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Drug interaction between idelalisib and diazepam resulting in altered mental status and respiratory failure

John B Bossaer1, Kanishka Chakraborty2

  • 11 Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, TN, USA.

Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners
|May 28, 2016
PubMed

Insights

New oral anticancer drugs like idelalisib can cause dangerous interactions. Clinicians must carefully monitor patients for adverse events, as drug interaction databases may not always detect these risks.

Area of Science:

  • Oncology
  • Clinical Pharmacology

Background:

  • Recent approvals of novel oral anticancer agents, often via accelerated pathways.
  • Potential for significant drug-drug interactions with these new therapies.
  • Clinician unfamiliarity may heighten interaction risks.

Observation:

  • A case of severe drug interaction involving idelalisib and diazepam.
  • Idelalisib (CYP3A4 inhibitor) potentiated diazepam (CYP3A4 substrate) effects.
  • Resulted in altered mental status and type II respiratory failure requiring hospitalization.

Findings:

  • Patient recovered rapidly after discontinuation of both interacting agents.
  • Substitution of lorazepam for diazepam, due to differing metabolism, allowed safe co-administration with idelalisib.
  • Standard drug interaction databases failed to consistently flag this specific interaction.

Implications:

  • Highlights the critical need for heightened clinical vigilance with new oral anticancer drugs.
  • Emphasizes that reliance solely on drug interaction databases can be insufficient.
  • Underscores the importance of understanding drug metabolism pathways (e.g., CYP3A4) for managing polypharmacy in cancer patients.
Keywords:
Idelalisibdiazepamdrug interactiondrug interaction database

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