Drug Interaction Report

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

Clofarabine causes myelosuppression which may be severe and prolonged. Serious and fatal hemorrhage, including cerebral, gastrointestinal and pulmonary hemorrhage associated with thrombocytopenia has occurred. It is recommended to monitor complete blood counts including platelets and coagulation parameters and treat accordingly. Care should be exercised when using this agent in patients with bone marrow depression.

The ustekinumab in Otulfi has a major potential interaction with High Blood Pressure.

The use of ustekinumab may cause posterior leukoencephalopathy syndrome. One case of reversible posterior leukoencephalopathy syndrome (RPLS) was observed in clinical studies of psoriasis and psoriatic arthritis. No cases of RPLS were observed in clinical studies of Crohn's disease. Conditions with which it has been associated include preeclampsia, eclampsia, acute hypertension, cytotoxic agents and immunosuppressive therapy. Caution and close monitoring is advised when prescribing this agent to patients at risk of RPLS. It is recommended to administer appropriate treatment and discontinue therapy if RPLS is suspected.

The ustekinumab in Otulfi has a moderate potential interaction with History, Tuberculosis.

Before initiating certain interleukin inhibitors, patients should be screened for latent tuberculosis infection with a tuberculin skin test. Do not administer these agents to patients with an active tuberculosis infection. Patients testing positive in tuberculosis screening should be treated by standard medical practice prior to therapy. Anti-tuberculosis therapy should be considered prior to initiation of therapy in patients with a past history of latent or active tuberculosis in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent tuberculosis but having risk factors for tuberculosis infection.

The ustekinumab in Otulfi has a major potential interaction with Immunodeficiency.

The use of ustekinumab may cause posterior leukoencephalopathy syndrome. One case of reversible posterior leukoencephalopathy syndrome (RPLS) was observed in clinical studies of psoriasis and psoriatic arthritis. No cases of RPLS were observed in clinical studies of Crohn's disease. Conditions with which it has been associated include preeclampsia, eclampsia, acute hypertension, cytotoxic agents and immunosuppressive therapy. Caution and close monitoring is advised when prescribing this agent to patients at risk of RPLS. It is recommended to administer appropriate treatment and discontinue therapy if RPLS is suspected.

Clofarabine has a major potential interaction with Infection.

Clofarabine injection may cause acute renal failure. Patients with infection, sepsis, or tumor lysis syndrome may be at increased risk of renal toxicity when treated with clofarabine injection. It is recommended to monitor patients for renal toxicity and interrupt or discontinue clofarabine injection as necessary.

The ustekinumab in Otulfi has a moderate potential interaction with Infection.

There have been reports of serious infections, including infections with opportunistic pathogens, and reactivation of latent infections in patients receiving interleukin inhibitors. Treatment with these agents should not be initiated in patients with an active infection until the infection resolves or is adequately treated. Caution is recommended when considering the use of interleukin inhibitors in patients with a history of recurrent infections, underlying conditions which may predispose them to infections, or chronic, latent, or localized infections.

Clofarabine has a moderate potential interaction with Liver Disease.

Severe and fatal hepatotoxicity, including hepatitis and hepatic failure, has occurred with the use of clofarabine. Monitor hepatic function and for signs and symptoms of hepatitis and hepatic failure. It is recommended to discontinue clofarabine immediately for Grade 3 or greater liver enzyme and/or bilirubin elevation of the liver, or veno-occlusive disease is suspected. Care should be exercised when using this agent in patients with liver disease.

Clofarabine has a moderate potential interaction with Noninfectious Colitis.

Fatal and serious cases of enterocolitis, including neutropenic colitis, cecitis, and C. difficile colitis, have occurred during treatment with clofarabine. This has occurred more frequently within 30 days of treatment, and in the setting of combination chemotherapy. Enterocolitis may lead to necrosis, perforation, hemorrhage or sepsis complications. Monitor patients for signs and symptoms of enterocolitis and treat promptly. Care should be exercised when treating patients presenting with symptoms of enterocolitis.

The ustekinumab in Otulfi has a major potential interaction with Posterior Reversible Encephalopathy Syndrome.

The use of ustekinumab may cause posterior leukoencephalopathy syndrome. One case of reversible posterior leukoencephalopathy syndrome (RPLS) was observed in clinical studies of psoriasis and psoriatic arthritis. No cases of RPLS were observed in clinical studies of Crohn's disease. Conditions with which it has been associated include preeclampsia, eclampsia, acute hypertension, cytotoxic agents and immunosuppressive therapy. Caution and close monitoring is advised when prescribing this agent to patients at risk of RPLS. It is recommended to administer appropriate treatment and discontinue therapy if RPLS is suspected.

Clofarabine has a moderate potential interaction with Renal Dysfunction.

The use of clofarabine may cause acute renal failure. It is recommended to reduce the dose by 50% in patients with CrCl of 30 to 60 mL/min. At this time the manufacturer is not able to make a dosage recommendation in patients with CrCl less than 30 mL/min or in those on dialysis as there is insufficient information in this patient population. Care should be exercised when using this agent in patients with renal dysfunction.

Clofarabine has a major potential interaction with Sepsis.

Clofarabine injection may cause acute renal failure. Patients with infection, sepsis, or tumor lysis syndrome may be at increased risk of renal toxicity when treated with clofarabine injection. It is recommended to monitor patients for renal toxicity and interrupt or discontinue clofarabine injection as necessary.

The ustekinumab in Otulfi has a major potential interaction with Skin Cancer.

In clinical trials malignancies have been observed in patients receiving ustekinumab. Patients should be monitored for non-melanoma skin cancers (NMSCs), particularly those patients who have had prior prolonged phototherapy treatment. Periodic skin examination is recommended for all patients, particularly those with risk factors for skin cancer. Caution should be exercised when considering ustekinumab for the treatment of patients with a history of malignancy, those who have a known malignancy, or in continuing treatment in patients who develop malignancy while receiving this agent.

The ustekinumab in Otulfi has a major potential interaction with Toxemia of pregnancy.

The use of ustekinumab may cause posterior leukoencephalopathy syndrome. One case of reversible posterior leukoencephalopathy syndrome (RPLS) was observed in clinical studies of psoriasis and psoriatic arthritis. No cases of RPLS were observed in clinical studies of Crohn's disease. Conditions with which it has been associated include preeclampsia, eclampsia, acute hypertension, cytotoxic agents and immunosuppressive therapy. Caution and close monitoring is advised when prescribing this agent to patients at risk of RPLS. It is recommended to administer appropriate treatment and discontinue therapy if RPLS is suspected.

The ustekinumab in Otulfi has a moderate potential interaction with Tuberculosis, Active.

Before initiating certain interleukin inhibitors, patients should be screened for latent tuberculosis infection with a tuberculin skin test. Do not administer these agents to patients with an active tuberculosis infection. Patients testing positive in tuberculosis screening should be treated by standard medical practice prior to therapy. Anti-tuberculosis therapy should be considered prior to initiation of therapy in patients with a past history of latent or active tuberculosis in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent tuberculosis but having risk factors for tuberculosis infection.

The ustekinumab in Otulfi has a moderate potential interaction with Tuberculosis, Latent.

Before initiating certain interleukin inhibitors, patients should be screened for latent tuberculosis infection with a tuberculin skin test. Do not administer these agents to patients with an active tuberculosis infection. Patients testing positive in tuberculosis screening should be treated by standard medical practice prior to therapy. Anti-tuberculosis therapy should be considered prior to initiation of therapy in patients with a past history of latent or active tuberculosis in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent tuberculosis but having risk factors for tuberculosis infection.

Clofarabine has a major potential interaction with Tumor Lysis Syndrome.

Clofarabine injection may cause acute renal failure. Patients with infection, sepsis, or tumor lysis syndrome may be at increased risk of renal toxicity when treated with clofarabine injection. It is recommended to monitor patients for renal toxicity and interrupt or discontinue clofarabine injection as necessary.

The ustekinumab in Otulfi has a moderate potential interaction with Vaccination.

Patients requiring non-live vaccination during a course of ustekinumab may not be protected from the vaccine as the immune response might not be sufficient to prevent the disease. It is recommended to be up-to-date with all required immunizations, as recommended by current immunization guidelines, before initiating therapy with ustekinumab. BCG vaccines should not be given during treatment with ustekinumab or for one year prior to initiating treatment or one year following discontinuation of treatment. Caution is advised when administering live vaccines to household contacts of patients receiving ustekinumab because of the potential risk for shedding from the household contact and transmission to patient.