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Oncology Drug Interactions — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipOncology Drug InteractionsSCE Infectious Diseases

A patient taking enzalutamide needs intravenous meropenem for susceptible Pseudomonas bacteraemia. A mechanism-based interaction check finds no relevant shared metabolic or transporter pathway. What is the best action?

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Correct answer: A — Use standard-dose meropenem and review other enzalutamide interactions

The best answer is “Use standard-dose meropenem and review other enzalutamide interactions”. Meropenem is not dependent on CYP3A4, so enzalutamide induction does not meaningfully reduce exposure; stewardship should not turn an unsupported interaction into undertreatment. Drug-interaction assessment should be mechanism based; absence of a plausible metabolic or transporter pathway prevents unnecessary changes to effective antimicrobial therapy.

Reference: British National Formulary interactions index: https://bnf.nice.org.uk/interactions/