Paclitaxel interactions

Use of REYATAZ without ritonavir is not recommended when coadministered with drugs highly dependent on CYP2C8 with narrow therapeutic indices (eg, paclitaxel, repaglinide). (Atazanavir label, Drug interactions)

Patients who have previously experienced a hypersensitivity reaction to paclitaxel may develop a hypersensitivity reaction to docetaxel that may include severe or fatal reactions such as anaphylaxis. (Docetaxel label, Warnings and precautions)

Pneumonitis Pneumonitis, including some cases that were fatal, occurred in 4% of patients receiving protein bound paclitaxel in combination with gemcitabine. (Paclitaxel label, Warnings and precautions)

…within at least 72 hours of treatment with ketoconazole Antineoplastics irinotecan dasatinib, lapatinib, nilotinib bortezomib, busulphan, docetaxel, erlotinib, imatinib, ixabepilone, paclitaxel, trimetrexate, vinca alkaloids Irinotecan: The potential increase in plasma concentrations of irinotecan when coadministered with ketoconazole tablets may increase the risk… (Ketoconazole label, Drug interactions)

• NEXAVAR in combination with carboplatin and paclitaxel is contraindicated in patients with squamous cell lung cancer [see Warnings and Precautions ( 5.8 )] . (Sorafenib label, Contraindications)

AC Anthracycline (doxorubicin) and cyclophosphamide. → Paclitaxel+Trastuzumab 3.2% (64/2000) Includes 1 patient with fatal cardiomyopathy and 1 patient with sudden death without documented etiology. (Trastuzumab label, Warnings and precautions)

…patients with NSCLC, resume treatment if recommended at permanently reduced doses for both weekly protein-bound paclitaxel for Injectable Suspension (albumin-bound) and every-3-week carboplatin after ANC recovers to at least 1,500 cells/mm 3 and platelet count of at least 100,000 cells/mm 3 on Day 1 or to an ANC of at least 500 cells/mm 3 and platelet count of… (Paclitaxel label, Warnings and precautions)

…that Potentiate Cyclophosphamide Toxicities Toxicity Drugs Increased hematotoxicity and/or immunosuppression ● ACE inhibitors: ACE inhibitors can cause leukopenia. ● Natalizumab ● Paclitaxel: Increased hematotoxicity has been reported when cyclophosphamide was administered after paclitaxel infusion. ● Thiazide diuretics ● Zidovudine Increased cardiotoxicity ●… (Cyclophosphamide label, Drug interactions)

Agents Metabolized by CYP2C8 Deferasirox inhibits CYP2C8 resulting in an increase in CYP2C8 substrate (e.g., repaglinide and paclitaxel) concentration when these drugs are coadministered. (Deferasirox label, Drug interactions)

Paclitaxel Paclitaxel, when given prior to doxorubicin hydrochloride, increases the plasma-concentrations of doxorubicin and its metabolites. (Doxorubicin label, Drug interactions)

Table 7: Drugs Affected by Phenytoin Interacting Agent Examples Drugs whose efficacy is impaired by phenytoin Azoles Fluconazole, ketoconazole, itraconazole, posaconazole, voriconazole Antineoplastic agents Irinotecan, paclitaxel, teniposide Delavirdine Phenytoin can substantially reduce the concentrations of delavirdine. (Fosphenytoin label, Drug interactions)

(C) CYP2C8 Substrates Gemfibrozil is a strong inhibitor of CYP2C8 and may increase exposure of drugs mainly metabolized by CYP2C8 (e.g., dabrafenib, enzalutamide, loperamide, montelukast, paclitaxel, pioglitazone, rosiglitazone). (Gemfibrozil label, Drug interactions)

Paclitaxel : In cancer patients receiving TYKERB and paclitaxel (CYP2C8 and P-gp substrate), 24-hour systemic exposure (AUC) of paclitaxel was increased 23%. (Lapatinib label, Drug interactions)

In patients taking ARAVA, exposure of drugs metabolized by CYP2C8 (e.g., paclitaxel, pioglitazone, repaglinide, rosiglitazone) may be increased. (Leflunomide label, Drug interactions)

Table 3: Drugs Affected by Phenytoin Interacting Agent Examples Drugs whose efficacy is impaired by phenytoin Azoles Fluconazole, ketoconazole, itraconazole, posaconazole, voriconazole Antineoplastic agents Irinotecan, paclitaxel, teniposide Delavirdine Phenytoin can substantially reduce the concentrations of delavirdine. (Phenytoin label, Drug interactions)

In patients taking AUBAGIO, exposure of drugs metabolized by CYP2C8 (e.g., paclitaxel, pioglitazone, repaglinide, rosiglitazone) may be increased. (Teriflunomide label, Drug interactions)

Concomitant administration of R verapamil can decrease the clearance of paclitaxel. (Verapamil label, Drug interactions)

Etoposide, vinorelbine, paclitaxel, and docetaxel No dosage adjustment needed. (Aprepitant label, Drug interactions)

Effects of VEGZELMA on Other Drugs No clinically meaningful effect on the pharmacokinetics of irinotecan or its active metabolite SN38, interferon alfa, carboplatin or paclitaxel was observed when bevacizumab was administered in combination with these drugs; however, 3 of the 8 patients receiving bevacizumab with paclitaxel and carboplatin had lower paclitaxel… (Bevacizumab label, Drug interactions)

Etoposide, vinorelbine, paclitaxel, and docetaxel No dosage adjustment needed. (Fosaprepitant label, Drug interactions)