Erlotinib with Amiodarone Interaction Details
Brand Names Associated with Erlotinib
- Erlotinib
- Tarceva®
Brand Names Associated with Amiodarone
- Amiodarone
- Cordarone®
- Pacerone®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Feb 27, 2024
Interaction Effect
Neurotoxicity
Interaction Summary
Concomitant use of amiodarone (a P-gp inhibitor) and erlotinib (a P-gp substrate) caused severe neurotoxicity in a case report of a 64-year-old man. Erlotninb was discontinued, but symptoms recurred with rechallenge. Dosage reduction of both agents resulted in no further toxicity[1].
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Concomitant use of amiodarone (a P-gp inhibitor) and erlotinib (a P-gp substrate) caused severe neurotoxicity in a case report of a 64-year-old man. Erlotinib was discontinued, but symptoms recurred with rechallenge. Dosage reduction of both agents resulted in no further toxicity[1].
Mechanism Of Interaction
Inhibition of erlotinib P-gp efflux transport by amiodarone
Literature Reports
A) A case report described severe neurotoxicity in a 64-year-old man with lung cancer who initiated palliative systemic chemotherapy with erlotinib 150 mg/day and 6 weeks later received an amiodarone IV bolus of 300 mg for atrial fibrillation. He presented 5 hours after the amiodarone bolus with lightheadedness and weakness with loss of muscle strength and paresthesia of the left upper and lower extremities. While in the hospital, he had 2 more episodes of atrial fibrillation that required reversal with amiodarone. Four days after his initial presentation with atrial fibrillation, he had expressive aphasia, headache, and 2 generalized tonic-clonic seizures (Glasgow Coma Scale 10) that required clonazepam. Six days after the seizures, amiodarone was decreased to 200 mg/day and erlotinib was discontinued; the next day, he was discharged on erlotinib 150mg/day and amiodarone 200 mg/day. He returned to the hospital within a few hours with intermittent paralysis in both lower extremities. Erlotinib was decreased to 100 mg/day, amiodarone was continued at 200 mg/day, and no further toxicity occurred [1].
References
1 ) Lopez Brunso M, Toro Blanch C, Sais Girona E, et al: Probable drug-drug interaction between erlotinib and amiodarone causes severe neurotoxicity in a patient with advanced lung cancer. Anticancer Drugs 2018; 29(4):380-383.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...
Erlotinib Overview
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Erlotinib is used to treat certain types of non-small cell lung cancer that has spread to nearby tissues or to other parts of the body in patients who have already been treated with at least one other chemotherapy medication and have not gotten better. Erlotinib is also used in combination with another medication (gemcitabine [Gemzar]) to treat pancreatic cancer that has spread to nearby tissues or to other parts of the body and cannot be treated with surgery. Erlotinib is in a class of medications called kinase inhibitors. It works by blocking the action of an abnormal protein that signals cancer cells to multiply. This helps slow or stop the spread of cancer cells.
Amiodarone Overview
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Amiodarone is used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias (a certain type of abnormal heart rhythm when other medications did not help or could not be tolerated. Amiodarone is in a class of medications called antiarrhythmics. It works by relaxing overactive heart muscles.
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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.