AHA guidance identifies potential drug-to-drug interactions between CV, cancer medications
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In a recent American Heart Association scientific statement, a committee provided an overview of drug-to-drug interactions between cancer drugs and commonly used CV medications.
Published in Circulation, the scientific statement asserts the importance of recognition of potential cancer and CV drug interactions, consideration of alternative medications when possible and careful monitoring of patients in this population.
“Cardio-oncology is a rapidly evolving field in which patients with cancer and CV risk or disease are exposed to complex medication regimens. To optimize these patients, you have to be proficient in the pharmacotherapy for both. An important aspect is drug interactions to further reduce risk,” Craig Beavers, PharmD, cardiovascular clinical pharmacy coordinator at UK HealthCare, assistant adjunct professor with the University of Kentucky College of Pharmacy and chair of the statement writing committee, told Healio. “The document provides a quick reference and overview of common interactions and allows clinicians to determine if a potential interaction exists and any considerations. Of course, it does not cover every agent — or any agent in development — but does provide guidance on what to do in that situation.”
Considerations for drug-to-drug interactions
The document offered the following practice considerations for the management of potential drug-to-drug interactions in patients with cancer and CVD.
Tyrosine kinase inhibitors such as dasatinib (Sprycel, Bristol Myers Squibb), ibrutinib (Imbruvica; Janssen, Pharmacyclics) and imatinib depend on acid environments for absorption and consideration should be given to the need for acid suppression therapy or a tyrosine kinase inhibitor not affected by basic environment should be selected, according to the statement.
Inhibition of various renal transporters by amiodarone and verapamil may increase levels of renally cleared anticancer agents such as vinblastine, increasing risk for toxicity, the committee wrote. If possible, these CV agents should be discontinued before therapy is started, according to the statement.
The committee added that patients on CV therapies that rely on renal clearance should be monitored closely if continued during treatment with nephrotoxic anticancer therapy.
IV anthracyclines, both conventional and liposomal, cyclophosphamide, taxanes, cytarabine and tyrosine kinase inhibitors can induce P-glycoprotein. According to the statement, physicians should be aware of the CV drugs that are P-glycoprotein substrates.
Moreover, several chemotherapeutic agents and supportive therapies can have significant drug interactions, and a dose reduction or alternate therapy may be needed, according to the statement.
Consult pharmacists about drug interactions
“The biggest takeaway is to be familiar with the common interaction pathways and profiles for the commons agents in each category,” Beavers told Healio. “It is also important to realize it is not possible to know all these, given the dynamic landscape in oncology. Be sure to consult your pharmacists on the multidisciplinary team.”
Please see the scientific statement for full details on the AHA’s overview of drug-to-drug interactions of common CV and cancer medications.
For more information:
Craig Beavers, PharmD, can be reached at craig.beaverspharmd@gmail.com.
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