Vinblastine Erythromycin

P-gp (ABCB1) Verapamil, digoxin, mitoxantrone, vinblastine, doxorubicin, losartan, talinolol, cortisol, dexamethasone, colchicine, loperamide, domperidone, indinavir, erythromycin, tetracycline, itraconazole, cyclosporine, methotrexate, amitryptyline, phenobarbital, morphine, cimetidine, and others... 

A4 inhibitors - Patients receiving cytochrome P450 3A4 inhibitors, such as macrolide antibiotics (erythromycin and clarithromycin), antifungal agents (ketoconazole, itraconazole, and miconazole), or cyclosporine or vinblastine should not receive doses of tolterodine greater than 1 mg twice/day (greater than 2 mg/day for ER capsules). 

Secondary> hyperparathyroidism 30 mg PO daily Parathyroid carcinoma 30 mg PO bid titrate q2—4wk based on Ca PTH levels swallow whole take w/ food Caution [C, /—] w/ Szs Disp Tabs SE N/V/D, myalgia, dizziness, 4- Ca2+ Interactions T Effects W/ CYP3A4 inhibitors such as ketoconazole, itraconazole, erythromycin T effects OF drugs metabolized at CYP2D6 such as TCA, thioridazine, flecainide, vinblastine EMS Monitor ECG for signs of hypocalcemia (T QT interval) OD May cause severe hypocalcemia calcium salts can be given... 

Heparin and its salts are incompatible with many drugs including alteplase, amikacin sulfate, amiodarone hydrochloride, ampicillin sodium, aprotinin, benzylpenicillin potassium or sodium, cephalothin sodium, ciprofloxacin lactate, cytarabine, dacarbazine, daunorubicin hydrochloride, diazepam, dobutamine hydrochloride, doxorubicin hydrochloride, droperidol, erythromycin lactobionate, gentamicin sulfate, haloperidol lactate, hyaluronidase, hydrocortisone sodium succinate, kanamycin sulfate, methicillin sodium, netilmicin sulfate, some opioid analgesics, oxytetracycline hydrochloride, some phenothiazines, polymyxin B sulfate, streptomycin sulfate, tetracycline hydrochloride, tobramycin sulfate, vancomycin hydrochloride, vinblastine sulfate, cisatracurium besylate, labetalol hydrochloride, nicardipine hydrochloride, cefmetazole, sodium ions, and fat emulsion.110 112... 

Acyclovir Erythromycin Ivermectin Itraconazole Rifampin Actinomycin D Daunorubicin Doxorubicin Docetaxel Epirubicin Etoposide Imatinib Irinotecan Paclitaxel Vinblastine Vincristine Amprenavir Indinavir Nelfinavir Ritonavir Saquinavir Cyclosporine A Tacrolimus Digoxin Quinidine Verapamil Diltiazem Aldosterone Cortisol Corticosterone Dexamethasone Hydrocortisone Cyclosporine Metkephamid Enkephalin... 

CLARITHROMYCIN, ERYTHROMYCIN VINCA ALKALOIDS -VINBLASTINE, VINCRISTINE, VINORELBINE t adverse effects of vinblastine and vincristine Inhibition of CYP3A4-mediated metabolism. Also inhibition of P-gp efflux of vinblastine Monitor FBCs. Watch for early features of toxicity (pain, numbness, tingling in the fingers and toes, jaw pain, abdominal pain, constipation, ileus). Consider selecting an alternative drug... 

Drugs that are known to be substrates of P-gp include antihistamines (e.g. terfenadine), digoxin, ciclosporin, hydrocortisone and other steroids and drugs used in chemotherapy (e.g. paclitaxel, vinblastine). Ciclosporin, in addition to being a substrate of P-gp, is also an inhibitor of P-gp. Drugs known to induce P-gp include morphine, dexamethasone, phenobarbital, rifampin and St John s wort. Inhibitors of P-gp include amiodarone, amitriptyline, atorvastatin, chlorpromazine, ciclosporin, erythromycin, fluphenazine, haloperidol, quinidine, ritonavir and verapamil,... 

Toward the end of a phase I study of vinblastine plus oral ciclosporin to reverse multidrug resistance, three patients also received erythromycin to raise their ciclosporin concentrations all developed severe toxicity consistent with a much higher dose of vinblastine than was actually given (94). 

Tobe SW, Siu LL, Jamal SA, Skorecki KL, Murphy GF, Warner E. Vinblastine and erythromycin an unrecognized... 

Clinically important, potentially hazardous interactions with alprazolam, amphotericin B, anisindione, anticoagulants, dicumarol, eplerenone, erythromycin, methadone, midazolam, phenobarbital, phenytoin, ramelteon, sulfonylureas, trabectedin, vinblastine, vincristine, warfarin... 

Clinically important, potentially hazardous interactions with alfuzosin, alprazolam, amphotericin B, anisindione, antacids, aprepitant, astemizole, atorvastatin, bosentan, ciclesonide, cimetidine, clorazepate, conivaptan, cyproterone, dasatinib, dexamethasone, dicumarol, didanosine, eplerenone, erythromycin, ethotoin, fentanyl, fesoterodine, fosamprenavir, fosphenytoin, grapefruit juice, HMG-CoA reductase inhibitors, imatinib, ixabepilone, lapatinib, lopinavir, lovastatin, mephenytoin, methylprednisolone, micafungin, midazolam, nilotinib, pimozide, prednisolone, prednisone, quinidine, rifampin, rimonabant, rivaroxaban, sildenafil, silodosin, simvastatin, sirolimus, solifenacin, temsirolimus, terfenadine, tolvaptan, triazolam, vardenafil, vinblastine, vincristine, warfarin... 

Three patients with renal eell eareinoma given ciclosporin 10 or 13 mg/kg daily and erythromycin 1 g daily for 3 days developed severe toxicity when given vinblastine 7 to 10 mg/m on the third day. Ciclosporin was used as a modifier of multidrug resistanee and erythromycin was given to aehieve higher eielosporin levels at a lower dose (see Ciclosporin -i- An-... 

Uncertain, but erythromycin inhibits the cytochrome P450 isoenzyme CYP3A4, which is concerned with the metabolism of vinblastine. This would be expected to reduce the metabolism of vinblastine resulting in an... 

Information seems to be limited to this report. On the basis of their findings the authors suggest that erythromycin should be avoided at the time of vinblastine infusion. Use with clarithromycin may be safe. The UK manufacturers of vincristine and vindesine have warned that caution should be exercised in patients taking any drugs known to inhibit the CYP3A subfamily because of the risk of an earlier onset and/or increased severity of adverse effects. One manufacturer of vinblastine states that erythromycin may increase vinblastine toxicity. Note that itraconazole, another CYP3A4 inhibitor, is known to increase the toxicity of vincristine, see Vinca alkaloids -i- Azoles , p.668. 

Vitamin A Strychnine Testosterone Cephalosporin Reserpine Penicillin V Prostaglandin E2 Lysergic acid Erythromycin B Vinblastine Morphine Vitamin Bj2 Cocaine Taxol... 

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