Potential interactions between antineoplastic agents and medicines used to treat Covid-19

J Oncol Pharm Pract. 2022 Dec;28(8):1737-1748. doi: 10.1177/10781552211040494. Epub 2021 Oct 12.

Abstract

Introduction: Cancer patients with Covid-19 are exposed to treatment combinations that can potentially result in interactions that adversely affect patient outcomes. This study aimed to identify potential drug-drug interactions between antineoplastic agents and medicines used to treat Covid-19.

Methods: We conducted a search for potential interactions between 201 antineoplastic agents and 26 medicines used to treat Covid-19 on the Lexicomp® and Micromedex® databases. The following data were extracted: interaction severity ("major" and "contraindicated") and interaction effects (pharmacokinetic and pharmacodynamic). We also sought to identify the therapeutic indication of the antineoplastic drugs involved in the potential drug-drug interactions.

Results: A total of 388 "major" or "contraindicated" drug-drug interactions were detected. Eight drugs or combinations (baricitinib, lopinavir/ritonavir, atazanavir, darunavir, azithromycin, chloroquine, hydroxychloroquine, and sirolimus) accounted for 91.5% of these interactions. The class of antineoplastic agents with the greatest potential for interaction was tyrosine kinase inhibitors (accounting for 46.4% of all interactions). The findings show that atazanavir, baricitinib, and lopinavir/ritonavir can affect the treatment of all common types of cancer. The most common pharmacokinetic effect of the potential drug-drug interactions was increased plasma concentration of the antineoplastic medicine (39.4%).

Conclusions: Covid-19 is a recent disease and pharmacological interventions are undergoing constant modification. This study identified a considerable number of potential drug-drug interactions. In view of the vulnerability of patients with cancer, it is vital that health professionals carefully assess the risks and benefits of drug combinations.

Keywords: Covid-19; antineoplastic agents; drug–drug interactions.

MeSH terms

  • Antineoplastic Agents* / adverse effects
  • Antiviral Agents* / adverse effects
  • Atazanavir Sulfate
  • COVID-19 Drug Treatment*
  • Drug Combinations
  • Drug Interactions
  • Humans
  • Lopinavir / adverse effects
  • Ritonavir / adverse effects

Substances

  • Antineoplastic Agents
  • Antiviral Agents
  • Atazanavir Sulfate
  • baricitinib
  • Drug Combinations
  • Lopinavir
  • Ritonavir