What are the potential drug interactions with Dupixent (dupilumab) in patients with a history of atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyposis?

Dupixent Drug Interactions

Dupixent (dupilumab) has minimal clinically significant drug-drug interactions, as it is a monoclonal antibody that does not undergo hepatic metabolism via cytochrome P450 enzymes. 1

Key Drug Interaction Considerations

Live Vaccines - Primary Contraindication

• Avoid live vaccines immediately before and during Dupixent therapy, as the immunomodulatory effects may theoretically reduce vaccine efficacy or increase infection risk 1
• Complete all age-appropriate vaccinations per current immunization guidelines prior to initiating Dupixent treatment 1
• Inactivated vaccines may be administered during Dupixent therapy without restriction 1

Corticosteroid Interactions - Tapering Required

• Do not abruptly discontinue systemic or inhaled corticosteroids when starting Dupixent, as this may precipitate adrenal insufficiency or unmask previously suppressed conditions 1
• Gradual corticosteroid tapering under direct physician supervision is essential to avoid systemic withdrawal symptoms 1
• For patients with asthma, maintain current asthma medications (including inhaled corticosteroids and bronchodilators) without adjustment unless directed by the treating physician 1

Antihistamine Considerations - Specific to Allergic Fungal Sinusitis

• In patients with allergic Aspergillus sinusitis receiving both Dupixent and nonsedating antihistamines, exercise caution with antihistamines that prolong QT interval (e.g., terfenadine, astemizole - though these are largely withdrawn from market) due to potential cardiac arrhythmia risk 2
• Modern second-generation antihistamines (cetirizine, loratadine, desloratadine, fexofenadine) do not have significant interactions with Dupixent 3

Concomitant Topical Therapies - No Restrictions

• Dupixent can be used with or without topical corticosteroids for atopic dermatitis 1
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) may be used concurrently but should be reserved for problem areas (face, neck, intertriginous regions, genital areas) 1
• Intranasal corticosteroids (mometasone furoate) are routinely combined with Dupixent for chronic rhinosinusitis with nasal polyposis without interaction concerns 2, 4

Leukotriene Modifiers - Safe Combination

• Montelukast, zafirlukast, and zileuton can be safely combined with Dupixent without drug interactions 2
• This combination may provide additive benefit for patients with both nasal polyps and asthma 2, 5

Critical Clinical Pitfalls

Helminth Infections

• Screen for and treat parasitic (helminth) infections before initiating Dupixent, as IL-4/IL-13 blockade may impair the immune response to parasites 1
• If helminth infection develops during treatment, temporarily discontinue Dupixent until infection resolves 1

Asthma Management in Multi-Indication Patients

• For patients using Dupixent for atopic dermatitis, chronic rhinosinusitis, or other non-asthma indications who also have comorbid asthma, do not adjust or discontinue asthma medications without explicit physician guidance 1
• Dupixent is not a rescue medication and will not relieve acute bronchospasm 1

Pregnancy and Lactation

• No known drug interactions exist, but enrollment in the pregnancy exposure registry (1-877-311-8972) is recommended for women who become pregnant during Dupixent therapy 1
• Unknown whether Dupixent passes into breast milk; this is a counseling point rather than a contraindication 1

Pharmacokinetic Profile Supporting Minimal Interactions

• As a subcutaneously administered IgG4 monoclonal antibody, Dupixent undergoes proteolytic catabolism rather than hepatic metabolism 1
• No cytochrome P450 enzyme involvement eliminates the most common mechanism of drug-drug interactions 1
• Renal or hepatic impairment does not require dose adjustment, further supporting the absence of metabolic interactions 1