Drug Interaction Report

MONITOR CLOSELY: Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism is unknown. Tendinitis and tendon rupture have most frequently involved the Achilles tendon, although cases involving the rotator cuff (the shoulder), the hand, the biceps, and the thumb have also been reported. Some have required surgical repair or resulted in prolonged disability. Tendon rupture can occur during or up to several months after completion of fluoroquinolone therapy.

MANAGEMENT: Caution is recommended if fluoroquinolones are prescribed in combination with corticosteroids, particularly in patients with other concomitant risk factors (e.g., age over 60 years; recipient of kidney, heart, and/or lung transplant). Patients should be advised to stop taking the fluoroquinolone, avoid exercise and use of the affected area, and promptly contact their physician if they experience pain, swelling, or inflammation of a tendon. In general, fluoroquinolones should only be used to treat conditions that are proven or strongly suspected to be caused by bacteria and only if the benefits outweigh the risks.

GENERALLY AVOID: Prophylactic use of systemic corticosteroids prior to CD19- or BCMA-directed genetically modified autologous T cell immunotherapy may interfere with the therapeutic effects of such drugs as axicabtagene ciloleucel, brexucabtagene autoleucel, idecabtagene vicleucel, ciltacabtagene autoleucel and lisocabtagene maraleucel. The mechanism for this interaction has not been delineated. Administration of systemic corticosteroids in an effort to manage the toxicities associated with these drugs does not affect the expansion and persistence of CAR T cells.

MANAGEMENT: The prophylactic use of systemic corticosteroids prior to CD19- or BCMA-directed genetically modified autologous T cell immunotherapy with drugs such as axicabtagene ciloleucel, brexucabtagene autoleucel, idecabtagene vicleucel, ciltacabtagene autoleucel and lisocabtagene maraleucel is not recommended. However, systemic corticosteroids may be used for the management of adverse effects associated with these drugs, such as cytokine release syndrome and neurological-related toxicities, without affecting the expansion and persistence of CAR T cells.

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.