As with any drug regimen, it is important to pay close attention to drug combinations and food items that might possibly interfere with absorption and blood serum levels or lead to side effects. The information shown below is compiled from information obtained from the makers of each respective therapy. The information is provided as a service and resource that might prove helpful to provide potential discussion points with your doctor or CML Specialist.
Drugs used in the treatment of CML are quite powerful and it is important that you inform your doctor of any medications you are taking prior to beginning therapy.
Below you will find access to lists of known interactions, as well as a link to a Drug Interaction Checker.
Bosulif (Bosutinib) - Ketoconazole, an anti-fungal, is known to increase the levels of the drug > 5 times the normal dosage, as well as extend the half-life. If you are taking this drug and are being treated for a fungal infection, please discuss the impact of anti-fungals with your doctor.
Iclusig (Ponatinib) - Scroll to section seven (7) when the page loads.
Hydroxyurea (This third-party link may be slow to load. Patience please.)
Checking for Drug Interactions
Drug Interactions Checker from Drugs.com (quick and easy/free sign up with no personal information collected) This checker has the ability to compare multiple drugs at the same time simply by listing them, separated by commas, in the input field/"drugs box."
Access the Drug Interaction Checker by MedScape (may require free membership)
While the National CML Society works to keep this list current and up to date, it is possible that there are drugs not listed here that could have potential adverse effects when added to a CML therapy regimen. When in doubt, consult with your physician or a treatment professional.
There are a variety of foods that have the potential* to affect the absorption and/or serum levels (the level of drug in a person's bloodstream).
Citrus - citrus fruit, and other items containing citrus, has the propensity to increase serum levels dramatically. This results in the potential for too much drug to be in your system. If you are taking any of the TKIs (Tyrosine Kinase Inhibitors), care should be taken with citrus fruits, particularly grapefruit, grapefruit juice, or grapefruit extract.
Pomegranate - is also known to interact with TKIs and should be avoided.
Lactose Intolerance - Dasatinib** (Sprycel) and Nilotinib*** (Tasigna) contains lactose (milk sugars) and should not be taken prior to discussing with your doctor.
Herbs, Botanicals, and Other Products
Some herbs are known to affect the serum level (amount of drug in the blood stream) of therapy agents used in treating CML.
St. Johns Wort - known to DECREASE the serum level of TKIs in the blood stream. This herb should be avoided to alleviate the possibility of hindering the activity of your therapy drug.
The following herbs are known to INCREASE the serum level of TKIs in the blood stream. These herbs should be avoided as they may inadvertently cause accidental overdose of your therapy drug.
There are additional herbal products that interact with TKIs, however the exact interaction has yet to be fully determined. It is suggested that you refrain from the use of the following herbs due to the potential to cause adverse reactions:
Green Tea (in copious amounts, or large amounts of extracts)✣
Teas (dandelion, pepperment, chamomile)✣
*the food interactions shared above have the potential to interfere with absorption of TKIs. It does not mean that these food items are completely off-limits to the CML population. Since every case is unique, discuss these things with your doctor.
**Sprycel contains 135 mg of lactose monohydrate in a 100 mg daily dose and 189 mg of lactose monohydrate in a 140 mg daily dose.
***Tasigna contains lactose and is therefore not recommended for patients with rare hereditary problems of galactose intolerance (galactosemia), severe lactase deficiency with a severe degree of intolerance to lactose-containing products or of glucose-galactose malabsorbtion.
✣ A word about Green Tea: when consumed in normal, rational amounts it has not been known to cause adverse effects. For some time, the NCMLS has been harshly criticized by some online forums, saying that we advocate abstinence from Green Tea. Green Tea and some others have been listed here because they were noted as possibly impacting one's TKI by all the pharmaceutical companies responsible for their distribution. Please use your own discretion. Please don't shoot the messenger.
We are continuing to populate this information. Thank you for your patience.