Drug General Information (ID: DDI4P79UD2)
Drug Name			Panobinostat		Drug Info		Betrixaban		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Histone Deacetylase Inhibitors				Anticoagulants/Factor Xa Inhibitors
Structure

Mechanism of Panobinostat-Betrixaban Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Panobinostat				Betrixaban
Mechanism		Risk of bleeding Antiplatelet effects				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Panobinostat and Betrixaban

Recommended Action
Management		Concomitant use of other medications that interfere with platelet function or coagulation should be considered cautiously in patients treated with panobinostat. Close clinical and laboratory observation for bleeding complications is recommended during therapy. A complete blood cell count should be performed prior to and at least weekly during treatment according to treatment protocols, including monitoring for thrombocytopenia. Dose modifications may be required based on individual patient tolerability. Patients should be advised to promptly report any signs of bleeding to their doctor, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References
1	Cerner Multum, Inc. "Australian Product Information.".
2	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
3	Product Information. Farydak (panobinostat). Novartis Pharmaceuticals, East Hanover, NJ.