Drug General Information (ID: DDIEYG1ZNA)
Drug Name			Melphalan		Drug Info		Certolizumab pegol		Drug Info
Drug Type		Small molecule				Monoclonal antibody
Therapeutic Class		Antineoplastics				Tnf Alfa Inhibitors

Mechanism of Melphalan-Certolizumab pegol Interaction (Severity Level: Major)
Additive immunosuppressive effects Click to Show/Hide Mechanism Graph
Drug Name		Melphalan				Certolizumab pegol
Mechanism		Immunosuppressive effects				Immunosuppressive effects
Key Mechanism Factor 1
		Factor Name		Immunosuppressive effects
		Factor Description		Immunosuppression is when your immune system is not functioning as it should. The immune system is made up of cells, tissues and organs that help the body fight off infections. If the immune system is suppressed, an infection that your body was able to control may become serious or even fatal.
Mechanism Description		Additive immunosuppressive effects by the combination of Melphalan and Certolizumab pegol

Recommended Action
Management		Patients receiving a TNF blocker alone or with other immunosuppressive or myelosuppressive agents should be monitored closely for the development of infections. TNF blocker therapy should be discontinued if a serious infection or sepsis occurs. Close monitoring for signs and symptoms of HSTCL (e.g., splenomegaly, hepatomegaly, abdominal pain, persistent fever, night sweats, weight loss) is also recommended during use of TNF blockers, particularly in combination with other immunosuppressants such as azathioprine and mercaptopurine.

References
1	Product Information. Cimzia (certolizumab). UCB Pharma Inc, Smyrna, GA.
2	Product Information. Simponi (golimumab). Centocor Inc, Malvern, PA.
3	FDA. U.S. Food and Drug Administration "FDA Drug Safety Communication: Drug labels for the Tumor Necrosis Factor-alpha (TNFa) blockers now include warnings about infection with Legionella and Listeria bacteria. ".