Basic Information
ID DDInter1975 and DDInter2212
Interaction Probiotic use during immunosuppressant or intense antineoplastic therapy may theoretically increase the risk of infections from the live microorganisms contained in probiotic products.
Management Caution is advised when probiotics are used during immunosuppressant or intense antineoplastic therapy. It may be advisable to avoid using probiotics, particularly products containing saccharomyces boulardii, in patients who are significantly immunosuppressed unless benefits are anticipated to outweigh the potential risk of infection.
References [1] Salminen MK, Rautelin H, Tynkkynen S, et al. "Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG." Clin Infect Dis 38 (2004): 62-9 [2] Salminen MK, Tynkkynen S, Rautelin H, et al. "Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland." Clin Infect Dis 35 (2002): 1155-60 [3] Rautio M, Jousimies-Somer H, Kauma H, et al. "Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG." Clin Infect Dis 28 (1999): 1159-60 [4] Schlegel L, Lemerle S, Geslin P "Lactobacillus species as opportunistic pathogens in immunocompromised patients." Eur J Clin Microbiol Infect Dis 17 (1998): 887-8 [5] Saxelin M, Chuang NH, Chassy B, et al. "Lactobacilli and bacteremia in southern Finland, 1989-1992" Clin Infect Dis 22 (1996): 564-6 [6] Husni RN, Gordon SM, Washington JA, Longworth DL "Lactobacillus bacteremia and endocarditis: review of 45 cases." Clin Infect Dis 25 (1997): 1048-55 [7] Oggioni MR, Pozzi G, Valensin PE, Galieni P, Bigazzi C "Recurrent septicemia in an immunocompromised patient due to probiotic strains of Bacillus subtilis." J Clin Microbiol 36 (1998): 325-6 [8] Mackay AD, Taylor MB, Kibbler CC, Hamilton-Miller JM "Lactobacillus endocarditis caused by a probiotic organism." Clin Microbiol Infect 5 (1999): 290-2 [9] Borriello SP, Hammes WP, Holzapfel W, et al. "Safety of probiotics that contain lactobacilli or bifidobacteria." Clin Infect Dis 36 (2003): 775-80 [10] Lolis N, Veldekis D, Moraitou H, et al. "Saccharomyces boulardii fungaemia in an intensive care unit patient treated with caspofungin." Crit Care 12 (2008): epub [11] Boyle RJ, Robins-Browne RM, Tang ML "Probiotic use in clinical practice: what are the risks?" Am J Clin Nutr 83 (2006): 1256-64
Alternative for Idecabtagene vicleucel -
Alternative for Lactobacillus rhamnosus -
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.