Defibrotide – Uses, Dosage, Side Effects, Interaction

RxHarun

1 year ago

Defibrotide is a mixture of single-stranded oligodeoxyribonucleotides derived from the intestinal mucosa of pigs, with anti-thrombotic, thrombolytic, and fibrinolytic activities. Upon administration, and although the exact mechanism of action has yet to be fully elucidated, defibrotide induces the release of prostaglandin I2 (PGI2), E2 (PGE2), and prostacyclin and reduces the expression of adhesion molecules on endothelial cells. This relaxes the smooth muscle of blood vessels and prevents platelets from adhering to each other and to the endothelium. This protects the endothelium lining blood vessels. Defibrotide increases tissue plasminogen activator (tPA) and decreases plasminogen activator inhibitor-1 activity. This increases the activity of plasmin, prevents blood clot formation, and dissolves blood clots.

Defibrotide is a complex mixture of single-stranded polydeoxyribonucleotides derived from porcine intestinal mucosa that has antithrombotic and profibrinolytic activity and is used in the treatment of severe sinusoidal obstruction syndrome (SOS) after hematopoietic cell transplantation (HCT). Defibrotide is used in patients with severe liver injury and has not been associated with worsening of serum aminotransferase elevations during therapy and has not been linked to cases of clinically apparent, idiosyncratic liver injury.

Defibrotide Sodium is a polydeoxyribonucleotide with antithrombotic, thrombolytic, and fibrinolytic properties. Defibrotide induces the release of prostaglandin 12 and reduces the expression of adhesion molecules on endothelial cells, thereby interfering with platelet and leukocyte adhesion to the endothelium. (NCI04) Defibrotide is the sodium salt of a mixture of single-stranded oligodeoxyribonucleotides derived from porcine mucosal DNA. It has been shown to have antithrombotic, anti-inflammatory, and anti-ischemic properties (but without associated significant systemic anticoagulant effects). It is marketed under the brand names Dasovas (FM), Noravid, and Prociclide in a variety of countries. In the USA it was approved in March 2016 as Defitelio.

Mechanism of Action

The drug appears to prevent the formation of blood clots and to help dissolve blood clots by increasing levels of prostaglandin I2, E2, and prostacyclin, altering platelet activity, increasing tissue plasminogen activator function, and decreasing activity of tissue plasminogen activator inhibitor. Prostaglandin I2 relaxes the smooth muscle of blood vessels and prevents platelets from adhering to each other. Prostaglandin E2 at certain concentrations also inhibits platelet aggregation. Moreover, the drug provides additional beneficial anti-inflammatory and antiischemic activities as recent studies have shown. It is yet unclear if the latter effects can be utilized clinically (e.g., treatment of ischemic stroke).

Defibrotide is a deoxyribonucleic acid derivative extracted from mammalian organs, which has been developed for the treatment of a number of vascular disorders. It appears to increase fibrinolysis and may possess antithrombotic, antiatherosclerotic, and anti-ischaemic actions, probably due to its ability to selectively increase prostaglandin I2 and E2 levels and to increase tissue plasminogen activator and decrease plasminogen activator inhibitor function. Defibrotide is available as an intravenous and intramuscular preparation, and also as an oral formulation for long-term use.

Indications

Indicated for the treatment of severe hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), with renal or pulmonary dysfunction following hematopoietic stem-cell transplantation (HSCT).
Defitelio is indicated for the treatment of severe hepatic veno-occlusive disease (VOD) also known as sinusoidal obstructive syndrome (SOS) in hematopoietic stem-cell transplantation (HSCT) therapy. It is indicated in adults and in adolescents, children, and infants over 1 month of age.
Defibrotide is a complex mixture of single-stranded polydeoxyribonucleotides derived from porcine intestinal mucosa that has antithrombotic and profibrinolytic activity and is used in the treatment of severe sinusoidal obstruction syndrome (SOS) after hematopoietic cell transplantation (HCT). Defibrotide is used in patients with severe liver injury.
Defibrotide injection is used to treat adults and children with hepatic veno-occlusive disease (VOD; blocked blood vessels inside the liver, also known as sinusoidal obstruction syndrome), who have kidney or lung problems after receiving a hematopoietic stem-cell transplant (HSCT; procedure in which certain blood cells are removed from the body and then returned to the bo

Use in Cancer

Defibrotide sodium is approved to treat:

Hepatic veno-occlusive disease (also known as sinusoidal obstruction syndrome) in adults and children who also have kidney or lung problems after receiving a stem cell transplant.

Contraindications

an increased risk of bleeding
bleeding
The use of defibrotide for people who are already taking anticoagulants is dangerous and the use of other drugs that affect platelet aggregation, like NSAIDs, should be done with care.
Defibrotide should not be given to people who have a difficult time maintaining steady blood pressure.^[rx]

Dosage

Strengths: 80 mg/mL

Hepatic Veno-Occlusive Disease

6.25 mg/kg IV every 6 hours given as a constant 2-hour infusion
Duration of therapy: Minimum of 21 days; if signs and symptoms of hepatic venous-occlusive disease (VOD) remain after 21 days, continue this drug until resolution of VOD or up to a maximum of 60 days. Baseline body weight prior to the preparative regimen for hematopoietic stem-cell transplantation (HSCT) should be used to calculate the dose.

Pediatric Dose for Hepatic Veno-Occlusive Disease

1 Month or Older:

6.25 mg/kg IV every 6 hours given as a constant 2-hour infusion
Duration of therapy: Minimum of 21 days; if signs and symptoms of hepatic venous-occlusive disease (VOD) remain after 21 days, continue this drug until resolution of VOD or up to a maximum of 60 days.
Baseline body weight prior to the preparative regimen for hematopoietic stem-cell transplantation (HSCT) should be used to calculate the dose.

Dose Adjustments

TREATMENT MODIFICATIONS FOR TOXICITY OR INVASIVE PROCEDURES:

Severe or Life-Threatening Hypersensitivity Reaction (Anaphylaxis): Discontinue this drug permanently; do not resume treatment.
Persistent, Severe, or Potentially Life-Threatening Bleeding: Withhold this drug; treat the underlying cause and provide supportive care as indicated; consider resuming treatment at the same dose and infusion volume when bleeding stops and the patient is hemodynamically stable.
Recurrent Significant Bleeding: Discontinue this drug permanently; do not resume treatment.
Invasive Procedures: Discontinue this drug at least 2 hours prior to an invasive procedure; resume treatment after the procedure as soon as any procedure-related risk of bleeding is resolved.

Administration advice:

Use an infusion set equipped with a 0.2-micron in-line filter.
Flush the IV line (peripheral or central) with a 5% dextrose injection or 0.9% sodium chloride injection immediately before and after administration.

Side Effects

The Most Common

dizziness
diarrhea
vomiting
nausea
nose bleeding
rash
hives
itching
swelling of the face, lips, tongue or throat
unusual bleeding or bruising
blood in urine or stool
headache
confusion
slurred speech
vision changes
fever, cough, or other signs of infection

More common

Black, tarry stools
bloody nose
bloody stools
blurred vision
chills
confusion
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
fast heartbeat
fever
lightheadedness
rapid, shallow breathing
sweating
unusual tiredness or weakness
vomiting of blood or material that looks like coffee grounds
Chest pain
cough or hoarseness
lower back or side pain
painful or difficult urination
sneezing
sore throat
tightness in the chest
troubled breathing

Rare

abdominal pain
dizziness
headache
increased menstrual bleeding
Difficulty with swallowing
hives, itching, or skin rash
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
itchy skin
rash
stiff, sore, hot, or painful joints
sudden pain or swelling in muscles
signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
signs of bleeding in the stomach (e.g., bloody, black, or tarry stools; spitting up of blood; vomiting blood or material that looks like coffee grounds)
signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
signs of severe skin reactions (e.g., blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort)

Drug Interaction

Abciximab	The risk or severity of bleeding can be increased when Abciximab is combined with Defibrotide.
Abrocitinib	The risk or severity of bleeding and thrombocytopenia can be increased when Defibrotide is combined with Abrocitinib.
Aceclofenac	The risk or severity of bleeding and hemorrhage can be increased when Aceclofenac is combined with Defibrotide.
Acemetacin	The risk or severity of bleeding and hemorrhage can be increased when Defibrotide is combined with Acemetacin.
Acenocoumarol	The risk or severity of bleeding can be increased when Defibrotide is combined with Acenocoumarol.
Acetylsalicylic acid	Acetylsalicylic acid may increase the antiplatelet activities of Defibrotide.
Albutrepenonacog alfa	The therapeutic efficacy of Albutrepenonacog alfa can be decreased when used in combination with Defibrotide.
Alclofenac	The risk or severity of bleeding and hemorrhage can be increased when Alclofenac is combined with Defibrotide.
Aldesleukin	The risk or severity of bleeding can be increased when Defibrotide is combined with Aldesleukin.
Alemtuzumab	The risk or severity of bleeding can be increased when Defibrotide is combined with Alemtuzumab.
Alteplase	The risk or severity of bleeding can be increased when Defibrotide is combined with Alteplase.
Altretamine	The risk or severity of bleeding can be increased when Defibrotide is combined with Altretamine.
Aminophenazone	The risk or severity of bleeding and hemorrhage can be increased when Aminophenazone is combined with Defibrotide.
Aminosalicylic acid	The risk or severity of bleeding can be increased when Aminosalicylic acid is combined with Defibrotide.
Amsacrine	The risk or severity of bleeding can be increased when Defibrotide is combined with Amsacrine.
Anagrelide	The risk or severity of bleeding can be increased when Anagrelide is combined with Defibrotide.
Ancrod	The risk or severity of bleeding can be increased when Defibrotide is combined with Ancrod.
Andexanet alfa	The therapeutic efficacy of Andexanet alfa can be decreased when used in combination with Defibrotide.
Anistreplase	The risk or severity of bleeding can be increased when Defibrotide is combined with Anistreplase.
Anti-inhibitor	The therapeutic efficacy of Anti-inhibitor coagulant complex can be decreased when used in combination with Defibrotide.
Antihemophilic	The therapeutic efficacy of Antihemophilic factor (recombinant), PEGylated can be decreased when used in combination with Defibrotide.
Antihemophilic factor	The therapeutic efficacy of Antihemophilic factor human can be decreased when used in combination with Defibrotide.
Antihemophilic	The therapeutic efficacy of Antihemophilic factor, human recombinant can be decreased when used in combination with Defibrotide.
Antipyrine	The risk or severity of bleeding and hemorrhage can be increased when Antipyrine is combined with Defibrotide.
Antithrombin Alfa	The risk or severity of bleeding can be increased when Defibrotide is combined with Antithrombin Alfa.
Antithrombin III	The risk or severity of bleeding can be increased when Defibrotide is combined with Antithrombin III human.
Antrafenine	The risk or severity of bleeding and hemorrhage can be increased when Antrafenine is combined with Defibrotide.
Apixaban	Apixaban may increase the anticoagulant activities of Defibrotide.
Aprotinin	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Aprotinin.
Ardeparin	The risk or severity of bleeding can be increased when Defibrotide is combined with Ardeparin.
Argatroban	The risk or severity of bleeding can be increased when Defibrotide is combined with Argatroban.
Arsenic trioxide	The risk or severity of bleeding can be increased when Defibrotide is combined with Arsenic trioxide.
Azacitidine	The risk or severity of bleeding can be increased when Defibrotide is combined with Azacitidine.
Azficel-T	The risk or severity of adverse effects can be increased when Defibrotide is combined with Azficel-T.
Azithromycin	The risk or severity of adverse effects can be increased when Azithromycin is combined with Defibrotide.
Balsalazide	The risk or severity of bleeding and hemorrhage can be increased when Balsalazide is combined with Defibrotide.
Belinostat	The risk or severity of bleeding can be increased when Defibrotide is combined with Belinostat.
Bemiparin	The risk or severity of bleeding can be increased when Defibrotide is combined with Bemiparin.
Bendamustine	The risk or severity of bleeding can be increased when Defibrotide is combined with Bendamustine.
Bendroflumethiazide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Bendroflumethiazide.
Benorilate	The risk or severity of bleeding and hemorrhage can be increased when Benorilate is combined with Defibrotide.
Benoxaprofen	The risk or severity of bleeding and hemorrhage can be increased when Benoxaprofen is combined with Defibrotide.
Benzthiazide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Benzthiazide.
Benzydamine	The risk or severity of bleeding and hemorrhage can be increased when Benzydamine is combined with Defibrotide.
Beroctocog alfa	The therapeutic efficacy of Beroctocog alfa can be decreased when used in combination with Defibrotide.
Betrixaban	The risk or severity of bleeding can be increased when Defibrotide is combined with Betrixaban.
Bexarotene	The risk or severity of bleeding can be increased when Defibrotide is combined with Bexarotene.
Bismuth subsalicylate	The risk or severity of bleeding can be increased when Bismuth subsalicylate is combined with Defibrotide.
Bivalirudin	The risk or severity of bleeding can be increased when Defibrotide is combined with Bivalirudin.
Blinatumomab	The risk or severity of bleeding can be increased when Defibrotide is combined with Blinatumomab.
Bortezomib	The risk or severity of bleeding can be increased when Defibrotide is combined with Bortezomib.
Bosutinib	The risk or severity of bleeding can be increased when Defibrotide is combined with Bosutinib.
Bumadizone	The risk or severity of bleeding and hemorrhage can be increased when Bumadizone is combined with Defibrotide.
Busulfan	The risk or severity of bleeding can be increased when Defibrotide is combined with Busulfan.
Cabazitaxel	The risk or severity of bleeding can be increased when Defibrotide is combined with Cabazitaxel.
Cangrelor	The risk or severity of bleeding can be increased when Defibrotide is combined with Cangrelor.
Capecitabine	The risk or severity of bleeding can be increased when Defibrotide is combined with Capecitabine.
Caplacizumab	The risk or severity of bleeding can be increased when Caplacizumab is combined with Defibrotide.
Carbamazepine	The risk or severity of bleeding can be increased when Defibrotide is combined with Carbamazepine.
Carbimazole	Carbimazole may increase the anticoagulant activities of Defibrotide.
Carboplatin	The risk or severity of bleeding can be increased when Defibrotide is combined with Carboplatin.
Carfilzomib	The risk or severity of bleeding can be increased when Defibrotide is combined with Carfilzomib.
Carmustine	The risk or severity of bleeding can be increased when Defibrotide is combined with Carmustine.
Carprofen	The risk or severity of bleeding and hemorrhage can be increased when Carprofen is combined with Defibrotide.
Catridecacog	The therapeutic efficacy of Catridecacog can be decreased when used in combination with Defibrotide.
Cefaclor	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefaclor.
Cefadroxil	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefadroxil.
Cefalotin	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefalotin.
Cefamandole	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefamandole.
Cefamandole nafate	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefamandole nafate.
Cefapirin	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefapirin.
Cefazolin	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefazolin.
Cefdinir	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefdinir.
Cefditoren	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefditoren.
Cefepime	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefepime.
Cefixime	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefixime.
Cefmenoxime	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefmenoxime.
Cefmetazole	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefmetazole.
Cefonicid	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefonicid.
Cefoperazone	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefoperazone.
Ceforanide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Ceforanide.
Cefotaxime	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefotaxime.
Cefotetan	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefotetan.
Cefotiam	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefotiam.
Cefoxitin	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefoxitin.
Cefpiramide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefpiramide.
Cefpirome	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefpirome.
Cefpodoxime	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefpodoxime.
Cefprozil	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefprozil.
Cefradine	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefradine.
Ceftaroline fosamil	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Ceftaroline fosamil.
Ceftazidime	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Ceftazidime.
Ceftibuten	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Ceftibuten.
Ceftizoxime	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Ceftizoxime.
Ceftobiprole	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Ceftobiprole.
Ceftobiprole medocaril	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Ceftobiprole medocaril.
Ceftolozane	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Ceftolozane.
Ceftriaxone	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Ceftriaxone.
Cefuroxime	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cefuroxime.
Celecoxib	The risk or severity of bleeding and hemorrhage can be increased when Celecoxib is combined with Defibrotide.

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Cephalexin	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cephalexin.
Cephaloglycin	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cephaloglycin.
Chenodeoxycholic acid	The risk or severity of adverse effects can be increased when Defibrotide is combined with Chenodeoxycholic acid.
Chlorambucil	The risk or severity of bleeding can be increased when Defibrotide is combined with Chlorambucil.
Chloramphenicol	The risk or severity of bleeding can be increased when Defibrotide is combined with Chloramphenicol.
Chlorothiazide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Chlorothiazide.
Cholic Acid	The risk or severity of adverse effects can be increased when Defibrotide is combined with Cholic Acid.
Choline magnesium	The risk or severity of bleeding and hemorrhage can be increased when Choline magnesium trisalicylate is combined with Defibrotide.
Choline salicylate	The risk or severity of bleeding can be increased when Choline salicylate is combined with Defibrotide.
Cilostazol	The risk or severity of bleeding can be increased when Cilostazol is combined with Defibrotide.
Cisplatin	The risk or severity of bleeding can be increased when Defibrotide is combined with Cisplatin.
Citalopram	The risk or severity of hemorrhage can be increased when Citalopram is combined with Defibrotide.
Cladribine	The risk or severity of bleeding can be increased when Defibrotide is combined with Cladribine.
Clofarabine	The risk or severity of bleeding can be increased when Defibrotide is combined with Clofarabine.
Clopidogrel	The risk or severity of bleeding can be increased when Clopidogrel is combined with Defibrotide.
Coagulation Factor IX	The therapeutic efficacy of Coagulation Factor IX (Recombinant) can be decreased when used in combination with Defibrotide.
Coagulation Factor IX	The therapeutic efficacy of Coagulation Factor IX Human can be decreased when used in combination with Defibrotide.
Coagulation factor VII	The therapeutic efficacy of Coagulation factor VII human can be decreased when used in combination with Defibrotide.
Coagulation	The therapeutic efficacy of Coagulation factor VIIa Recombinant Human can be decreased when used in combination with Defibrotide.
Coagulation factor X	The therapeutic efficacy of Coagulation factor X human can be decreased when used in combination with Defibrotide.
Collagenase	The risk or severity of adverse effects can be increased when Defibrotide is combined with Collagenase clostridium histolyticum.
Conjugated estrogens	Conjugated estrogens may decrease the anticoagulant activities of Defibrotide.
Cyclopenthiazide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cyclopenthiazide.
Cyclophosphamide	The risk or severity of bleeding can be increased when Defibrotide is combined with Cyclophosphamide.
Cyclothiazide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Cyclothiazide.
Cyproterone acetate	The risk or severity of adverse effects can be increased when Cyproterone acetate is combined with Defibrotide.
Cytarabine	The risk or severity of bleeding can be increased when Defibrotide is combined with Cytarabine.
Dabigatran	The risk or severity of bleeding can be increased when Defibrotide is combined with Dabigatran.
Dabigatran etexilate	Dabigatran etexilate may increase the anticoagulant activities of Defibrotide.
Dacarbazine	The risk or severity of bleeding can be increased when Defibrotide is combined with Dacarbazine.
Dactinomycin	The risk or severity of bleeding can be increased when Defibrotide is combined with Dactinomycin.
Dalteparin	The risk or severity of bleeding can be increased when Defibrotide is combined with Dalteparin.
Damoctocog alfa pegol	The therapeutic efficacy of Damoctocog alfa pegol can be decreased when used in combination with Defibrotide.
Danaparoid	The risk or severity of bleeding can be increased when Defibrotide is combined with Danaparoid.
Dasatinib	The risk or severity of bleeding and hemorrhage can be increased when Dasatinib is combined with Defibrotide.
Daunorubicin	The risk or severity of bleeding can be increased when Defibrotide is combined with Daunorubicin.
Decitabine	The risk or severity of bleeding can be increased when Defibrotide is combined with Decitabine.
Deferasirox	The risk or severity of gastrointestinal bleeding can be increased when Defibrotide is combined with Deferasirox.
Dehydrocholic acid	The risk or severity of adverse effects can be increased when Defibrotide is combined with Dehydrocholic acid.
Deoxycholic acid	The risk or severity of adverse effects can be increased when Defibrotide is combined with Deoxycholic acid.
Desirudin	The risk or severity of bleeding can be increased when Defibrotide is combined with Desirudin.
Desogestrel	The risk or severity of adverse effects can be increased when Desogestrel is combined with Defibrotide.
Desvenlafaxine	The risk or severity of hemorrhage can be increased when Desvenlafaxine is combined with Defibrotide.
Dexibuprofen	The risk or severity of bleeding can be increased when Dexibuprofen is combined with Defibrotide.
Dexketoprofen	The risk or severity of bleeding and hemorrhage can be increased when Dexketoprofen is combined with Defibrotide.
Dexrazoxane	The risk or severity of bleeding can be increased when Defibrotide is combined with Dexrazoxane.
Dextran	The risk or severity of bleeding can be increased when Defibrotide is combined with Dextran.
Diclofenac	The risk or severity of bleeding and hemorrhage can be increased when Diclofenac is combined with Defibrotide.
Dicoumarol	The risk or severity of bleeding can be increased when Defibrotide is combined with Dicoumarol.
Dienogest	The risk or severity of adverse effects can be increased when Dienogest is combined with Defibrotide.
Diethylstilbestrol	Diethylstilbestrol may decrease the anticoagulant activities of Defibrotide.
Diflunisal	The risk or severity of bleeding and hemorrhage can be increased when Diflunisal is combined with Defibrotide.
Dinutuximab	The risk or severity of bleeding can be increased when Defibrotide is combined with Dinutuximab.
Dipyridamole	The risk or severity of bleeding can be increased when Dipyridamole is combined with Defibrotide.
Docetaxel	The risk or severity of bleeding can be increased when Defibrotide is combined with Docetaxel.
Doxorubicin	The risk or severity of bleeding can be increased when Defibrotide is combined with Doxorubicin.
Doxycycline	The risk or severity of bleeding can be increased when Doxycycline is combined with Defibrotide.
Drospirenone	The risk or severity of adverse effects can be increased when Drospirenone is combined with Defibrotide.
Drostanolone	Drostanolone propionate may increase the anticoagulant activities of Defibrotide.
Drotrecogin alfa	The risk or severity of bleeding can be increased when Defibrotide is combined with Drotrecogin alfa.
Duloxetine	The risk or severity of hemorrhage can be increased when Duloxetine is combined with Defibrotide.
Dydrogesterone	Dydrogesterone may decrease the anticoagulant activities of Defibrotide.
Edetic acid	The risk or severity of bleeding can be increased when Defibrotide is combined with Edetic acid.
Edoxaban	The risk or severity of bleeding can be increased when Edoxaban is combined with Defibrotide.
Eftrenonacog alfa	The therapeutic efficacy of Eftrenonacog alfa can be decreased when used in combination with Defibrotide.
Emicizumab	The therapeutic efficacy of Emicizumab can be decreased when used in combination with Defibrotide.
Enoxaparin	The risk or severity of bleeding can be increased when Defibrotide is combined with Enoxaparin.
Epirubicin	The risk or severity of bleeding can be increased when Defibrotide is combined with Epirubicin.
Epoprostenol	The risk or severity of bleeding can be increased when Epoprostenol is combined with Defibrotide.
Eptifibatide	The risk or severity of bleeding can be increased when Eptifibatide is combined with Defibrotide.
Eribulin	The risk or severity of bleeding can be increased when Defibrotide is combined with Eribulin.
Erythromycin	The risk or severity of bleeding can be increased when Erythromycin is combined with Defibrotide.
Escitalopram	The risk or severity of bleeding can be increased when Escitalopram is combined with Defibrotide.
Esterified estrogens	Esterified estrogens may decrease the anticoagulant activities of Defibrotide.
Estetrol	The risk or severity of adverse effects can be increased when Estetrol is combined with Defibrotide.
Estradiol	The risk or severity of adverse effects can be increased when Estradiol is combined with Defibrotide.
Estradiol acetate	Estradiol acetate may decrease the anticoagulant activities of Defibrotide.
Estradiol benzoate	Estradiol benzoate may decrease the anticoagulant activities of Defibrotide.
Estradiol cypionate	Estradiol cypionate may decrease the anticoagulant activities of Defibrotide.
Estradiol valerate	Estradiol valerate may decrease the anticoagulant activities of Defibrotide.
Estriol	Estriol may decrease the anticoagulant activities of Defibrotide.
Estrone sulfate	Estrone sulfate may decrease the anticoagulant activities of Defibrotide.
Ethinylestradiol	The risk or severity of adverse effects can be increased when Ethinylestradiol is combined with Defibrotide.
Ethynodiol diacetate	The risk or severity of adverse effects can be increased when Ethynodiol diacetate is combined with Defibrotide.
Etodolac	The risk or severity of bleeding and hemorrhage can be increased when Etodolac is combined with Defibrotide.
Etonogestrel	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Etonogestrel.
Etoposide	The risk or severity of bleeding can be increased when Defibrotide is combined with Etoposide.
Etoricoxib	The risk or severity of bleeding and hemorrhage can be increased when Etoricoxib is combined with Defibrotide.
Everolimus	The risk or severity of bleeding can be increased when Defibrotide is combined with Everolimus.
Factor IX Complex	The therapeutic efficacy of Factor IX Complex (Human) can be decreased when used in combination with Defibrotide.
Factor XIII (human)	The therapeutic efficacy of Factor XIII (human) can be decreased when used in combination with Defibrotide.
Fenbufen	The risk or severity of bleeding and hemorrhage can be increased when Fenbufen is combined with Defibrotide.
Fenoprofen	The risk or severity of bleeding and hemorrhage can be increased when Fenoprofen is combined with Defibrotide.
Fibrinogen human	The therapeutic efficacy of Fibrinogen human can be decreased when used in combination with Defibrotide.
Floctafenine	The risk or severity of bleeding and hemorrhage can be increased when Floctafenine is combined with Defibrotide.
Floxuridine	The risk or severity of bleeding can be increased when Defibrotide is combined with Floxuridine.
Flucytosine	The risk or severity of bleeding can be increased when Defibrotide is combined with Flucytosine.
Fludarabine	The risk or severity of bleeding can be increased when Defibrotide is combined with Fludarabine.
Fluindione	The risk or severity of bleeding can be increased when Defibrotide is combined with Fluindione.
Fluorouracil	The risk or severity of bleeding can be increased when Defibrotide is combined with Fluorouracil.

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Fluoxetine	The risk or severity of hemorrhage can be increased when Fluoxetine is combined with Defibrotide.
Flurbiprofen	The risk or severity of bleeding and hemorrhage can be increased when Flurbiprofen is combined with Defibrotide.
Fluvoxamine	The risk or severity of hemorrhage can be increased when Fluvoxamine is combined with Defibrotide.
Fondaparinux	The risk or severity of bleeding can be increased when Defibrotide is combined with Fondaparinux.
Gemcitabine	The risk or severity of bleeding can be increased when Defibrotide is combined with Gemcitabine.
Gemtuzumab ozogamicin	The risk or severity of bleeding can be increased when Defibrotide is combined with Gemtuzumab ozogamicin.
Gestrinone	The risk or severity of adverse effects can be increased when Gestrinone is combined with Defibrotide.
Ginkgo biloba	Ginkgo biloba may increase the anticoagulant activities of Defibrotide.
Glucosamine	Glucosamine may increase the antiplatelet activities of Defibrotide.
Glycol salicylate	The risk or severity of bleeding and hemorrhage can be increased when Glycol salicylate is combined with Defibrotide.
Hemin	Hemin may increase the anticoagulant activities of Defibrotide.
Heparin	The risk or severity of bleeding can be increased when Defibrotide is combined with Heparin.
Hydrochlorothiazide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Hydrochlorothiazide.
Hydroflumethiazide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Hydroflumethiazide.
Hydroxyprogesterone	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Hydroxyprogesterone caproate.
Hydroxyurea	The risk or severity of bleeding can be increased when Defibrotide is combined with Hydroxyurea.
Ibritumomab tiuxetan	The risk or severity of adverse effects can be increased when Defibrotide is combined with Ibritumomab tiuxetan.
Ibrutinib	The risk or severity of bleeding and hemorrhage can be increased when Ibrutinib is combined with Defibrotide.
Ibuprofen	The risk or severity of bleeding can be increased when Ibuprofen is combined with Defibrotide.
Icosapent	The risk or severity of bleeding and hemorrhage can be increased when Icosapent is combined with Defibrotide.
Icosapent ethyl	The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Defibrotide.
Idarubicin	The risk or severity of bleeding can be increased when Defibrotide is combined with Idarubicin.
Ifosfamide	The risk or severity of bleeding can be increased when Ifosfamide is combined with Defibrotide.
Iloprost	The risk or severity of bleeding can be increased when Iloprost is combined with Defibrotide.
Imatinib	The risk or severity of bleeding can be increased when Defibrotide is combined with Imatinib.
Indomethacin	The risk or severity of bleeding and hemorrhage can be increased when Indomethacin is combined with Defibrotide.
Interferon alfa-2a	The risk or severity of bleeding can be increased when Defibrotide is combined with Interferon alfa-2a.
Interferon alfa-2b	The risk or severity of bleeding can be increased when Defibrotide is combined with Interferon alfa-2b.
Interferon alfa-n1	The risk or severity of bleeding can be increased when Defibrotide is combined with Interferon alfa-n1.
Interferon alfa-n3	The risk or severity of bleeding can be increased when Defibrotide is combined with Interferon alfa-n3.
Interferon alfacon-1	The risk or severity of bleeding can be increased when Defibrotide is combined with Interferon alfacon-1.
Interferon beta-1b	The risk or severity of bleeding can be increased when Defibrotide is combined with Interferon beta-1b.
Interferon gamma-1b	The risk or severity of bleeding can be increased when Defibrotide is combined with Interferon gamma-1b.
Irinotecan	The risk or severity of bleeding can be increased when Defibrotide is combined with Irinotecan.
Isocarboxazid	The risk or severity of bleeding and hemorrhage can be increased when Isocarboxazid is combined with Defibrotide.
Isoxicam	The risk or severity of bleeding and hemorrhage can be increased when Isoxicam is combined with Defibrotide.
Ixabepilone	The risk or severity of bleeding can be increased when Defibrotide is combined with Ixabepilone.
Ketoprofen	The risk or severity of bleeding and hemorrhage can be increased when Ketoprofen is combined with Defibrotide.
Ketorolac	The risk or severity of bleeding and hemorrhage can be increased when Ketorolac is combined with Defibrotide.
Latamoxef	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Latamoxef.
Lenalidomide	The risk or severity of bleeding can be increased when Defibrotide is combined with Lenalidomide.
Lepirudin	The risk or severity of bleeding can be increased when Defibrotide is combined with Lepirudin.
Levocarnitine	The therapeutic efficacy of Defibrotide can be increased when used in combination with Levocarnitine.
Levomilnacipran	The risk or severity of hemorrhage can be increased when Levomilnacipran is combined with Defibrotide.
Levonorgestrel	The risk or severity of adverse effects can be increased when Levonorgestrel is combined with Defibrotide.
Linezolid	The risk or severity of bleeding and hemorrhage can be increased when Linezolid is combined with Defibrotide.
Lomustine	The risk or severity of bleeding can be increased when Defibrotide is combined with Lomustine.
Loracarbef	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Loracarbef.
Lornoxicam	The risk or severity of bleeding and hemorrhage can be increased when Lornoxicam is combined with Defibrotide.
Loxoprofen	The risk or severity of bleeding and hemorrhage can be increased when Loxoprofen is combined with Defibrotide.
Lumiracoxib	The risk or severity of bleeding and hemorrhage can be increased when Lumiracoxib is combined with Defibrotide.
Lynestrenol	The risk or severity of adverse effects can be increased when Lynestrenol is combined with Defibrotide.
Mechlorethamine	The risk or severity of bleeding can be increased when Defibrotide is combined with Mechlorethamine.
Meclofenamic acid	The risk or severity of bleeding and hemorrhage can be increased when Meclofenamic acid is combined with Defibrotide.
Medrogestone	Medrogestone may decrease the anticoagulant activities of Defibrotide.
Medroxyprogesterone	The risk or severity of adverse effects can be increased when Medroxyprogesterone acetate is combined with Defibrotide.
Mefenamic acid	The risk or severity of bleeding and hemorrhage can be increased when Mefenamic acid is combined with Defibrotide.
Megestrol acetate	The risk or severity of adverse effects can be increased when Megestrol acetate is combined with Defibrotide.
Meloxicam	The risk or severity of bleeding and hemorrhage can be increased when Meloxicam is combined with Defibrotide.
Melphalan	The risk or severity of bleeding can be increased when Defibrotide is combined with Melphalan.
Menthyl salicylate	The risk or severity of bleeding and hemorrhage can be increased when Menthyl salicylate is combined with Defibrotide.
Mercaptopurine	The risk or severity of bleeding can be increased when Defibrotide is combined with Mercaptopurine.
Mesalazine	The risk or severity of bleeding and hemorrhage can be increased when Mesalazine is combined with Defibrotide.
Mestranol	The risk or severity of adverse effects can be increased when Mestranol is combined with Defibrotide.
Methimazole	Methimazole may increase the anticoagulant activities of Defibrotide.
Methotrexate	The risk or severity of bleeding can be increased when Defibrotide is combined with Methotrexate.
Methyl salicylate	The risk or severity of bleeding can be increased when Methyl salicylate is combined with Defibrotide.
Methylene blue	The risk or severity of bleeding and hemorrhage can be increased when Methylene blue is combined with Defibrotide.
Mifepristone	The risk or severity of adverse effects can be increased when Mifepristone is combined with Defibrotide.
Milnacipran	The risk or severity of hemorrhage can be increased when Milnacipran is combined with Defibrotide.
Minaprine	The risk or severity of bleeding and hemorrhage can be increased when Minaprine is combined with Defibrotide.
Mitomycin	The risk or severity of bleeding can be increased when Defibrotide is combined with Mitomycin.
Mitoxantrone	The risk or severity of bleeding can be increased when Defibrotide is combined with Mitoxantrone.
Moclobemide	The risk or severity of bleeding and hemorrhage can be increased when Moclobemide is combined with Defibrotide.
Moroctocog alfa	The therapeutic efficacy of Moroctocog alfa can be decreased when used in combination with Defibrotide.
Mosunetuzumab	The risk or severity of bleeding can be increased when Defibrotide is combined with Mosunetuzumab.
Nabumetone	The risk or severity of bleeding and hemorrhage can be increased when Nabumetone is combined with Defibrotide.
Nadroparin	The risk or severity of bleeding can be increased when Defibrotide is combined with Nadroparin.
Naproxen	The risk or severity of bleeding and hemorrhage can be increased when Naproxen is combined with Defibrotide.
Nefazodone	The risk or severity of hemorrhage can be increased when Nefazodone is combined with Defibrotide.
Nelarabine	The risk or severity of bleeding can be increased when Defibrotide is combined with Nelarabine.
Nialamide	The risk or severity of bleeding and hemorrhage can be increased when Nialamide is combined with Defibrotide.
Nilotinib	The risk or severity of bleeding can be increased when Defibrotide is combined with Nilotinib.
Nimesulide	The risk or severity of bleeding and hemorrhage can be increased when Nimesulide is combined with Defibrotide.
Nintedanib	The risk or severity of bleeding can be increased when Nintedanib is combined with Defibrotide.
Nomegestrol	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Nomegestrol.
Nomegestrol acetate	The risk or severity of adverse effects can be increased when Nomegestrol acetate is combined with Defibrotide.
Nonacog beta pegol	The therapeutic efficacy of Nonacog beta pegol can be decreased when used in combination with Defibrotide.
Norelgestromin	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Norelgestromin.
Norethisterone	The risk or severity of adverse effects can be increased when Norethisterone is combined with Defibrotide.
Norethynodrel	The risk or severity of adverse effects can be increased when Norethynodrel is combined with Defibrotide.
Norgestimate	The risk or severity of adverse effects can be increased when Norgestimate is combined with Defibrotide.
Norgestrel	The risk or severity of adverse effects can be increased when Norgestrel is combined with Defibrotide.
Obeticholic acid	The risk or severity of adverse effects can be increased when Defibrotide is combined with Obeticholic acid.
Obinutuzumab	The risk or severity of adverse effects can be increased when Defibrotide is combined with Obinutuzumab.
Olaparib	The risk or severity of bleeding can be increased when Defibrotide is combined with Olaparib.
Olive oil	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Olive oil.
Olsalazine	The risk or severity of bleeding and hemorrhage can be increased when Olsalazine is combined with Defibrotide.
Omacetaxine	The risk or severity of bleeding can be increased when Defibrotide is combined with Omacetaxine mepesuccinate.
Omega-3 fatty acids	Omega-3 fatty acids may increase the antiplatelet activities of Defibrotide.

Omega-3-acid ethyl	The risk or severity of bleeding can be increased when Omega-3-acid ethyl esters is combined with Defibrotide.
Omega-3-carboxylic	The therapeutic efficacy of Defibrotide can be increased when used in combination with Omega-3-carboxylic acids.
Oxaliplatin	The risk or severity of bleeding can be increased when Defibrotide is combined with Oxaliplatin.
Oxaprozin	The risk or severity of bleeding and hemorrhage can be increased when Oxaprozin is combined with Defibrotide.
Oxyphenbutazone	The risk or severity of bleeding and hemorrhage can be increased when Oxyphenbutazone is combined with Defibrotide.
Paclitaxel	The risk or severity of bleeding can be increased when Defibrotide is combined with Paclitaxel.
Padeliporfin	The risk or severity of bleeding can be increased when Defibrotide is combined with Padeliporfin.
Palbociclib	The risk or severity of bleeding can be increased when Defibrotide is combined with Palbociclib.
Pantothenic acid	The therapeutic efficacy of Pantothenic acid can be decreased when used in combination with Defibrotide.
Parecoxib	The risk or severity of bleeding and hemorrhage can be increased when Parecoxib is combined with Defibrotide.
Pargyline	The risk or severity of bleeding and hemorrhage can be increased when Pargyline is combined with Defibrotide.
Parnaparin	The risk or severity of bleeding can be increased when Defibrotide is combined with Parnaparin.
Paroxetine	The risk or severity of hemorrhage can be increased when Paroxetine is combined with Defibrotide.
Peginterferon alfa-2a	The risk or severity of bleeding can be increased when Defibrotide is combined with Peginterferon alfa-2a.
Peginterferon alfa-2b	The risk or severity of bleeding can be increased when Defibrotide is combined with Peginterferon alfa-2b.
Peginterferon beta-1a	The risk or severity of bleeding can be increased when Defibrotide is combined with Peginterferon beta-1a.
Pemetrexed	The risk or severity of bleeding can be increased when Defibrotide is combined with Pemetrexed.
Penicillamine	The risk or severity of bleeding can be increased when Defibrotide is combined with Penicillamine.
Pentosan polysulfate	The risk or severity of adverse effects can be increased when Pentosan polysulfate is combined with Defibrotide.
Pentostatin	The risk or severity of bleeding can be increased when Defibrotide is combined with Pentostatin.
Pentoxifylline	The therapeutic efficacy of Defibrotide can be increased when used in combination with Pentoxifylline.
Phenelzine	The risk or severity of bleeding and hemorrhage can be increased when Phenelzine is combined with Defibrotide.
Phenindione	The risk or severity of bleeding can be increased when Defibrotide is combined with Phenindione.
Phenprocoumon	The risk or severity of bleeding can be increased when Defibrotide is combined with Phenprocoumon.
Phenyl aminosalicylate	The risk or severity of bleeding can be increased when Phenyl aminosalicylate is combined with Defibrotide.
Phenylalanine	The risk or severity of bleeding can be increased when Defibrotide is combined with Phenylalanine.
Phenylbutazone	The risk or severity of bleeding and hemorrhage can be increased when Phenylbutazone is combined with Defibrotide.
Piroxicam	The risk or severity of bleeding and hemorrhage can be increased when Piroxicam is combined with Defibrotide.
Polyestradiol	Polyestradiol phosphate may decrease the anticoagulant activities of Defibrotide.
Polythiazide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Polythiazide.
Pomalidomide	The risk or severity of bleeding can be increased when Defibrotide is combined with Pomalidomide.
Ponatinib	The risk or severity of bleeding can be increased when Defibrotide is combined with Ponatinib.
Potassium Iodide	Potassium Iodide may increase the anticoagulant activities of Defibrotide.
Potassium perchlorate	Potassium perchlorate may increase the anticoagulant activities of Defibrotide.
Prasugrel	The risk or severity of bleeding can be increased when Defibrotide is combined with Prasugrel.
Procaine	The risk or severity of bleeding and hemorrhage can be increased when Procaine is combined with Defibrotide.
Procarbazine	The risk or severity of bleeding and hemorrhage can be increased when Procarbazine is combined with Defibrotide.
Progesterone	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Progesterone.
Propylthiouracil	Propylthiouracil may increase the anticoagulant activities of Defibrotide.
Protein C	The risk or severity of bleeding can be increased when Defibrotide is combined with Protein C.
Protein S human	The risk or severity of bleeding can be increased when Defibrotide is combined with Protein S human.
Prothrombin	The therapeutic efficacy of Prothrombin can be decreased when used in combination with Defibrotide.
Quinestrol	Quinestrol may decrease the anticoagulant activities of Defibrotide.
Quinidine	The therapeutic efficacy of Defibrotide can be increased when used in combination with Quinidine.
Quinine	The therapeutic efficacy of Defibrotide can be increased when used in combination with Quinine.
Raltitrexed	The risk or severity of bleeding can be increased when Defibrotide is combined with Raltitrexed.
Rasagiline	The risk or severity of bleeding and hemorrhage can be increased when Rasagiline is combined with Defibrotide.
Reteplase	The risk or severity of bleeding can be increased when Defibrotide is combined with Reteplase.
Reviparin	The risk or severity of bleeding can be increased when Defibrotide is combined with Reviparin.
Rituximab	The risk or severity of bleeding can be increased when Defibrotide is combined with Rituximab.
Rivaroxaban	Defibrotide may increase the anticoagulant activities of Rivaroxaban.
Rofecoxib	The risk or severity of bleeding and hemorrhage can be increased when Rofecoxib is combined with Defibrotide.
Ropeginterferon alfa	The risk or severity of bleeding can be increased when Defibrotide is combined with Ropeginterferon alfa-2b.
Rurioctocog alfa	The therapeutic efficacy of Rurioctocog alfa pegol can be decreased when used in combination with Defibrotide.
Ruxolitinib	The risk or severity of bleeding can be increased when Defibrotide is combined with Ruxolitinib.
Safinamide	The risk or severity of bleeding and hemorrhage can be increased when Safinamide is combined with Defibrotide.
Salicylamide	The risk or severity of bleeding and hemorrhage can be increased when Salicylamide is combined with Defibrotide.
Salicylic acid	The risk or severity of bleeding and hemorrhage can be increased when Salicylic acid is combined with Defibrotide.
Salsalate	The risk or severity of bleeding and hemorrhage can be increased when Salsalate is combined with Defibrotide.
Selegiline	The risk or severity of bleeding and hemorrhage can be increased when Selegiline is combined with Defibrotide.
Sertraline	The risk or severity of bleeding can be increased when Sertraline is combined with Defibrotide.
Sibutramine	The risk or severity of hemorrhage can be increased when Sibutramine is combined with Defibrotide.
Sildenafil	The risk or severity of hemorrhage can be increased when Defibrotide is combined with Sildenafil.
Sirolimus	The risk or severity of bleeding can be increased when Defibrotide is combined with Sirolimus.
Sodium citrate	The risk or severity of bleeding can be increased when Defibrotide is combined with Sodium citrate.
Sorafenib	The risk or severity of bleeding can be increased when Defibrotide is combined with Sorafenib.
Soybean oil	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Soybean oil.
Streptokinase	The risk or severity of bleeding can be increased when Defibrotide is combined with Streptokinase.
Streptozocin	The risk or severity of bleeding can be increased when Defibrotide is combined with Streptozocin.
Sugammadex	The risk or severity of bleeding and hemorrhage can be increased when Defibrotide is combined with Sugammadex.
Sulfasalazine	The risk or severity of bleeding and hemorrhage can be increased when Sulfasalazine is combined with Defibrotide.
Sulfinpyrazone	The risk or severity of bleeding can be increased when Sulfinpyrazone is combined with Defibrotide.
Sulindac	The risk or severity of bleeding and hemorrhage can be increased when Sulindac is combined with Defibrotide.
Sulodexide	The risk or severity of bleeding can be increased when Defibrotide is combined with Sulodexide.
Susoctocog alfa	The therapeutic efficacy of Susoctocog alfa can be decreased when used in combination with Defibrotide.
Sy Estrogens, A	Synthetic Conjugated Estrogens, A may decrease the anticoagulant activities of Defibrotide.
S Estrogens, B	Synthetic Conjugated Estrogens, B may decrease the anticoagulant activities of Defibrotide.
Tacrolimus	The risk or severity of bleeding can be increased when Defibrotide is combined with Tacrolimus.
Tamoxifen	The risk or severity of bleeding can be increased when Tamoxifen is combined with Defibrotide.
Taurocholic acid	The risk or severity of adverse effects can be increased when Defibrotide is combined with Taurocholic acid.
Tauroursodeoxycholic	The risk or severity of adverse effects can be increased when Defibrotide is combined with Tauroursodeoxycholic acid.
Tazobactam	The risk or severity of bleeding can be increased when Tazobactam is combined with Defibrotide.
Tedizolid phosphate	The risk or severity of bleeding can be increased when Defibrotide is combined with Tedizolid phosphate.
Temozolomide	The risk or severity of bleeding can be increased when Defibrotide is combined with Temozolomide.
Temsirolimus	The risk or severity of bleeding can be increased when Defibrotide is combined with Temsirolimus.
Tenecteplase	The risk or severity of bleeding can be increased when Defibrotide is combined with Tenecteplase.
Teniposide	The risk or severity of bleeding can be increased when Defibrotide is combined with Teniposide.
Tenoxicam	The risk or severity of bleeding and hemorrhage can be increased when Tenoxicam is combined with Defibrotide.
Testosterone	Testosterone may increase the anticoagulant activities of Defibrotide.
Testosterone cypionate	Testosterone cypionate may increase the anticoagulant activities of Defibrotide.
Testosterone	Testosterone enantate benzilic acid hydrazone may increase the anticoagulant activities of Defibrotide.
Testosterone enanthate	Testosterone enanthate may increase the anticoagulant activities of Defibrotide.
Testosterone propiona	Testosterone propionate may increase the anticoagulant activities of Defibrotide.
Testosterone undecanoate	Testosterone undecanoate may increase the anticoagulant activities of Defibrotide.
Thalidomide	The risk or severity of bleeding can be increased when Defibrotide is combined with Thalidomide.
Thiotepa	The risk or severity of bleeding can be increased when Defibrotide is combined with Thiotepa.
Tiaprofenic acid	The risk or severity of bleeding and hemorrhage can be increased when Tiaprofenic acid is combined with Defibrotide.
Tibolone	Tibolone may increase the anticoagulant activities of Defibrotide.
Ticagrelor	The risk or severity of bleeding can be increased when Defibrotide is combined with Ticagrelor.
Ticlopidine	The risk or severity of bleeding can be increased when Ticlopidine is combined with Defibrotide.

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Tinzaparin	The risk or severity of bleeding can be increased when Defibrotide is combined with Tinzaparin.
Tioguanine	The risk or severity of bleeding can be increased when Defibrotide is combined with Tioguanine.
Tipranavir	Tipranavir may increase the antiplatelet activities of Defibrotide.
Tirofiban	The risk or severity of bleeding can be increased when Tirofiban is combined with Defibrotide.
Tofacitinib	The risk or severity of bleeding can be increased when Defibrotide is combined with Tofacitinib.
Tolfenamic acid	The risk or severity of bleeding and hemorrhage can be increased when Tolfenamic acid is combined with Defibrotide.
Tolmetin	The risk or severity of bleeding and hemorrhage can be increased when Tolmetin is combined with Defibrotide.
Topotecan	The risk or severity of bleeding can be increased when Defibrotide is combined with Topotecan.
Toremifene	The risk or severity of bleeding can be increased when Toremifene is combined with Defibrotide.
Tositumomab	The risk or severity of adverse effects can be increased when Defibrotide is combined with Tositumomab.
Trabectedin	The risk or severity of bleeding can be increased when Defibrotide is combined with Trabectedin.
Tranylcypromine	The risk or severity of bleeding and hemorrhage can be increased when Tranylcypromine is combined with Defibrotide.
Trastuzumab emtansine	The risk or severity of bleeding can be increased when Defibrotide is combined with Trastuzumab emtansine.
Trazodone	The risk or severity of bleeding can be increased when Trazodone is combined with Defibrotide.
Treprostinil	The risk or severity of adverse effects can be increased when Defibrotide is combined with Treprostinil.
Triamcinolone	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Triamcinolone.
Trichlormethiazide	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Trichlormethiazide.
Triflusal	The risk or severity of bleeding can be increased when Defibrotide is combined with Triflusal.
Trolamine salicylate	The risk or severity of bleeding can be increased when Trolamine salicylate is combined with Defibrotide.
Turoctocog alfa	The therapeutic efficacy of Turoctocog alfa can be decreased when used in combination with Defibrotide.
Turoctocog alfa pegol	The therapeutic efficacy of Turoctocog alfa pegol can be decreased when used in combination with Defibrotide.
Ulipristal	The therapeutic efficacy of Defibrotide can be decreased when used in combination with Ulipristal.
Urokinase	Urokinase may increase the anticoagulant activities of Defibrotide.
Ursodeoxycholic	The risk or severity of adverse effects can be increased when Defibrotide is combined with Ursodeoxycholic acid.
Valdecoxib	The risk or severity of bleeding and hemorrhage can be increased when Valdecoxib is combined with Defibrotide.
Venlafaxine	The risk or severity of bleeding can be increased when Defibrotide is combined with Venlafaxine.
Vinblastine	The risk or severity of bleeding can be increased when Defibrotide is combined with Vinblastine.
Vindesine	The risk or severity of bleeding can be increased when Defibrotide is combined with Vindesine.
Vinorelbine	The risk or severity of bleeding can be increased when Defibrotide is combined with Vinorelbine.
Vitamin E	Vitamin E may increase the antiplatelet activities of Defibrotide.
Von Willebrand	The therapeutic efficacy of Von Willebrand factor human can be decreased when used in combination with Defibrotide.
Vorapaxar	The risk or severity of bleeding and hemorrhage can be increased when Vorapaxar is combined with Defibrotide.
Vorinostat	The risk or severity of bleeding can be increased when Defibrotide is combined with Vorinostat.
Vortioxetine	The risk or severity of bleeding can be increased when Vortioxetine is combined with Defibrotide.
Warfarin	The risk or severity of bleeding can be increased when Defibrotide is combined with Warfarin.
Ximelagatran	The risk or severity of bleeding can be increased when Defibrotide is combined with Ximelagatran.
Zidovudine	The risk or severity of bleeding can be increased when Defibrotide is combined with Zidovudine.
Zimelidine	The risk or severity of hemorrhage can be increased when Zimelidine is combined with Defibrotide.

Pregnancy and Lactation

US FDA pregnancy category: Not assigned

Pregnancy

There are no controlled data on human pregnancy. Use is not recommended unless clearly needed. The manufacturer makes no recommendation regarding use during pregnancy. No data exist regarding the use of this drug in pregnant women. Advise pregnant women of the potential risk of miscarriage.

Lactation

There are no adequate studies on women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

How should this medicine be used?

Defibrotide injection comes as a solution (liquid) to be injected intravenously (into a vein) over 2 hours by a doctor or nurse in a medical facility. It is usually injected once every 6 hours for 21 days but may be given for up to 60 days. The length of treatment depends on how well your body responds to the medication and the side effects that you may experience.

Your doctor may need to delay or stop your treatment if you experience certain side effects. Be sure to tell your doctor how you are feeling during your treatment with defibrotide.

What special precautions should I follow?

Before receiving defibrotide injection,

tell your doctor and pharmacist if you are allergic to defibrotide, any other medications, or any of the ingredients in defibrotide injection. Ask your pharmacist for a list of the ingredients.
tell your doctor if you are taking or have received anticoagulants (‘blood thinners) such as apixaban (Eliquis), dabigatran (Pradaxa), dalteparin (Fragmin), edoxaban (Savaysa), enoxaparin (Lovenox), fondaparinux (Arixtra), heparin, rivaroxaban (Xarelto), and warfarin (Coumadin, Jantoven) or if you will be receiving medications thrombolytic medications tissue plasminogen activators such as alteplase (Activase), reteplase (Retavase), or tenecteplase (TNKase). Your doctor will probably tell you not to use defibrotide injections if you are taking or using one or more of these medications.
tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
tell your doctor if you are bleeding anywhere on your body or if you have bleeding problems.
tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while receiving, call your doctor. Do not breastfeed while receiving defibrotide injection.

References