Onivyde interactions: Alcohol, medications, and other factors

Before you start treatment with Onivyde, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Onivyde interacts with supplements, herbs, or vitamins, see the “Onivyde and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Onivyde. Keep in mind that this table doesn’t include all drugs that may interact with Onivyde. Some of these interactions are described in detail just below in “Drug interactions in depth.”

In some cases, factors or conditions could prevent your doctor from prescribing Onivyde due to the risk of harm. These are known as contraindications. The contraindications of Onivyde include:

Having had an allergic reaction to Onivyde or any of its ingredients

If you have had an allergic reaction to Onivyde or any of its ingredients, your doctor will likely not prescribe Onivyde. This includes irinotecan hydrochloride, which is the salt form of the active ingredient in Onivyde. Receiving Onivyde could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Note: Before you start treatment with Onivyde, it’s important to tell your doctor if this contraindication applies to you. They can determine whether to prescribe Onivyde.

There aren’t any known interactions between Onivyde and alcohol. However, if you drink alcohol, your doctor may advise you to avoid or limit it during Onivyde treatment.

This is because drinking alcohol while receiving the drug may worsen some of Onivyde’s side effects. For example, you may experience:

• nausea
• vomiting
• diarrhea
• dehydration

In addition, consuming large amounts of alcohol can cause liver damage. Onivyde may also cause liver damage as a side effect. This means that drinking alcohol during Onivyde treatment may increase the risk of liver problems.

If you consume alcohol during Onivyde treatment, these side effects may be more likely to occur. If you have questions about drinking alcohol during Onivyde treatment, talk with your doctor. To learn about side effects of Onivyde, see the “Side effects” section in this article.

Note: Onivyde has a boxed warning about the risk of severe diarrhea. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see “Boxed warnings” at the top of this article.

Here’s a closer look at certain drug interactions of Onivyde.

Certain antibiotics

Onivyde can interact with certain antibiotic drugs, which are used to treat bacterial infections.

Interaction result: Taking certain antibiotics with Onivyde can raise your risk of Onivyde side effects.

Interaction explained: Certain antibiotics can reduce the action of an enzyme (type of protein) in your body called cytochrome P450 3A4 (CYP3A4). This enzyme helps metabolize (clear) drugs from your body. By reducing CYP3A4 activity, these antibiotics can cause a buildup of Onivyde. A higher level of Onivyde in your body is more likely to cause side effects.

Examples of antibiotic drugs: Here are some antibiotics that may interact with Onivyde:

• clarithromycin
• erythromycin (Ery-Tab, others)

Steps you or your doctor may take: Your doctor will likely avoid prescribing the antifungals listed above with Onivyde. If you need treatment for a bacterial infection while receiving Onivyde, your doctor will usually prescribe an antibiotic that doesn’t interact with Onivyde.

If your doctor prescribes Onivyde with one of the antibiotics listed above, they may reduce your Onivyde dosage. They’ll also monitor you closely. Tell your doctor right away if you have new or increased side effects of Onivyde. To learn more, see the “Side effects” section in this article.

If you have questions about taking an antibiotic with Onivyde, talk with your doctor or pharmacist.

Certain antifungals

Onivyde can interact with certain antifungal drugs, which are used to treat fungal infections.

Interaction result: Taking certain antifungals with Onivyde can raise your risk of Onivyde side effects.

Interaction explained: Certain antifungals can reduce the action of CYP3A4. Since this enzyme helps clear the drug from your body, reducing its activity can cause Onivyde to build up in your system. A higher level of Onivyde raises your risk of having side effects.

Examples of antifungal drugs: Here are some antifungals that may interact with Onivyde:

• itraconazole (Sporanox, Tolsura)
• ketoconazole
• posaconazole (Noxafil)
• voriconazole (Vfend)

Steps you or your doctor may take: Your doctor will usually avoid prescribing the drugs listed above with Onivyde. If you need treatment for a fungal infection while receiving Onivyde, your doctor will likely prescribe an antifungal that doesn’t interact with Onivyde.

If your doctor prescribes Onivyde with one of the antifungals listed above, they may reduce your dosage of Onivyde. They’ll also monitor you closely for side effects. Tell your doctor right away if you have new or worsening side effects of Onivyde. For details, see the “Side effects” section in this article.

If you have questions about taking an antifungal with Onivyde, talk with your doctor or pharmacist.

Certain seizure medications

Onivyde can interact with certain seizure medications, which are used to treat seizure disorders such as epilepsy.

Interaction result: Receiving Onivyde with certain seizure medications can make Onivyde less effective at treating pancreatic cancer.

Interaction explained: Certain seizure medications can increase the action of CYP3A4. This enzyme helps break down and clear Onivyde from your body. With increased CYP3A4 activity, Onivyde may break down faster. This may lower the level of Onivyde in your body. A low level of the drug may make it less effective at treating your condition.

Examples of seizure medications: Here are some seizure medications that may interact with Onivyde:

• carbamazepine (Tegretol, others)
• phenobarbital (Sezaby)
• phenytoin (Dilantin)

Steps you or your doctor may take: Your doctor will usually avoid prescribing Onivyde with the medications listed above. If you take one of these medications, your doctor may recommend switching to a different seizure medication at least 2 weeks before you start treatment with Onivyde.

If you have questions about taking a seizure medication with Onivyde, talk with your doctor or pharmacist.

Onivyde may have other interactions, such as with supplements, foods, vaccines, or lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Onivyde.

Onivyde interactions with supplements

Before you start treatment with Onivyde, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Onivyde interactions with herbs

Doctors will typically recommend you avoid taking St. John’s wort during Onivyde treatment. St. John’s wort is an herbal supplement people may take to treat depression and other conditions.

St. John’s wort may speed up the activity of an enzyme in your body called CYP3A4. This enzyme helps break down Onivyde.

By speeding up this enzyme, St. John’s wort can cause Onivyde to break down more quickly. And this may lead to a low level of Onivyde in your system. If the level of Onivyde in your body is too low, the drug may not work to treat your condition.

Your doctor may be able to suggest a treatment option other than St. John’s wort.

Onivyde interactions with vitamins

There are no specific reports of vitamins interacting with Onivyde. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Onivyde.

Onivyde interactions with food

Grapefruit and grapefruit juice can interact with Onivyde. Specifically, grapefruit products can stop your body from breaking down Onivyde. This raises the level of Onivyde in your body, which increases your risk of side effects. Due to this risk, your doctor may recommend not consuming grapefruit and grapefruit juice while receiving the drug.

Onivyde interactions with vaccines

Onivyde is known to interact with live vaccines. A live vaccine contains live but weakened pieces of the virus or bacterium it’s meant to defend against. When your immune system is healthy, live vaccines usually won’t cause infection.

But Onivyde can weaken your immune system. So if you get a live vaccine, your body may not be able to fight the virus or bacterium. This may cause you to become sick or develop symptoms of the illness the vaccine is meant to prevent.

Examples of live vaccines to avoid during Onivyde treatment include:

• measles, mumps, rubella (MMR)
• chickenpox
• flu vaccine (nasal spray form)

Before starting Onivyde, talk with your doctor or pharmacist about any vaccines you may need.

Onivyde interactions with lab tests

Onivyde isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

ONIVYDE INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Onivyde. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Onivyde. The impact of cannabis may affect how well you stick to your Onivyde treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Onivyde. Before you start Onivyde treatment, be sure to talk with your doctor about your health history. Onivyde may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Onivyde include:

• Neutropenia: If you have neutropenia, treatment with Onivyde can make it worse. Your doctor likely won’t give you Onivyde until your neutrophils recover. Onivyde has a boxed warning about the risk of severe neutropenia. A boxed warning is the most serious warning from the FDA. For details, see “Boxed warnings” at the top of this article.
• Diarrhea or bowel obstruction: Onivyde can cause and worsen diarrhea. If you have a bowel obstruction, your doctor likely won’t give you Onivyde because it could be dangerous for you. Onivyde has a boxed warning about the risk of severe diarrhea. To learn more, see “Boxed warnings” at the top of this article.
• Allergic reaction: If you’ve had an allergic reaction to Onivyde, any of its ingredients, or a similar drug called irinotecan hydrochloride, your doctor will likely not prescribe Onivyde. This is because receiving the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: If received during breastfeeding, Onivyde may have serious side effects on a child who is breastfed. You should not breastfeed while receiving Onivyde and for 1 month after your last dose. If you’re breastfeeding or planning to, talk with your doctor before starting Onivyde. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: Onivyde can harm a developing fetus and is not safe to receive while pregnant. If you’re pregnant or planning to become pregnant, tell your doctor before starting Onivyde. They can advise you on the right treatment plan for you. If you’re able to become pregnant, you should use birth control while receiving Onivyde and for 7 months after your last dose. If you’re male and have a sexual partner who can become pregnant, you should use condoms while receiving Onivyde and for 4 months after your last dose.

Note: Sex and gender exist on spectrums. Use of the term “male” refers to sex assigned at birth.

You can take certain steps to help prevent interactions with Onivyde. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Onivyde label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Onivyde doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions by following your doctor’s instructions for care during Onivyde treatment.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.