Drug interactions - summary

+ Ixabepilone

Azole antifungals ( fluconazole , itraconazole, ketoconazole, voriconazole )
coadministration increased ixabepilone AUC . Consider dose reduction.
Monitor closely for toxicities

Carbamaxepine
Carbamazepine may decrease ixabepilone concentration, leading to subthrapeutic levels

Delavirdine
Delavirirdine may increase ixabepilone concnentration. Avoid co-administration

Dexamethasone
Dexamethasone may decrease ixabepilone concentration. leading to subtherapeutic levels

Macrolide antibiotics ( clarithromycin, erythromycin )                                                       macrolides may increase ixabipilone concentration. Avoid co-administration

Nefazodone
Mefazodone may increase ixabepilone concentration. Avoid co-administration

Penobarbital
Phenibarbital may decrease ixabeilone concentration, leading to subtherapeutic levels

Phenytoin
Phenytoin may decrease ixabepilone conentration,leading to subtherapeutic levels

Rifamycins  ( rifabutin, rifampin )
Rifamycin may decrease ixabepilone conentration,leading to subtherapeutic levels

Telithromycin
Telithromycin  may increase ixabepilone concentration and should be avoided

Verapramil
Verapramil may increase ixabepilone plasma concentration. Use caution and monitor toxicites

Breast cancer

Most common adverse reactions-  ( 15% )
alpoecia, diarhea, fatigue/asthenia, musculoskeletal pain, nause and vomiting.

Cardiovascular-
dizziness 6%     fatigue/asthenia   55%  sensory neuropathy 60%

Dermatologic
Alopecia  25%   nail disorder  20%  Palmar -plantar syndrome  55%   skin hyperpigmentation  9%

GI
Abdominal pain  20%  anorexia  30%    constipation 20%  diarrhea  40%

Musculoskeletal
Muscular pain  20%  myalgia 30%

Hypersensitivity reactions to the components

Special Precautions/warnings

Peripheral neuropathy-
Monitor patients treated with ixbepilone for symptoms of neuropathy, burning sensation,
hyperesthesia, parathesia, discomfort or neuropathic pain.

Mylosuppression-
Myelosuppression is dose related and primarily manifested as neutropenia
Patients who experience severe neutropenia should have the dose reduced

Hypersensitivity reactions- do not treat  treat patients with a history of hypersensitivity
reactions to agents containing ployoxyethylated castor oil with ixabepilone.
Premeditate all patients with H1 and H2 antagonist approximately 1 hour before ixabepilone
infusion and observe for hypersensitivity reactions

Pregnancy
If the patient becomes pregnant while taking this drug appraise the patient of the potential
hazard to the fetus.

Lactation-
Decide whether to discontinue the drug or the breast feeding taking into the importance
of the drug to the mother.

Children -
Safety and effectiveness of ixabepilone in children have not been established.

Elderly -
Few toxicity related deaths occurred in patients 65 years of age with normal baseline hepatic function or mild impairment

Monitoring-
Monitor patients treated with ixbepilone for symptoms of neuropathy, burning sensation,
hyperesthesia, parathesia, discomfort or neuropathic pain.

Indication-

Breast cancer

Dosage-

40mg/m2 administered intravenously IV over 3 hours every 3 weeks.
Doses for patients with body surface area greater than 2,2m2 should be calculated
based on 2.2m2

1. Advice patients to report to their doctor about any numbness , tingling of the hands or feet.

2. Inform your Doctor if the fever of 100F or more or other evidence of potential infection,
such as chills, cough or burning on urination develops.

3. Inform your doctor if you experience urticaria, pruritus, rash, flushing, swelling , chest tightness, or hypersensitivity related reactions.

4. Inform your doctor if you have chest pain, difficulty in breathing ,palpitations, or unusual weight gain

Pregnancy
If the patient becomes pregnant while taking this drug appraise the patient of the potential
hazard to the fetus.

Lactation-
Decide whether to discontinue the drug or the breast feeding taking into the importance
of the drug to the mother.

Children -
Safety and effectiveness of ixabepilone in children have not been established.

Elderly -
Few toxicity related deaths have occurred in patients 65 years of age with normal baseline hepatic function or mild impairment