sk and severity of serotonin syndrome, use caution when administering dolasetron with other drugs that have serotonergic properties such as Monoamine oxidase inhibitors. If serotonin syndrome is suspected, discontinue dolasetron and concurrent serotonergic agents and initiate appropriate medical treatment. Serotonin syndrome is characterized by rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death.
Moxifloxacin: Due to a possible risk for QT prolongation and torsade de pointes (TdP), dolasetron and moxifloxacin should be used together cautiously. Dolasetron has been associated with a dose-dependant prolongation in the QT, PR, and QRS intervals on an electrocardiogram. Use of dolasetron injection for the prevention of chemotherapy-induced nausea and vomiting is contraindicated because the risk of QT prolongation is higher with the doses required for this indication; when the injection is used at lower doses (i.e., those approved for post-operative nausea and vomiting) or when the oral formulation is used, the risk of QT prolongation is lower and caution is advised. Prolongation of the QT interval has been reported with administration of moxifloxacin. Post-marketing surveillance has identified very rare cases of ventricular arrhythmias including torsade de pointes (TdP), usually in patients with severe underlying proarrhythmic conditions. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin, therefore the recommended dose or infusion rate should not be exceeded. According to the manufacturer, moxifloxacin should be avoided in patients taking drugs that can result in prolongation of the QT interval.
Nilotinib: Avoid the concomitant use of nilotinib with other agents that prolong the QT interval, such as dolasetron. Nilotinib is a CYP3A4 and CYP2D6 inhibitor and dolasetron is a substrate of CYP3A4 and CYP2D6; administering these drugs together may result in increased dolasetron levels. If the use of dolasetron is necessary, hold nilotinib therapy. If these drugs are used together, consider a dolasetron dose reduction and monitor patients for toxicity (e.g., QT interval prolongation).
Norfloxacin: Due to a possible risk for QT prolongation and torsade de pointes (TdP), dolasetron and norfloxacin should be used together cautiously. Dolasetron has been associated with a dose-dependant prolongation in the QT, PR, and QRS intervals on an electrocardiogram. Use of dolasetron injection for the prevention of chemotherapy-induced nausea and vomiting is contraindicated because the risk of QT prolongation is higher with the doses required for this indication; when the injection is used at lower doses (i.e., those approved for post-operative nausea and vomiting) or when the oral formulation is used, the risk of QT prolongation is lower and caution is advised. Quinolones have been associated with a risk of QT prolongation and torsade de pointes (TdP). Although extremely rare, torsade de pointes has been reported during post-marketing surveillance of norfloxacin. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. Norfloxacin should be used cautiously with other agents that may prolong the QT interval or increase the risk of TdP.
Nortriptyline: Tricyclic antidepressants should be used cautiously and with close mo |
