Drug Interaction Report

Clopidogrel has a major potential interaction with Bleeding Disorder.

Clopidogrel is contraindicated in patients with active pathological bleeding such as peptic ulcer or intracranial hemorrhage.

Venetoclax has a moderate potential interaction with Fever.

Venetoclax can cause neutropenia. It is recommended to monitor for fever and signs suggestive of an infection. Monitor complete blood count during the course of therapy and reduce dose or interrupt treatment for severe neutropenia. Therapy with this agent should be administered cautiously in patients with preexisting bone marrow depression or blood dyscrasias.

Venetoclax has a moderate potential interaction with Infection.

Venetoclax can cause neutropenia. It is recommended to monitor for fever and signs suggestive of an infection. Monitor complete blood count during the course of therapy and reduce dose or interrupt treatment for severe neutropenia. Therapy with this agent should be administered cautiously in patients with preexisting bone marrow depression or blood dyscrasias.

Clopidogrel has a moderate potential interaction with Liver Disease.

The pharmacokinetic disposition of clopidogrel in patients with liver disease has not been established. Clopidogrel undergoes biotransformation to an active metabolite that has not yet been isolated and an inactive form that represents approximately 85% of circulating clopidogrel. The metabolic and therapeutic activity of clopidogrel may be altered in patients with hepatic impairment and should be administered cautiously in patients with severe hepatic dysfunction. Clinical monitoring of hepatic function and bleeding activity is recommended.

Venetoclax has a moderate potential interaction with Liver Disease.

In vitro studies demonstrated that venetoclax is predominantly metabolized in the liver by CYP450 3A4/5. Based on pharmacokinetic analysis with subjects with mild and moderate hepatic impairment, the venetoclax exposures were similar to those with normal hepatic function; therefore, no dose adjustment is recommended in patients with mild or moderate hepatic impairment. Based on the drug metabolism, an increase in adverse events might result in patients with moderate to severe hepatic impairment. It is recommended to monitor patients with moderate to severe hepatic impairment carefully for signs of toxicity during the initiation and the weekly dose ramp-up phase. Caution is advised when using this agent in patients with severe hepatic impairment as it pharmacokinetics has not been studied.

Venetoclax has a moderate potential interaction with Neutropenia.

Venetoclax can cause neutropenia. It is recommended to monitor for fever and signs suggestive of an infection. Monitor complete blood count during the course of therapy and reduce dose or interrupt treatment for severe neutropenia. Therapy with this agent should be administered cautiously in patients with preexisting bone marrow depression or blood dyscrasias.

Venetoclax has a moderate potential interaction with Renal Dysfunction.

Based on pharmacokinetic analysis with subjects with mild and moderate renal impairment, the venetoclax exposures were similar to those with normal renal function; therefore, no dose adjustment is recommended in these patients. The pharmacokinetics of venetoclax has not been studied in subjects with severe renal impairment. Patients with reduced renal function are at increased risk of tumor lysis syndrome (TLS) and these patients may require more intensive monitoring and care to reduce the risk of TLS at the start of treatment. Patients should be assessed for risk factor that may contribute to an increase risk for TLS and complete blood chemistries should be monitored regularly. Dose interruption is recommended if needed based on clinical findings.

Clopidogrel has a minor potential interaction with Renal Dysfunction.

Clopidogrel is partially eliminated by the kidney. Approximately 50% of clopidogrel is excreted in the urine and 45% in the feces. Plasma concentrations of the inactive metabolite and the degree of platelet inhibition are reduced in patients with severe renal impairment (creatinine clearance of 5-15 mL/min). However, bleeding times in patients with severe renal impairment did not differ from those with normal renal function. No dosage adjustment is recommended for patients with compromised renal function.

Venetoclax has a moderate potential interaction with Tumor Lysis Syndrome.

Based on pharmacokinetic analysis with subjects with mild and moderate renal impairment, the venetoclax exposures were similar to those with normal renal function; therefore, no dose adjustment is recommended in these patients. The pharmacokinetics of venetoclax has not been studied in subjects with severe renal impairment. Patients with reduced renal function are at increased risk of tumor lysis syndrome (TLS) and these patients may require more intensive monitoring and care to reduce the risk of TLS at the start of treatment. Patients should be assessed for risk factor that may contribute to an increase risk for TLS and complete blood chemistries should be monitored regularly. Dose interruption is recommended if needed based on clinical findings.

Venetoclax has a moderate potential interaction with Vaccination.

The administration of live attenuated vaccines should be avoided prior to, during, and after therapy with venetoclax until B-cell recovery occurs. It is recommended to be up-to-date with all required immunizations, as recommended by current immunization guidelines, before initiating therapy. The safety and efficacy of immunization with live attenuated vaccines during or following venetoclax therapy have not been studied. Venetoclax may interfere with the response to immunization and the vaccinations may be less effective.