Drug General Information (ID: DDIWRA4Z05)
Drug Name			Dalteparin		Drug Info		Ibrutinib		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anticoagulants				Antineoplastics/Bruton Tyrosine Kinase Inhibitor
Structure

Mechanism of Dalteparin-Ibrutinib Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Dalteparin				Ibrutinib
Mechanism		Risk of bleeding Anticoagulant				Risk of bleeding Antiplatelet 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 Dalteparin and Ibrutinib

Recommended Action
Management		Concomitant use of other medications that interfere with platelet function or coagulation should be considered cautiously in patients treated with ibrutinib. Close clinical and laboratory observation for bleeding complications is recommended during therapy. The INR should be monitored more frequently during coadministration of warfarin.

References
1	Agencia Espaola de Medicamentos y Productos Sanitarios Healthcare "Centro de informacion online de medicamentos de la AEMPS - CIMA.".
2	Cerner Multum, Inc. "Canadian Product Information.".
3	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
4	Product Information. Imbruvica (ibrutinib). Pharmacyclics Inc, Sunnyvale, CA.