Interactions : אינטראקציות

4.5      Interactions with other medicinal products and other forms of interaction

When combined with other chemotherapies, ZAVEDOS can lead to additive toxicity, particularly with regards to medullary/haematological effects and gastrointestinal effects (see section 4.4). Heart function must be monitored throughout the treatment if ZAVEDOS is used in chemotherapy that also involves other potentially cardiotoxic products, as well as if other products for cardiac disease (e.g.
calcium channel blockers) are used concomitantly.
Changes in hepatic or renal function caused by concomitant treatments can affect the metabolism, pharmacokinetics, efficacy and/or toxicity of idarubicin (see section 4.4.).
Additive myelosuppression can appear when radiotherapy takes place concomitantly or two to three weeks before treatment with ZAVEDOS.
INTERACTIONS COMMON TO ALL CYTOTOXIC AGENTS
Contraindicated combinations (see section 4.3)
+    Live attenuated vaccines (against yellow fever, chickenpox, herpes zoster, measles, mumps, rubella, tuberculosis, rotavirus, influenza) and for the 6 months following the discontinuation of chemotherapy Risk of potentially fatal generalised vaccine disease.

Inadvisable combinations (see section 4.4)
+       Olaparib
Risk of increased cytotoxic myelosuppressive effect.
+   Phenytoin (and, by extrapolation, fosphenytoin)
Risk of occurrence of seizures due to decreased gastrointestinal absorption by the cytotoxic agent of phenytoin alone, or risk of an increase in toxicity and a loss of efficacy of the cytotoxic agent due to an increase in the hepatic metabolism by phenytoin or by fosphenytoin.

Associations requiring precautions for use
+ Antivitamin K
Increased risk of thrombosis and bleeding in the course of tumour diseases. In addition, possible interaction between the AVK and chemotherapy.
More frequent monitoring of the INR.

Associations to be taken into account
+ Flucytosine
Risk of increased haematological toxicity.
+ Immunosuppressive drugs (ciclosporin, everolimus, sirolimus, tacrolimus, temsirolimus).
Excessive immunodepression with a risk of lymphoproliferative syndrome.