Drug General Information (ID: DDI6MDVEQG)
Drug Name			Lomustine		Drug Info		Asparaginase Erwinia chrysanthemi		Drug Info
Drug Type		Small molecule				Protein/peptide
Therapeutic Class		Antineoplastics				Antineoplastics

Mechanism of Lomustine-Asparaginase Erwinia chrysanthemi Interaction (Severity Level: Moderate)
Increased risk of hepatotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Lomustine				Asparaginase Erwinia chrysanthemi
Mechanism		Hepatotoxicity				Hepatotoxicity
Key Mechanism Factor 1
		Factor Name		Hepatotoxicity
		Factor Description		Combination of drugs that can induce hepatotoxicity may increase the risk of liver injury. Symptoms vary depending on the level of exposure and the total extent of liver damage, and may cause few symptoms if the damage is mild, and eventually lead to liver failure in patients with severe damage.
Mechanism Description		Increased risk of hepatotoxicity by the combination of Lomustine and Asparaginase Erwinia chrysanthemi

Recommended Action
Management		The risk of additive hepatotoxicity should be considered when asparaginase is used with other hepatotoxic agents (e.g., alcohol, androgens, antituberculosis agents, azole antifungal agents, ACE inhibitors, macrolide antibiotics, nonsteroidal anti-inflammatory agents, nucleoside reverse transcriptase inhibitors, sulfonamides, thiazolidinediones, and statins). Liver function tests should be monitored at regular intervals during asparaginase treatment with or without other hepatotoxic drugs. Patients should be advised to seek medical attention if they experience potential symptoms of hepatotoxicity such as right upper quadrant pain, increasing abdominal size, fever, rash, itching, anorexia, nausea, vomiting, fatigue, malaise, dark urine, pale stools, and jaundice.

References
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9	Product Information. Asparlas (calaspargase pegol). Servier, Boston, MA.
10	Product Information. Elspar (asparaginase). Merck & Co, Inc, West Point, PA.
11	Product Information. Erwinaze (asparaginase Erwinia chrysanthemi). EUSA Pharma, Newtown, PA.
12	Product Information. Oncaspar (pegaspargase). Rhone-Poulenc Rorer, Collegeville, PA.
13	Burke PW, Aldoss I, Lunning MA, et.al "High-grade PEGylated asparaginase-related hepatotoxicity occurrence in a pediatric-inspired adult acute lymphoblastic leukemia regimen does not necessarily predict recurrent hepatotoxicity in subsequent cycles." Blood 122 (2013): 2671. [PMID: 29407583]