Interactions : אינטראקציות

4.5   Interaction with other medicinal products and other forms of interaction
Cardioxane is excreted unchanged via the kidney, as well as metabolized by dihydropyrimidine amidohydrolase (DHPase) in the liver and kidney to ring-opened metabolites. Co-administration of doxorubicin (50 to 60 mg/m2) or epirubicin (60 to 100 mg/m2) did not affect Cardioxane pharmacokinetics significantly.

In studies, Cardioxane did not affect the pharmacokinetics of doxorubicin. There is limited evidence from studies that suggests that epirubicin clearance may be increased when dexrazoxane is pre-administered, this occurred at high doses of epirubicin (120-135 mg/m2).

Cardioxane may increase haematological toxicity induced by chemotherapy or radiation, requiring careful monitoring of haematological parameters during the first two treatment cycles (see section 4.4).

Cardioxane should not be mixed with any other medicinal products during infusion.

Concomitant use contraindicated:
Yellow fever vaccine: Risk of fatal generalised vaccine disease (see section 4.3).
Concomitant use not recommended:
Other live attenuated vaccines: 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: cytotoxic agents may reduce the absorption of phenytoin leading to an exacerbation of convulsions. Dexrazoxane is not recommended in combination with phenytoin.

Concomitant use to assess carefully:
Ciclosporin, tacrolimus: Excessive immunosuppression with risk of lymphoproliferative disease.