Crizotinib/ginger interaction
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Hepatitis: case report A 48‐year‐old woman developed hepatitis following concomitant use of crizotinib (for the treatment of lung adenocarcinoma) and ginger. The woman had a history of lung adenocarcinoma harbouring anaplastic lymphoma kinase rearrangement with mediastinal lymph nodes enlargement, lung mass and pleural effusion, which was diagnosed in March 2015. She initially received first line chemotherapy with pemetrexed and cisplatin. In November 2016, she started receiving crizotinib 250mg twice a day for lung adenocarcinoma [route not stated]. She was also started on aspirin [acetylsalicylic acid] concomitantly for a transient ischaemic attack (which she had in June 2015). Until 5 December 2017, her transaminases levels were normal. However, in January 2018, severe hepatic cytolysis with ALT of >20xULN was noted. The abdominal ultrasound was subnormal with fatty liver. Whereas, other laboratory tests were negative. Liver biopsy showed histological lesions indicative of acute drug induced hepatitis [time to reaction onset not stated]. The woman’s crizotinib treatment was stopped, following which a gradual improvement was noted in her liver function. Two days after crizotinib discontinuation, her crizotinib plasma trough concentration was 384 µg/L, against 205 µg/L in November 2017. Subsequently, it was found that she had been consuming an increasing amount of drink (>1 L/day) made from grated ginger, lemon juice, honey and hot water for nonmedical purposes since November 2017. Hepatitis was thought to be secondary to increase in crizotinib concentration during concomitant use of crizotinib and ginger. Revol B, et al. Pharmacokinetic herb-drug interaction between ginger and crizotinib. British Journal of Clinical Pharmacology 86: 1892-1893, No. 9, 30 Jan 2019. Available from: URL: http://doi.org/10.1111/bcp.13862 803501534
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Reactions 19 Sep 2020 No. 1822
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