Deoxycytidine Kinase Substrates/Cladribine Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Clofarabine, cytarabine, emtricitabine, fludarabine, gemcitabine, lamivudine, molnupiravir, nelarabine, zalcitabine and cladribine are changed by your body to their active forms. They may compete for the same enzymes and prevent each other from being activated.

What might happen:

The amount of active medicine in your body may decrease and they may not work as well.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to check to see how your medicines are working. Your doctor may want to change your medicine.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Epivir (lamivudine) UK summary of product characteristics. Viiv Healthcare UK Ltd July 2021.
  • 2.Mavenclad (cladribine) US prescribing information. EMD Serono, Inc. March, 2019.
  • 3.Chtioui H, Millius C, Lammle B, Lauterburg BH. Concomitant treatment with lamivudine renders cladribine inactive by inhibition of its phosphorylation. Br J Haematol 2009 Jan;144(1):136-7.
  • 4.Anderson PL, Kakuda TN, Lichtenstein KA. The cellular pharmacology of nucleoside- and nucleotide-analogue reverse-transcriptase inhibitors and its relationship to clinical toxicities. Clin Infect Dis 2004 Mar 1; 38(5):743-53.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.