Interactions : אינטראקציות

4.5    Interaction with other medicinal products and other forms of interaction

Due to the increase of thrombotic risk in case of tumoural diseases, the use of anticoagulative treatment is frequent. The high intra-individual variability of the coagulability during diseases, and the eventuality of interaction between oral anticoagulants and anticancer chemotherapy, require, if it is decided to treat the patient with oral anticoagulants, to increase frequency of the control of the INR monitoring.

Concomitant use contraindicated
- Yellow fever vaccine: risk of generalised vaccinal disease mortal (see section 4.3).

Concomitant use not recommended
- Live-attenuated vaccines (except yellow fever): Risk of systemic, possible fatal disease. This risk is increased in subjects who are already immunosuppressed by their underlying disease. Use an inactivated vaccine where this exists (poliomyelitis).
- Phenytoin, fosphenytoin: Risk of exacerbation of convulsions resulting from the decrease of phenytoin digestive absorption by the cytotoxic drug or risk of toxicity enhancement or lose of efficacy of the cytotoxic drug due to increased hepatic metabolism by phenytoin.
- Complex-forming compounds: Concomitant administration of carboplatin and complex-forming compounds should be avoided, as theoretically, the antineoplastic effects of carboplatin might be decreased. However, in animals and clinically, the antineoplastic effects of carboplatin were not influenced by diethylthiocarbamate.

Concomitant use to take into consideration
- Cyclosporin (and by extrapolation tacrolimus and sirolimus): Excessive immunosuppression with risk of lymphoproliferation.
- Nephrotoxic and/or ototoxic drugs: The concomitant use of carboplatin with nephrotoxic and/or ototoxic drugs (e.g., aminoglycoside antibiotics, loop diuretics) should be taken into account due to the cumulative nephrotoxicity and ear toxicity, particularly in renal failure patients.
- Myelosuppressive compounds: Myelosuppression is worsened by therapy combining carboplatin with other compounds that are myelosuppressive.