CANCIDASaAntibacterials/ Antimycotics: rifampin Antiepileptics: carbamazepine, phenytoin Antiretrovirals: efavirenz, nevirapine Steroids/ Immunosuppressants: cyclosporine, dexamethasone, tacrolimus |
Fluconazole16,aAntiretrovirals: zidovudine Bronchodilators: theophylline Diuretics: hydrochlorothiazide Gastric acid modifiers: cimetidine, cisapride Oral contraceptives: ethinyl estradiol, levonorgestrel Oral hypoglycemics: glipizide, glyburide, tolbutamide Psychotropic agents: phenytoin, short-acting benzodiazepines Steroids/ Immunosuppressants: cyclosporine, tacrolimus Others: rifabutin, rifampin, terfenadine, warfarin |
Voriconazole17,aAntiarrhythmics: quinidine Antineoplastics: vinblastine, vincristine Antiretrovirals: amprenavir, delavirdine, efavirenz, nelfinavir, nevirapine, ritonavir, saquinavir Gastric acid modifiers: cisapride, omeprazole Long-acting barbiturates: mephobarbital, phenobarbital Oral hypoglycemics: sulfonylureas Psychotropic agents: alprazolam, carbamazepine, midazolam, phenytoin, pimozide, triazolam Statins: atorvastatin Steroids/ Immunosuppressants: cyclosporine, sirolimus, tacrolimus Others: astemizole, ergot alkaloids (ergotamine, dihydroergotamine), rifabutin, rifampin, terfenadine, warfarin |
AmBisome18,bNo formal clinical studies of drug interactions have been conducted with AmBisome. However, the following drugs are known to interact with amphotericin B and may interact with AmBisome: Antifungals: azoles (clotrimazole, fluconazole, ketoconazole, miconazole, etc), flucytosine Antineoplastic agents Corticosteroids Digitalis glycosides Leukocyte transfusions Other nephrotoxic medications Skeletal muscle relaxants |
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Contraindications |
Contraindications |
Contraindications |
Contraindications |
a Drug categories that are derived from Gubbins et al do not necessarily indicate that the products listed interact with all the drugs in this category.19
b Drug categories as listed in AmBisome Prescribing Information.
Concomitant use of CANCIDAS with cyclosporine should be limited to patients for whom the potential benefit outweighs the potential risk of increased hepatic enzyme abnormalities. See the Warning in the Prescribing Information.
Unlike Azoles, CANCIDAS Is Not an Inhibitor of the Cytochrome P450 System16,17
- In vitro studies demonstrate that CANCIDAS is not an inhibitor of any enzyme in the cytochrome P450 system, is not a substrate for P-glycoprotein, and is a poor substrate for cytochrome P450 enzymes.
References
CANCIDAS is contraindicated in patients with hypersensitivity to any component of this product.
Laboratory abnormalities in liver function tests have been seen in healthy volunteers and patients treated with CANCIDAS. In some patients with serious underlying conditions who were receiving multiple concomitant medications with CANCIDAS, isolated cases of clinically significant hepatic dysfunction, hepatitis, and hepatic failure have been reported; a causal relationship to CANCIDAS has not been established. Patients who develop abnormal liver function tests during therapy with CANCIDAS should be monitored for evidence of worsening hepatic function and evaluated for risk/benefit of continuing therapy with CANCIDAS.
For patients receiving CANCIDAS and tacrolimus, standard monitoring of tacrolimus blood concentrations and appropriate tacrolimus dosage adjustments are recommended.
Adult patients on rifampin should receive 70 mg of CANCIDAS daily. When CANCIDAS is co-administered to adult patients with inducers of drug clearance, such as efavirenz, nevirapine, phenytoin, dexamethasone, or carbamazepine, use of a daily dose of 70 mg of CANCIDAS should be considered.
When CANCIDAS is co-administered to pediatric patients with inducers of drug clearance, such as rifampin, efavirenz, nevirapine, phenytoin, dexamethasone, or carbamazepine, a dose of 70 mg/m2 daily (not to exceed an actual daily dose of 70 mg) should be considered.
Possible histamine-mediated symptoms have been reported including rash, facial swelling, pruritus, sensation of warmth, or bronchospasm. Anaphylaxis has been reported during administration of CANCIDAS.
The most common adverse reactions in adult patients treated with CANCIDAS (≥10%), regardless of causality, are: diarrhea, pyrexia, chills, ALT/AST increase, blood alkaline phosphatase increase, and decrease of blood potassium.
The most common adverse reactions in pediatric patients treated with CANCIDAS, regardless of causality, were pyrexia (29.2%), blood potassium decreased (15.2%), diarrhea (14%), increased aspartate aminotransferase (11.7%), rash (11.7%), increased alanine aminotransferase (11.1%), hypotension (11.1%), and chills (11.1%).
There is no clinical experience in adult patients with severe hepatic insufficiency (Child-Pugh score >9) and in pediatric patients with any degree of hepatic insufficiency.
Administer by slow intravenous infusion (IV) over approximately 1 hour. Not for IV bolus administration.
Before prescribing CANCIDAS, please read the Prescribing Information.
