chapter
Other immunomodulating drugs
Pages 39

Clinical relevance is uncertain. Necessary to monitor for clinical toxicities

TOREMIFENE ANTIVIRALS

TOREMIFENE NNRTIs – EFAVIRENZ ≠ plasma concentrations of toremifene

Due to inhibition of metabolism of toremifene by the CYP3A4 isoenzymes by efavirenz

Clinical relevance is uncertain. Necessary to monitor for clinical toxicities

TOREMIFENE PROTEASE INHIBITORS – RITONAVIR

≠ plasma concentrations of toremifene

Due to inhibition of metabolism of toremifene by the CYP3A4 isoenzymes by ritonavir

Clinical relevance is uncertain. Necessary to monitor for clinical toxicities

TOREMIFENE CALCIUM CHANNEL BLOCKERS

≠ plasma concentrations of toremifene when co-administered with diltiazem, nifedipine or verapamil

Due to inhibition of CYP3A4mediated metabolism of toremifene

Clinical relevance is uncertain. Necessary to monitor for clinical toxicities

TOREMIFENE DIURETICS – THIAZIDES Risk of hypercalcaemia Additive effect Monitor calcium levels closely. Warn patients about the symptoms of hypercalcaemia

TOREMIFENE GRAPEFRUIT JUICE ≠ plasma concentrations of toremifene

Due to inhibition of metabolism of toremifene by the CYP3A4 isoenzymes by grapefruit juice

Clinical relevance is uncertain. Necessary to monitor for clinical toxicities

TOREMIFENE H2 RECEPTOR BLOCKERS – CIMETIDINE

≠ plasma concentrations of toremifene

Due to inhibition of metabolism of toremifene by the CYP3A4 isoenzymes by cimetidine

Clinical relevance is uncertain. Necessary to monitor for clinical toxicities

OTHER IMMUNOMODULATING DRUGS

ALL VACCINES – LIVE Risk of contracting disease from the vaccine

↓ immunity Avoid live vaccines for at least 3 months after completing immunomodulating therapy

ACITRETIN ➣ Other immunomodulating drugs, Retinoids below

A N

TIC A

N C

ER A

N D

IM M

U N

O M

O D

U LA

TIN G

D R

U G

S351

ANTICANCER AND IMMUNOMODULATING DRUGS OTHER IMMUNOMODULATING DRUGS Aminosalicylates

Additive effect Avoid co-administration ALDESLEUKIN ➣ Other immunomodulating drugs, Interleukin-2, below

AMINOSALICYLATES

AMINOSALICYLATES ANTICANCER AND IMMUNOMODULATING DRUGS

AMINOSALICYLATES MERCAPTOPURINE ≠ risk of bone marrow suppression Additive effect Monitor FBC closely AMINOSALICYLATES METHOTREXATE ≠ risk of hepatotoxicity with

sulfasalazine Additive hepatotoxic effects. Sulfasalazine competes with methotrexate for renal elimination

Monitor closely for symptoms of liver failure. Check LFTs at beginning of treatment and then weekly until stable, and repeat if there is clinical suspicion of liver disease

SALICYLATES – TOPICAL PORFIMER ≠ risk of photosensitivity reactions when porfimer is co-administered with hydrochlorothiazide

Attributed to additive effects Avoid exposure of skin and eyes to direct sunlight for 30 days after porfimer therapy

AMINOSALICYLATES AZATHIOPRINE ≠ blood levels of azathioprine and ≠ risk of side-effects

Due to inhibition of metabolism of purines by these aminosalicylates.