March 16, 2022
2 minute read
Disclosures: Beavers does not report any relevant financial information. Please see the statement for all relevant financial information from the other authors.
In a recent scientific statement from the American Heart Association, a committee provided an overview of drug interactions between cancer drugs and commonly used CV drugs.
Posted in Trafficthe scientific statement affirms the importance of recognizing potential interactions between cancers and CV drugs, considering alternative medications when possible, and carefully monitoring patients in this population.
“Cardio-oncology is a rapidly evolving field in which cancer patients with cardiovascular risk or disease are exposed to complex treatment regimens. To optimize these patients, you must master the drug therapy of both. An important aspect is drug interactions to further reduce the risk,” Craig Beavers, PharmD, coordinator of cardiovascular clinical pharmacy at UK HealthCare, adjunct assistant professor at 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 doesn’t cover all agents – or any agents in development – but does provide guidance on what to do in this situation.
Drug Interaction Considerations
The document offered the following practical considerations for managing potential drug interactions in patients with cancer and cardiovascular disease.
Tyrosine kinase inhibitors such as dasatinib (Sprycel, Bristol Myers Squibb), ibrutinib (Imbruvica; Janssen, Pharmacyclics), and imatinib are dependent on acidic environments for absorption and consideration should be given to the need for acid suppression therapy or a tyrosine kinase inhibitor unaffected by basal environment should be selected, according to the statement.
Inhibition of various renal transporters by amiodarone and verapamil may increase the levels of kidney-cleared anticancer agents such as vinblastine, increasing the risk of toxicity, the committee wrote. If possible, these CV agents should be discontinued before treatment begins, according to the statement.
The committee added that patients on CV therapies that rely on renal clearance should be closely monitored if they are continued during treatment with nephrotoxic cancer therapy.
IV, conventional and liposomal anthracyclines, cyclophosphamide, taxanes, cytarabine, and tyrosine kinase inhibitors can induce P-glycoprotein. According to the statement, physicians should be aware of CV drugs that are P-glycoprotein substrates.
Additionally, several chemotherapy drugs and supportive therapies may have significant drug interactions, and dose reduction or alternative therapy may be required, according to the statement.
Consult pharmacists on drug interactions
“The biggest benefit is getting familiar with common interaction pathways and common agent profiles in each category,” Beavers told Healio. “It is also important to realize that it is not possible to know everything, given the dynamic landscape of oncology. Be sure to consult your pharmacists on the multidisciplinary team.
Please see the scientific statement for more details on the AHA’s overview of drug interactions for common CV and cancer drugs.
For more information:
Craig Beavers, Doctor of Pharmacy, can be reached at [email protected]