Cyclophosphamide with Etanercept Interaction Details

Brand Names Associated with Cyclophosphamide

Brand Names Associated with Etanercept

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Dec 26, 2023

Interaction Effect

Higher incidence of developing non-cutaneous solid malignancies

Interaction Summary

A higher incidence of non-cutaneous solid malignancies was observed in patients being treated for granulomatosis polyangiitis with a standard treatment, including cyclophosphamide, and who received etanercept in addition. Furthermore, clinical outcomes were not improved by the addition of etanercept to the regimen. The use of etanercept or etanercept biosimilar products in patients receiving immunosuppressive agents, such as cyclophosphamide, is not recommended.

Severity

Major

Onset

Delayed

Evidence

Probable

How To Manage Interaction

Concurrent administration of etanercept or etanercept biosimilar products in patients receiving cyclophosphamide may increase the incidence of developing non-cutaneous solid malignancies, especially in patients with granulomatosis polyangiitis, and is not recommended.

Mechanism Of Interaction

Unknown

Literature Reports

A) Etanercept, when given concurrently with immunosuppressive agents such as cyclophosphamide, caused a higher incidence of solid malignancies. A randomized, placebo-controlled study was conducted in 180 patients with granulomatosis polyangiitis were on a standard treatment (including cyclophosphamide, methotrexate, and corticosteroids). Among 89 patients who received etanercept, 5 developed a variety of non-cutaneous solid malignancies compared to none of those receiving placebo. In addition, clinical outcomes were not improved by the addition of etanercept to the standard treatment .

Cyclophosphamide Overview

• Cyclophosphamide is used alone or in combination with other medications to treat Hodgkin's lymphoma (Hodgkin's disease) and non-Hodgkin's lymphoma (types of cancer that begin in a type of white blood cells that normally fights infection); cutaneous T-cell lymphoma (CTCL, a group of cancers of the immune system that first appear as skin rashes); multiple myeloma (a type of cancer of the bone marrow); and certain types of leukemia (cancer of the white blood cells), including chronic lymphocytic leukemia (CLL), chronic myelogenous leukemia (CML), acute myeloid leukemia (AML, ANLL), and acute lymphoblastic leukemia (ALL). It is also used to treat retinoblastoma (cancer in the eye), neuroblastoma (a cancer that begins in nerve cells and occurs mainly in children), ovarian cancer (cancer that begins in the female reproductive organs where eggs are formed), and breast cancer. Cyclophosphamide is also used to treat nephrotic syndrome (a disease that is caused by damage to the kidneys) in children whose disease has not improved, has gotten worse, or has come back after taking other medications or in children who experienced intolerable side effects with other medications. Cyclophosphamide is in a class of medications called alkylating agents. When cyclophosphamide is used to treat cancer, it works by slowing or stopping the growth of cancer cells in your body. When cyclophosphamide is used to treat nephrotic syndrome, it works by suppressing your body's immune system.

Etanercept Overview

• Etanercept injection products are used alone or with other medications to relieve the symptoms of certain autoimmune disorders (conditions in which the immune system attacks healthy parts of the body and causes pain, swelling, and damage) including:

• • rheumatoid arthritis (condition in which the body attacks its own joints, causing pain, swelling, and loss of function) in adults,

  • psoriatic arthritis (condition that causes joint pain and swelling and scales on the skin) in adults,

  • juvenile idiopathic arthritis (JIA; a condition that affects children in which the body attacks its own joints, causing pain, swelling, loss of function, and delays in growth and development) in children 2 years of age and older,

  • ankylosing spondylitis (a condition in which the body attacks the joints of the spine and other areas causing pain and joint damage),

  • chronic plaque psoriasis (a skin disease in which red, scaly patches form on some areas of the body) in adults and children 4 years of age and older whose psoriasis is too severe to be treated by topical medications alone.

• Etanercept is in a class of medications called tumor-necrosis factor (TNF) inhibitors. It works by blocking the action of TNF, a substance in the body that causes inflammation

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.