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Acetaminophen and pyrilamine and Imatinib

Determining the interaction of Acetaminophen and pyrilamine and Imatinib and the possibility of their joint administration.

Check result:

Acetaminophen and pyrilamine <> Imatinib

Relevance: 17.08.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Talk to your doctor before using imatinib together with acetaminophen. Imatinib may cause liver damage, and taking it with acetaminophen-containing products may increase that risk. You should also avoid or limit the use of alcohol while being treated with either of these medications. Call your doctor immediately if you experience fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, or yellowing of the skin or the whites of your eyes during treatment with these medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR: In vitro inhibition data suggest that coadministration with imatinib may increase the plasma concentrations of acetaminophen. The proposed mechanism is imatinib inhibition of acetaminophen clearance via O-glucuronidation. However, no specific pharmacokinetic studies in humans have been performed. Pharmacodynamically, the potential may exist for additive adverse effects on the liver, since both agents individually are associated with hepatotoxicity. Cases of liver injury, including hepatic failure and hepatic necrosis, have been observed with imatinib use, particularly when combined with high-dose chemotherapy regimens. Most cases have been reversible, although approximately 0.5% have required permanent discontinuation of imatinib. In a phase 2 clinical trial, a patient who received a bone marrow transplant and had been taking acetaminophen (3000 to 3500 mg/day) regularly for fever died of acute liver failure 12 days after starting treatment with imatinib 600 mg/day. In a postmarketing case report, a patient developed severe hepatitis associated with coagulopathy five months after starting imatinib 400 mg/day for chronic myeloid leukemia. She began taking acetaminophen 500 to 1000 mg/day after the onset of symptoms. During hospitalization, her condition progressed to encephalopathy and she subsequently died of a cardiac arrest. Whether acetaminophen affected the clinical course and outcome of her hepatitis cannot be determined.

MANAGEMENT: Caution is advised if imatinib is used in combination with acetaminophen, particularly at higher dosages of the latter. All patients treated with imatinib should have liver function tests (transaminases, bilirubin, and alkaline phosphatase) prior to initiation of therapy and monthly thereafter or as clinically indicated. If elevations in bilirubin greater than 3 times institutional upper limit of normal (IULN) or liver transaminases greater than 5 times IULN occur, imatinib should be withheld until bilirubin levels decline to less than 1.5 times IULN and transaminase levels to less than 2.5 times IULN. Treatment may then be resumed at a reduced daily dosage (e.g., in adults: 400 mg to 300 mg, 600 mg to 400 mg, or 800 mg to 600 mg; in children: 340 to 260 mg/m2/day or 260 mg/m2/day to 200 mg/m2/day). Patients should be advised to seek medical attention if they experience potential signs and symptoms of hepatotoxicity such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. In addition, they should not take over-the-counter medications such as analgesics containing acetaminophen, flu preparations, or herbal products without first talking to their healthcare provider.

References

"Product Information. Gleevec (imatinib mesylate)." Novartis Pharmaceuticals, East Hanover, NJ.
Lin NU, Sarantopoulos S, Stone JR, et al. "Fatal hepatic necrosis following imatinib mesylate therapy." Blood 102 (2003): 3455-6

Acetaminophen and pyrilamine

Generic Name: acetaminophen / pyrilamine

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Synonyms: n.a.

What is Acetaminophen and pyrilamine?

Imatinib

Generic Name: imatinib

Brand name: Gleevec

Synonyms: n.a.

What is Imatinib?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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