Drug interactions- Summary-

+ Natalizumab-

Imunosuppressants eg. 6-mercaptopurine/azathropine/cyclosporine/methorexate/

and TNF- alpha inibitors

do not treat patients with Crohn's disease receiving natalizumab with concomittant immnosuppressantsor inhibitors of TNF. Taper corticosteroids in those patients with Crohn's disease

Crohn's disease

Multiple sclerosis

Metabolic-

weight decreased 2%, weight increased 2%,

Musculoskeletal -

Arthalgia 17%, joint swelling 3%, limb injury  4%, muscle cramps 5%, pain in extrimity 15%

Respiratory-

Loewer respiratory infection 15%,

Miscellaneous -

Chest discomfort 4%, fatigue 25%, herpis infection 6%, seasonal allergy 3%, tonsillitis 5%, tooth infection 7%, rigors 3% 

Hypersensitivity

Special precautions-

Infections- the immune syatem of natalizumab may increase the risk of infections.For patients with Crohn's disease who start natalizumab while on chronic corticosteroids, commence steroid withdrawal as soon as a therapeutic benefit has occurred. If the patient cannot discontinue systemic corticosteroids ithin 6 months, discontinue natalizumab

Antibody formation - if the presence of persistent antibodies is suspected, perform antibody testing. Antibodies may be detected and confirmed with sequential serum antibody tests

Hepatic effects- Discontinue natalizumab in patients with jaundice or other evidence of significant liver injury

Hypersensitivity reactions- hypersensitivity reactions have occurred in patients receiving natalizumab, including serious systemic reactions. If hypersensitivity reactions occur , discontinue administraion of the drug and initiate appropiate treatment  

Pregnancy- use natalizumab  during pregnancy only the potential benefits justifies the potential risk to  the fetus

Lactation- not known whethr the drug is excreted in human milk. Decide whether to discontinue breast feeding or the drug ,depending on the importance of the drug to the mother. 

Children- safety and effectiveness of natalizumab in children younger than 18 years  of age with  MS - multiple sclerosis  or Crohn's disease have not been established. Natalizumab is not indicated for use in children

Pregnancy-

Use natalizumab  during pregnancy only the potential benefits justifies the potential risk to  the fetus

Lactation-

Not known whether the drug is excreted in human milk. Decide whether to discontinue breast feeding or the drug ,depending on the importance of the drug to the mother. 

Children-

Safety and effectiveness of natalizumab in children younger than 18 years  of age with  MS - multiple sclerosis  or Crohn's disease have not been established. Natalizumab is not indicated for use in children