be avoided in those with severe liver dysfunction (Child-Pugh C). The recommended dosage should be reduced when administering ibrutinib to patients with mild or moderate liver dysfunction (Child-Pugh A and B); more frequent monitoring for ibrutinib adverse reactions is recommended for these patients.

In patients with chronic graft-versus-host disease, ibrutinib should be avoided in those with total bilirubin level greater than 3 times the upper limit of normal (3 x ULN), unless of nonhepatic origin or due to Gilbert's syndrome. The recommended dosage should be reduced when administering ibrutinib to patients with total bilirubin level greater than 1.5 to 3 x ULN, unless of nonhepatic origin or due to Gilbert's syndrome.

The sibutramine in Meridia has a major potential interaction with Renal Dysfunction.

Sibutramine is converted by the liver to two active metabolites, which are further metabolized to inactive substances and subsequently eliminated by the kidney. Due to a lack of clinical data, the manufacturer does not recommend the use of sibutramine in patients with severe renal and/or hepatic impairment. Based on limited pharmacokinetic data, sibutramine may be administered in mild or moderate hepatic insufficiency at normally recommended dosages.

Ibrutinib has a moderate potential interaction with Renal Dysfunction.

The use of ibrutinib in patients with mild to moderate renal dysfunction (CrCl greater than 25 mL/min [as estimated by Cockcroft-Gault equation]) is not expected to influence on the exposure to ibrutinib. Caution and close monitoring are recommended in patients with severe renal dysfunction and in patients on dialysis as no data are available for these patients.

The sibutramine in Meridia has a moderate potential interaction with Seizures.

Sibutramine and its metabolites inhibit the reuptake of norepinephrine, serotonin, and dopamine. In clinical trials, seizures were reported in < 0.1% of patients treated with sibutramine. Therapy with sibutramine should be administered cautiously in patients with or predisposed to seizures.

Ibrutinib has a moderate potential interaction with Smoking.

Fatal and serious cardiac arrhythmias and cardiac failure have occurred with ibrutinib. These adverse reactions occurred in patients with and without preexisting hypertension or cardiac comorbidities; patients with cardiac comorbidities may be at greater risk of these events. Ventricular tachyarrhythmias, atrial fibrillation, and atrial flutter have occurred in patients treated with ibrutinib, especially in patients with acute infections or cardiac risk factors (including hypertension, diabetes mellitus, history of cardiac arrhythmia). Cardiac history and function should be evaluated at baseline, and patients should be monitored for cardiac arrhythmias and cardiac function. Further evaluation (e.g., ECG, echocardiogram) should be obtained as indicated for patients who develop symptoms of arrhythmia (e.g., palpitations, lightheadedness, syncope, chest pain), new onset dyspnea, or other cardiovascular concerns. Cardiac arrhythmias and cardiac failure should be managed appropriately, dosage modification guidelines should be followed, and the risks and benefits of continued ibrutinib treatment should be considered.

Ibrutinib has a moderate potential interaction with Tumor Lysis Syndrome.

Tumor lysis syndrome has been reported with ibrutinib therapy infrequently. The baseline risk (e.g., high tumor burden) should be assessed and appropriate precautions should be taken. Patients should be monitored closely and treated as appropriate.

The sibutramine in Meridia has a moderate potential interaction with Type 2 Diabetes.

Obese, type 2 diabetic patients who achieve weight loss may demonstrate improved metabolic control of their disease as a result of their reduced weight. Therefore, patients with type 2 diabetes mellitus should be monitored during weight-reduction therapy (or therapy that may be expected to induce significant weight loss as a secondary effect) for hypoglycemia and reduced need for oral hypoglycemic medication or insulin, and the dosages of these agents adjusted accordingly. Patients should be apprised of the risk of hypoglycemia and be alert to potential signs and symptoms such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, and palpitation.