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Paracetamol while on Dasatinib
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Hi, I have found alot of contradictory guidance is given on Paracetamol and Ibuprofen generally, one doctor says you can take one with one TKI or the other, and then another says not. I am on Imatinib and so can’t say directly for Dasatinib, but work on the basis of taking either but for a limited time only, I know others that will take them but at half dose. Worth checking things on www.drugs.com and I have copied the following link http://www.drugs.com/interactions-check.php?drug_list=787-0,11-2744 Be careful for longer time use as TKI’s and these drugs do put a strain on the liver. Hope you both had a good Christmas. Nigel
Confusion over pain killers and drug interactions
Hi Nigel,
Interesting to refer to the drugs.com drugs checker;I have used this for imatinib but not for dasatinib.As a general point there seem to be nearly 230 potentially strong drug interactions with dasatinib.Going back to the issue of paracetamol and referring to the drugs.com site it is useful to search for acetaminophen which is the name used for this medication in the United States-the big danger it seems is the risk of stomach bleeding .
The other very useful source is of course the Haouala et al article on Drug and Food Interactions with TKI therapies -another thread in this forum refers.Interesting that aspirin and dasatinib is cited as being dangerous due to risk of thrombocytopenia,modification of platelets and severe bleeding the result.On closer inspection of the Haouala article and looking at any potential interaction between acetaminophen and dasatinib there is none indicated.However for imatinib there is in bold type ,so a study has been done, that indicates an interaction of "Inhibition of O-glucuronidation by imatinib".So essentially paracetamol/acetaminophen interferes with effective detoxification of both drugs through the liver via the process of using gluluronic acid as a cleanser.The overall mean terminal half life of dasatinib is relatively short at 3-5 hours as opposed that of imatinib of 19 hours so as long as one takes paracetomol say 12 hours after the dasatinib there might be less chance of any interaction?. It seems as if imatinib is always present in the system especially the liver and bile processing organs.I dont know if any research has been done on this issue and significance of different half lives of TKIS. Apparently paracetamol does interact with alcohol and add on a TKI like imatinib and the liver is really hammered.
So we have a number of small threads on the Forum asking for opinions on which painkillers are safe in combination with TKI s and members indicating differing advice being given by GPs and clinicians.Imatinib has been around the longest so for the latest generation TKIs we are just finding out the possible drug interactions.The biggest threats for all the TKIs and drug interactions seem to be liver damage and bleeding of the stomach or are there other important ones?
As an approach to pain management has anyone used more natural therapies such as acupucnture ,massage,meditation, avoiding certain foods and foods that help
Any views?
Best wishes
John
Thanks Nigel,
Hubby was on Imatinib at first (for about 7 months) and was told not to take paracetamol at all. Then due to signs of liver damage and his BCR-abl numbers going up, he was changed to Dasatinib but he wasn't told either way about Paracetamol. I checked with a pharmacist and she said it should be ok to take paracetamol with Dasatinib but I'm still not too sure. From what I've read so far, it seems the regular and prolonged use of paracetamol may be the issue rather than taking it one-off for pain/fever management. But in the end hubby decided to ride it out and not take anything for his headache which were really severe the first week after he started on Dasatinib but have subsided now.
Regards
Jyoti
