Chokri Ben Lamine: Common Hematology Drugs – ‘With or Without Food’ Guidance

Chokri Ben Lamine Adult Hematology, Stem Cell Transplantation and Cellular Therapy Assistant Consultant shared on X:

“Common Hematology Drugs: ‘With or Without Food’ Guidance

Chemotherapy Agents

Venetoclax (BCL-2 inhibitor)
Administration: WITH FOOD (high-fat meal preferred).
Why? Food increases absorption consistent drug levels and TLS prevention.

Imatinib (TKI for CML/Ph+ ALL)
Administration: WITH FOOD and a full glass of water.
Why? Reduces GI upset (nausea/vomiting).

Nilotinib (TKI for CML)
Administration: EMPTY STOMACH.
Why? Food increases drug absorption risk of QT prolongation.
Timing: Take 1 hour before or 2 hours after meals.

Dasatinib (TKI for CML/Ph+ ALL)
Administration: With or Without Food.
Notes: Avoid PPIs (e.g., omeprazole) reduces absorption.

Hydroxyurea (Cytoreduction for SCD, CML)
Administration: WITH OR WITHOUT FOOD.
Tip: Take with food if GI upset occurs. Stay hydrated to prevent nephrotoxicity.

Methotrexate (MTX) (Folate antagonist)
Administration: WITH FOOD to reduce GI irritation.
Tip: Avoid alcohol hepatotoxicity risk.

Bortezomib (Proteasome inhibitor for MM)
Administration: WITH OR WITHOUT FOOD.
Notes: If oral, avoid grapefruit/Seville oranges CYP3A4 interactions.

Anticoagulants

Warfarin (Vitamin K antagonist)
Administration: WITH OR WITHOUT FOOD.
Precaution: Consistent Vitamin K intake (green leafy vegetables) to stabilize INR.

Apixaban (DOAC)
Administration: WITH OR WITHOUT FOOD.
Tip: Better adherence if taken with meals.

Rivaroxaban (DOAC)
Administration: WITH FOOD (for doses ≥15 mg).
Why? Improves absorption and efficacy.

Dabigatran (DOAC)
Administration: WITH FOOD recommended to reduce GI side effects.
Tip: Do not chew/crush capsules → alters drug release.

Supportive Care Drugs

Iron Supplements (Ferrous sulfate, fumarate)
Administration: EMPTY STOMACH preferred for better absorption.
Exceptions: Take with food if GI upset occurs.
Avoid: Calcium-rich foods, antacids reduce absorption.

Folic Acid (Supportive care for MTX or SCD)
Administration: WITH OR WITHOUT FOOD.

Allopurinol (TLS prevention, gout prophylaxis)
Administration: WITH FOOD to reduce GI upset.

Vitamin B12 (Cobalamin)
Administration: With or Without Food (oral or IM).

Steroids

Prednisone/Prednisolone
Administration: WITH FOOD.
Why? Reduces risk of gastric irritation and ulcers.

Dexamethasone
Administration: WITH FOOD.
Tip: Morning dosing preferred to minimize insomnia.

Antibiotics/Antifungals in Hematology

Levofloxacin
Administration: WITH OR WITHOUT FOOD.
Avoid: Calcium, magnesium (dairy/antacids) → reduces absorption.

Itraconazole (Antifungal prophylaxis)
Solution: EMPTY STOMACH.
Capsule: WITH FOOD for better absorption.

Posaconazole
Administration: WITH FOOD (high-fat meal).

Voriconazole
Administration: EMPTY STOMACH.
Timing: 1 hour before or 1 hour after meals.

Immunomodulators

Thalidomide/Lenalidomide/Pomalidomide (MM)
Administration: WITH OR WITHOUT FOOD.

Notes:
Thalidomide take at bedtime to minimize sedation.
Avoid in pregnancy Teratogenic.

Quick Reference Table

DrugAdministrationKey Notes
VenetoclaxWith Food Reduces TLS risk, improves absorption
ImatinibWith Food Reduces GI upset

NilotinibEmpty Stomach Avoid food (QT prolongation)
Rivaroxaban ≥15 mgWith Food Improves absorption
Methotrexate (MTX)With FoodReduces GI irritation
Bortezomib With or Without FoodAvoid grapefruit

Iron Supplements Empty Stomach Better absorption; avoid calcium
Steroids (Prednisone) With Food Prevents gastric irritation
Itraconazole Solution Empty Stomach Better absorption
Posaconazole With Food High-fat meal preferred.”