Cosentyx drug interactions with Food, Drugs and Vaccines

Cosentyx (secukinumab) is a medication prescribed to treat autoimmune diseases like psoriasis, inflammatory arthritis, ankylosing spondylitis, etc, in both children and adults. 

It works by targeting interleukin-17A (IL-17A), a protein (cytokine) responsible for causing inflammation.

Cosentyx, in general, is safe and effective, but understanding its drug interactions can help avoid unwanted side effects and ensure effective treatment. 

How Cosentyx Works

• Cosentyx belongs to monoclonal antibodies, a class of drugs that target the immune system. 

• It suppresses hyperactive immune responses in the body by blocking IL-17A.

• This IL-17A plays a key role in inflammation, defence against infections, cancer, and autoimmune disorders.

Since it directly affects the immune system, combining it with other drugs might either:

• Increase the risk of infections,
• Reduce the effectiveness of treatment or
• Cause unexpected side effects

Being aware of these risks helps a healthcare provider manage therapy with Cosentyx safely.

Major Cosentyx Drug Interactions

1. With Immunosuppressants and Biologic Drugs

JAK Inhibitors (Janus Kinase Inhibitors)

• Examples: Baricitinib (Olumiant), Tofacitinib (Xeljanz), Upadacitinib (Rinvoq)

• Risk: Combining Cosentyx with JAK inhibitors can significantly increase the risk of life-threatening infections.

• Mechanism: Both Cosentyx and JAK inhibitors work by weakening the immune system.

• Management: Doctors usually avoid prescribing these together and may suggest alternative treatments if a patient is already on a JAK inhibitor.

Other Biologic Immunosuppressants

• Examples: Abatacept (Orencia), Canakinumab (Ilaris), Sarilumab (Kevzara), Tocilizumab (Actemra)
  
• Risk: Similar to JAK inhibitors, these combinations can also cause excessive immune suppression.

2. Cyclosporine

• What it is: This is an immunosuppressant used post-organ transplantation, for psoriasis and certain types of arthritis.

• Interaction Effects: Cosentyx can alter the metabolism of cyclosporine, either reducing its effectiveness or causing toxicity due to its accumulation.

• Risk: Increased chances for infections or reduced therapeutic effect.

• Mechanism: Both drugs weaken the immune system, making the body prone to infections. Further, altered metabolism can have therapeutic effects.

• Management: If both drugs are required, doctors are advised to monitor cyclosporine blood levels and adjust doses accordingly.

3. Warfarin (Blood Thinner)

• Warfarin is a widely used drug to prevent internal blood clots. It is metabolized by liver enzymes.

• Interaction Effects: Cosentyx enhances the concentration of liver enzymes metabolizing warfarin. This leads to decreased efficacy and increased chances of bleeding and internal clot formation.

• Management: Frequent INR monitoring and dosage adjustments can help maintain safe anticoagulation effects of warfarin when taken along with Cosentyx.

4. Alcohol

• Risk: Cosentyx does not directly interact with alcohol, but it may worsen side effects such as headaches, nausea, and diarrhea, and even aggravate psoriasis or arthritis symptoms.
  
• Recommendation: Limit or avoid alcohol, particularly if one is taking other immunosuppressive drugs.

5. Supplements, Vitamins, and Herbal Products

• Current Status: No major interactions are found for standard supplements (Vitamin D, multivitamins, etc.). However, caution is advised with immune-boosting herbs like Echinacea or Astragalus, which could neutralize Cosentyx’s effects.
  
• Recommendation: Always inform your doctor before starting any new supplement, vitamin, or herbal product.

6. Vaccine Interactions

• Vaccines are meant to strengthen the immune system.

• Of the available ones, live vaccines have weakened microbes that lack virulence and the ability to cause disease in normal individuals. 

• But, since Cosentyx weakens the immune system, these live vaccines might be unsafe during treatment.

• Live Vaccines to Avoid: MMR (Measles, Mumps, Rubella), Varicella, Zoster (live), Yellow fever, FluMist, Oral polio, Rotavirus, Oral typhoid vaccines.
  
• Recommendation: Complete all the required vaccines before starting Cosentyx. Inactivated (dead) vaccines (like flu shot injections) can be a safe alternative, but the overall immune response to vaccines may be reduced.

7. Medical Conditions That May Affect Cosentyx Use

Active or Chronic Infections:

• Treat infections first, preferably, or monitor closely during therapy.

Tuberculosis (TB):

• Screening for TB should be done before starting treatment.

• If detected, TB must be treated first before starting treatment with Cosentyx.

Inflammatory Bowel Disease (IBD):

• Cosentyx may worsen Crohn’s disease or ulcerative colitis as it blocks IL-17 protein, which is protective in nature in the gut.

• Further reports indicate that patients develop IBD due to treatment.

Latex Allergy:

• Cosentyx is available in sensoready pens (syringes) to be administered by the subcutaneous route. These syringes might contain rubber, a form of latex.

• If one is allergic to latex, they must inform the doctor to seek alternatives.

8. Medications That Are Generally Safe with Cosentyx

• Prednisone and other corticosteroids are used for inflammation

• Methotrexate is an antimetabolite often prescribed for treating arthritis.

• Aimovig (erenumab) is used to treat migraine. This acts by blocking calcitonin gene-related peptide (CGRP) receptor and, hence, the possible interaction with Cosentyx is limited.

• Vitamin D and most dietary supplements

• Ozempic, an anti-diabetic, and Wegovy, a weight loss drug, can be taken.

• Antibiotics like amoxicillin and antifungals, if an infection occurs

• NSAIDs like acetaminophen

• Inactivated vaccines

Prevention and Monitoring Strategies

Before Starting Cosentyx

• Complete vaccination schedule, especially live vaccines
  
• Treat any existing infections
  
• Perform TB screening
  
• Provide a full medication and supplement list to your doctor

During Treatment

• Avoid live vaccines entirely
  
• Practice good hygiene to minimize infection risk
  
• Watch for early signs of infections like fever, persistent cough, unusual fatigue, or slow-healing wounds
  
• Keep regular appointments for monitoring
  
• Limit or avoid alcohol
  
• Don’t start new medications without a doctor’s consultation

Remedies to manage any possible Interactions

If you suspect any drug interaction while using Cosentyx, here’s what to do:

Recognizing Serious Side Effects

Seek immediate medical attention if you experience:

• Fever, chills, persistent cough, or blood in phlegm
  
• Unexplained weight loss
  
• Warm, red, or painful skin sores
  
• Severe allergic reactions: difficulty breathing, swelling of the face or throat, hives
  
• New or worsening IBD symptoms: severe abdominal pain, bloody diarrhea
  

Special Populations

Pregnancy:

• Safety is not fully confirmed or established. Discuss risks and benefits with the doctor.

Breastfeeding:

• Passage of Cosentyx through breast milk is not established. Still, consult the doctor.

Children: 

• It can be given to children above 6 years of age; the dosing and monitoring differ from adults, but drug interactions are similar.

Older Adults:

• In general are readily prone to infection due to low immunity. Hence, closer monitoring is essential.

Bottom Line

Cosentyx is an effective treatment for autoimmune conditions, but drug interactions, vaccines, supplements, and medical conditions can influence its safety and efficacy. Most importantly:

• Avoid combining with other immunosuppressants or live vaccines
  
• Monitor key medications like warfarin and cyclosporine
  
• Follow prevention strategies and report any side effects promptly

With proper management, Cosentyx can be used safely and effectively.

Frequently Asked Questions and Answers

References:

• Novartis Cosentyx Prescribing Information
• Inhibiting IL-17A and IL-17F in Rheumatic Disease: Therapeutics Help to Elucidate Disease Mechanisms
• Cosentyx Interactions: Medications, Alcohol, and Others
• Drug Interactions between Cosentyx and Warfarin