Has anyone been prescribed Bile Acid Binders, such as Cholestyramine, Questran, Prevalite while taking Sprycel or any other TKI? If so, can you please tell me how much time before/after you allow between taking the binder and your TKI? How long have you taken them together and has the TKI remained effective against the CML? Bile Acid Binders are known to bind some medications and no one can tell me if TKI's would be affected by it, so I am hoping to find someone that has experienced this. I am PCRU for six months now on Sprycel and want to make sure I don't screw that up. Thanks for any info.
Bile Acid Binders with TKI's
Posted 25 June 2011 - 03:38 PM
There is no known interaction, so apparently the bile binders do not bind to TKI drugs to prevent absorption. That makes sense given that both drug types (TKIs and bile binders) are "salts".
Posted 25 June 2011 - 05:04 PM
No, Trey, unfortunately that is actually incorrect. The reason that there is "no known interaction" is because it has never been tested. I verified this with the doctor that worked on the development of sprycel. Bristol-Myer Squibb has never studied this, nor has Upsher-Smith who distributes Prevalite. They have specifically stated that, except for the extensive list of drugs noted to have interaction through testing and post release reports, all other drugs are unknown. Since I do not have a choice about taking this, that is the reason for my inquiry. I am in uncharted ground and am looking for anyone else who may have had actual experience with this. To assume that it is safe would be betting my remission foolishly. So...anyone else...?
Posted 25 June 2011 - 10:09 PM
Interactions are rarely "tested", they are more often reported (such as during a clincal trial, but also after FDA approval). Which is precisely why I used the phrase "no known interaction" -- none has been reported. It means that no interaction is known, because none have been reported. That does not mean there would never be one under any circumstance. But with respect to chemistry, an interaction would be very unlikely. But I hope someone else can answer your posting to your complete satisfaction.
Posted 25 June 2011 - 11:20 PM
Quick question - if you had achieved PCRU and worse came to worse that something you took interfered with the take up of your TKI, it would be picked up at your next PCR test (and CML is slow progressing so you would probably be sitting somewhere between MMR and PCRU) ? Then dropping the other medication and having your body receive the full amount of TKI, you should be back in PCRU fairly quickly? This appears to be the case from the trials where they are stopping the TKI to see if people have been cured.
Just asking for when I get to PCRU (being positive here) and want to trial a supplement.
Posted 26 June 2011 - 12:56 AM
Your scenerio is exactly accurate... as it was explained to me regarding my recent reduction trial with Sprycel. We are monitoring the next TWO PCR's to see if the remission holds after reducing Sprycel from 100mg a day to 70. Caught early enough, if I lost PCRU, it would not lead to resistance and should respond well to increasing the dose again. This is why adding binders to my daily program could not have come at a worse time...if the next PCR is positive we really wouldn't know if it was an uptake issue or a dose reduction issue. Unfortunately, both TKI's and binders are an absolute necessity right now, with no other options available to me in either case. I have researched this and consulted experts like crazy, and while I am giving the two drugs the widest time spread possible, it would be really good to hear someone's experience with this, if there is anyone else out there who has had to do both together.
Posted 26 June 2011 - 02:46 AM
Ah I see what your problem is, it might be worth getting on a few different CML boards and asking the question. Hopefully you get an answer.
Posted 26 June 2011 - 10:23 PM
Why did you have to go on a Bile Acid Binder. I think they are given when you have reflux from the intestine into the stomach, where as a PPI is used for reflux from the stomach into the esophagus. My problem with my Gleevec was the GERD,and thats why I am on the Nexium.
I am sure you can figure out a way to take it along with your TKI. Did you ask the drug company or your pharmacy about it? A lot of times they can give you more accurate information than the doctor can. Good Luck
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