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Author: Admin | 2025-04-28
Effect of Myelosuppressive Agents. Monitor therapyMiFEPRIStone: May increase the serum concentration of CYP2B6 Substrates (High risk with Inhibitors). Monitor therapyMivacurium: Cyclophosphamide may increase the serum concentration of Mivacurium. Monitor therapyNatalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Avoid combinationNivolumab: Immunosuppressants may diminish the therapeutic effect of Nivolumab. Consider therapy modificationOcrelizumab: May enhance the immunosuppressive effect of Immunosuppressants. Monitor therapyPalifermin: May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Consider therapy modificationPentostatin: May enhance the cardiotoxic effect of Cyclophosphamide. Monitor therapyPidotimod: Immunosuppressants may diminish the therapeutic effect of Pidotimod. Monitor therapyPimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Avoid combinationPromazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Monitor therapyProtease Inhibitors: May enhance the adverse/toxic effect of Cyclophosphamide. Specifically, the incidences of neutropenia, infection, and mucositis may be increased. Monitor therapyRoflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Consider therapy modificationSargramostim: Cyclophosphamide may enhance the adverse/toxic effect of Sargramostim. Specifically, the risk of pulmonary toxicity may be enhanced. Monitor therapySiponimod: Immunosuppressants may enhance the immunosuppressive effect of Siponimod. Monitor therapySipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Management: Evaluate patients to see if it is medically appropriate to reduce or discontinue therapy with immunosuppressants prior to initiating sipuleucel-T therapy. Consider therapy modificationSmallpox and Monkeypox Vaccine (Live): Immunosuppressants may diminish the therapeutic effect of Smallpox and Monkeypox Vaccine (Live). Monitor therapySuccinylcholine: Cyclophosphamide may increase the serum concentration of Succinylcholine. Management: Consider alternatives to succinylcholine in patients who have received cyclophosphamide in the past 10 days, or reduced succinylcholine doses (a serum pseudocholinesterase assay may help inform this reduction) with close monitoring. Consider therapy modificationTacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Avoid combinationTertomotide: Immunosuppressants may diminish the therapeutic effect of Tertomotide. Monitor therapyThiazide and Thiazide-Like Diuretics: May enhance the adverse/toxic effect of Cyclophosphamide. Specifically, granulocytopenia may be enhanced. Monitor therapyThiotepa: May increase the serum concentration of CYP2B6 Substrates (High risk with Inhibitors). Monitor therapyTofacitinib: Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants. Consider therapy modificationTrastuzumab: May enhance the neutropenic effect of Immunosuppressants. Monitor therapyUpadacitinib: Immunosuppressants may enhance the immunosuppressive effect of Upadacitinib. Avoid combinationVaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. Consider therapy modificationVaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Exceptions: Smallpox
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