Drug General Information (ID: DDIWHVIEP7)
Drug Name			Drotrecogin alfa		Drug Info		Cabozantinib		Drug Info
Drug Type		Protein/peptide				Small molecule
Therapeutic Class		Coagulation Modifiers				Vegf/Vegfr Inhibitors

Mechanism of Drotrecogin alfa-Cabozantinib Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Drotrecogin alfa				Cabozantinib
Mechanism		Risk of bleeding Anticoagulant effects				Risk of bleeding Antiplatelet/anticoagulant effects
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 Drotrecogin alfa and Cabozantinib

Recommended Action
Management		The potentially increased risk of bleeding versus the benefits of drotrecogin alfa therapy should be carefully considered in seriously ill septic patients who are currently receiving, or have recently received, agents that could interfere with coagulation such as salicylates, NSAIDs, low molecular weight heparins, thrombolytics, thrombin inhibitors, platelet inhibitors, or agents that commonly cause thrombocytopenia. Close clinical and laboratory monitoring for bleeding complications is recommended if concurrent therapy is required. Drotrecogin alfa should be discontinued immediately if clinically significant bleeding occurs.

References
1	Product Information. Xigris (drotrecogin alfa). Lilly, Eli and Company, Indianapolis, IN.