Cyclophosphamide with Saquinavir Interaction Details
Brand Names Associated with Cyclophosphamide
- CPM
- CTX
- Cyclophosphamide
- CYT
- Cytoxan®
Brand Names Associated with Saquinavir
- Invirase®
- Saquinavir
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 26, 2023
Interaction Effect
Increased risk of chemotherapy-induced mucositis, neutropenia, and infection
Interaction Summary
Concomitant use of cyclophosphamide with a protease inhibitor (PI) may increase the concentration of cytotoxic metabolites and increase the incidence of infection, neutropenia, or mucositis, possibly due to competitive inhibition of CYP metabolism of cyclophosphamide or inhibition of the P-glycoprotein efflux pump by PIs . During a drug-interaction study in patients with AIDS-related non-Hodgkin lymphoma, PI-based HAART regimens plus cyclosporine/docetaxel/etoposide (CDE) were associated with a significantly higher incidence rate of infection and neutropenia compared with a PI-sparing HAART plus CDE regimen. Use caution when coadministering cyclophosphamide and a PI, and closely monitor patients for cyclophosphamide-associated adverse effects or consider alternative antiretroviral therapy to PIs
Severity
Major
Onset
Unspecified
Evidence
Established
How To Manage Interaction
The coadministration of cyclophosphamide and a protease inhibitor may increase the concentration of cytotoxic metabolites resulting in an increased incidence of cyclophosphamide-associated adverse effects, such as infection, neutropenia, and mucositis. If concomitant use is required, use with caution and monitor patients for chemotherapy-induced adverse effects or consider alternative antiretroviral therapy to PIs .
Mechanism Of Interaction
Unknown
Literature Reports
A) During a drug-interaction study of patients recently diagnosed with AIDS-related non-Hodgkin lymphoma, administration of protease inhibitor-based (PI-based) HAART and cyclophosphamide/docetaxel/etoposide (CDE) resulted in increased incidences of chemotherapy-induced infection and neutropenia compared with PI-sparing HAART and CDE over 190 total cycles. Grade 3 or 4 infections requiring hospitalization were reported in significantly more patients administered PI-based HAART plus CDE (n=48; 48% vs 25%) compared with those treated with PI-sparing HAART plus CDE regimens (n=142), a similar significant difference was seen with Grade 4 neutropenia (54% and 38%). Day 10 and day 14 median neutrophil counts were significantly lower in patients who received concomitant PI-based HAART compared with patients who received concomitant PI-sparing HAART during CDEt .
Cyclophosphamide Overview
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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.
Saquinavir Overview
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Saquinavir is used in combination with ritonavir (Norvir) and other medications to treat human immunodeficiency virus (HIV) infection. Saquinavir is in a class of medications called protease inhibitors. It works by decreasing the amount of HIV in the blood. Although saquinavir does not cure HIV, it may decrease your chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer. Taking these medications along with practicing safer sex and making other lifestyle changes may decrease the risk of transmitting the HIV virus to other people.
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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:
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.