Interactions : אינטראקציות

4.5   Interaction with other medicinal products and other forms of interaction

In patients with CTX, no interaction studies with chenodeoxycholic acid and concomitantly administered medicinal products have been performed

Colestipol and antacid medicinal products
Chenodeoxycholic acid Leadiant should not be administered together with colestipol or antacid medicinal products containing aluminium hydroxide and/or smectite (aluminium oxide) since these preparations bind the active substance of chenodeoxycholic acid in the intestine and thus prevent its reabsorption and efficacy. If it is necessary to take a medicinal product containing one of these active substances it should be taken either 2 hours before or after taking Chenodeoxycholic acid Leadiant.

Colestyramine
Chenodeoxycholic acid Leadiant should not be administered together with colestyramine as it binds chenodeoxycholic acid in the intestine and thus prevents its reabsorption and efficacy. If it is necessary to take colestyramine, then Chenodeoxycholic acid Leadiant should be taken either one hour before colestyramine or 4-6 hours after.

Ciclosporin and sirolimus
Ciclosporin has been shown to reduce the synthesis of chenodeoxycholic acid by inhibition of CYP27A1 and increasing the activity of HMG CoA reductase. A similar effect on CYP27A1, albeit at higher doses, is also seen with sirolimus. Co-administration of Chenodeoxycholic acid Leadiant with ciclosporin or sirolimus should be avoided. If administration of ciclosporin or sirolimus is considered necessary, serum and urine bile alcohol levels should be closely monitored and the Chenodeoxycholic acid Leadiant dose adjusted accordingly.

Phenobarbital
Concomitant administration of chenodeoxycholic acid with phenobarbital increases HMG CoA reductase and thus counteracts one of the pharmacodynamics effects of chenodeoxycholic acid in CTX. If administration of phenobarbital is considered necessary, serum and urine bile alcohol levels should be closely monitored and the Chenodeoxycholic acid Leadiant dose adjusted accordingly.

Oral contraceptives
The administration of oral contraceptives reduces the pool size of chenodeoxycholic acid. Oral contraceptives therefore may worsen the underlying deficiency and counteract the effectiveness of Chenodeoxycholic acid Leadiant in CTX. Co-administration with oral contraceptives is not recommended.