O + V & Antibiotics?

[DRM18]

Does anyone here know which—if any—antibiotics someone being treated with Obinutuzumab & Venetoclax should avoid?

Just curious. Read something about that once, but can’t seem to remember it, nor re-find it.

—Dave!

[PlanetaryKim]

I think there are quite a few that need to be avoided, especially during venetoclax ramp-up, due to cyp3a4 interactions.

Long complex list part-way down this document: pdr.net/drug-summary/Vencle...

But some listed to avoid are: Ciprofloxacin, Amoxicillin, Clarithromycin, Cyclosporine,

There should be an easier list to find somewhere.

[DRM18 in reply to PlanetaryKim]

Thank you Kim! ... Interesting: I thought low-dose Cipro was sometimes given as a prophylactic antibiotic to CLL endurers? But apparently not in conjunction w/ Venetoclax? ... Should it ever come up, I wanna trust my GP, but so many of them are unfamiliar w/ new CLL treatments.

I hope they have easier access to a list of drug interactions than I do!

[PlanetaryKim in reply to DRM18]

Cipro is a favorite go-to antibiotic of doctors these days, because it is known for being effective on bacteria that are resistant to other antibiotics. So doctors reach for Cipro first. But I personally think it is the worst and most dangerous and have always refused it. It does seem to be listed as a strong inhibitor of CYP3A4. So that alone should rule it out for treating people on venetoclax (or ibrutinib) in my opinion. But there are other serious toxicities associated with cipro - something about tendons getting loose and tearing. It can have quite disabling consequences for some people. Personally, I ask doctors to use other antiobiotics and not Cipro or anything else in the fluoroquinolone family.

But be sure to also reminnd doctors that Venetoclax is metabolised by Cyp3A4. Most doctors are not really up on CYP3A4 interactions. But if you remind them, they will probably check with the pharmacist before prescribing.

[Hidden in reply to PlanetaryKim]

Thanks for the PDR reference Kim! Much better than the Abbivie prescribing info in terms of drug interactions, and a few other important tidbits of information. Just in the last several days, My CLL doc asked me to confirm CYP3A concerns about venetoclax interactions with other meds I am prescribed by another doctor. I did not even find in the Venetoclax document whether V is substrate, inducer or inhibitor... and there it is in the PDR: Substrate.

[Hidden]

antibiotics that are cy3pa inibitors are suggested to avoid

[Mcpill]

Just a quick note now, more later, but I am currently Taking Cipro and metronidazole. Really did not want to, but necessary. My CLL specialist told me to halve my Venetoclax ( 2 pills now) for 12 days. I am on the antibiotics for 10- thankfully after today, only 2 more days. I read about all the side effects here prior to starting the prescriptions, but ultimately relied on my specialists advice. Fortunately, while the last week has been difficult, and I cannot wAit to finish, I have avoided serious problems. Sometimes there really is not a lot of choice.

For respiratory infections( rare for me since diagnosis and pneumonia vaccinations in 2014) I have taken a Z pack without problems while on Imbruvica first, and later on Venclexta.

[CLLBGone]

I'm on O&V and thought I might need a dental procedure which I luckily did not need. When I asked my CLL doctor about antibiotics, this is the answer I received: "Just make sure that any antibiotic prescribed is not a CYP3A inducer or inhibitor."

Seems a bit cornfusing for sure. A specific list would be a bit more helpful, which I plan to get on my next visit.