Table 2.
Geriatric oncology pharmacology job aid.
| Medications | Effect | Reference |
|---|---|---|
| Allopurinol inhibits oral 6-MP metabolism | Increased exposure to 6-mercaptopurine | Zimms 1983, PMID: 6580097 |
| Anthracyclines | Incidence of CHF after anthracyclines increases progressively after age 70 | Balducci 1999, PMID: 10758578 Aapro 2010, PMID: 20956616 |
| Bevacizumab | Significant increase in ATE’s in patients > 65 years of age | Cassidy 2010, PMID: 19904559 Ranpura 2010, PMID: 20156114 |
| Carboplatin (flat dose) with aminoglycosides | Hearing loss | Lee 1988, PMID: 3278122 |
| Capecitabine | Adverse effects not greater in elderly patients; remember to adjust for renal function (adjustments begin at CrCl = 50 | |
| Dexamethasone and aprepitant | Inhibits hepatic metabolism of dexamethasone — reduce dexamethasone dose | |
| Docetaxel | Patients >65 years of age increased risk for neutropenia (Grade 4) and more febrile neutropenia | Ten Tije 2005, PMID: 15718305 |
| Etoposide | More Grade 4 toxicities in older patients | Miller 1997, PMID: 9815741 |
| Age a significant predictor of toxicity to fluorouracil (PS is not correlated to toxicity) | Monitor patients over 75 years of age receiving fluorouracil closely | Stein 1995, PMID:7804963 |
| Imatinib | Higher rates of myelosuppression and hypothyroidism for patients on levothyroxine | De Groot 2005, PMID: 16198662 |
| Phenytoin increases metabolism of irinotecan | Decreased effect of irinotecan | Prados 2004, PMID: 14769140 |
| Melphalan in the elderly with renal dysfunction | Dose adjust in myeloma patients | Sirohi 2001, PMID: 11487259 |
| NSAIDs reduce methotrexate clearance | Increased methotrexate toxicity | |
| Omeprazole and benzodiazepines | Inhibition of hepatic metabolism of BZD, enhanced effects | Gerson 2001, PMID: 11396546 |
| Paclitaxel | Reduced tolerance in patients with cancer over 75 years of age | Lichtman 2006, PMID: 16567769 |
| Reglan and SSRI | Risk of serotonin syndrome | Fisher 2002, PMID: 11816261 |
| Avoid verapamil/diltiazem with sunitinib and pozapanib | These nondihydropyridine calcium channel blockers are CYP-3A4 inhibitors | María José Méndez-Vidal 2012, PMID: 22821550 |
| Phenytoin and phenobarbital, inhibit hepatic metabolism of taxol | Increased paclitaxel exposure | Chang 1998, PMID: 9626220 |
| Decrease warfarin metabolism — fluconazole, tramadol, and tylenol | Decrease of warfarin metabolism, increased risk of bleeding | Scher 1997, PMID: 9161668 |
Run a drug/drug interaction report for any patient on ketoconazole, warfarin or phenytoin.