Hepatic veno-occlusive disease associated with immunosuppressive cyclophosphamide dosing and roxithromycin.
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Beltinger J, Haschke M, Kaufmann P, Michot M, Terracciano L, Krahenbuhl S
Hepatic veno-occlusive disease associated with immunosuppressive cyclophosphamide dosing and roxithromycin.
Ann Pharmacother. 2006 Apr;40(4):767-70. Epub 2006 Mar 7.
- PubMed ID
- 16595573 [ View in PubMed]
- Abstract
OBJECTIVE: To report on a patient developing hepatic veno-occlusive disease while being treated with immunosuppressive doses of cyclophosphamide (< or =2 mg/kg). CASE SUMMARY: A 66-year-old woman with autoimmune hemolytic anemia developed hepatic veno-occlusive disease while being treated with immunosuppressive cyclophosphamide 100 mg/day in combination with roxithromycin (total dose 600 mg/day). After all drugs were stopped, the patient recovered within 2 weeks. The Naranjo probability scale indicated a probable relationship between veno-occlusive disease and treatment with cyclophosphamide in this patient. DISCUSSION: Since roxithromycin inhibits CYP3A4, which is involved with cyclophosphamide metabolism, a drug-drug interaction could have been responsible. In addition, roxithromycin is an inhibitor of the drug transporter P-glycoprotein, possibly leading to accumulation of cyclophosphamide in endothelial cells. Alternatively, since cyclophosphamide has been reported to induce apoptosis, roxithromycin could have rendered endothelial cells more vulnerable for apoptosis. CONCLUSIONS: In specific patients, cyclophosphamide can be associated with hepatic veno-occlusive disease at immunosuppressive doses.
DrugBank Data that Cites this Article
- Drug Targets
Drug Target Kind Organism Pharmacological Action Actions Roxithromycin P-glycoprotein 1 Protein Humans UnknownNot Available Details