Aprepitant

Increased pimozide exposure. CINVANTI is contraindicated.

Increased alprazolam exposure may increase risk of adverse reactions with 3-day aprepitant regimen; monitor for benzodiazepine-related adverse reactions.

Strong CYP3A4 inducer substantially decreases aprepitant exposure, which may decrease efficacy. Avoid concomitant use.

Intervention Avoid concomitant use of aprepitant Examples Moderate inhibitor: diltiazem Strong inhibitors: ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir Strong CYP3A4 Inducers Clinical Impact Substantially decreased exposure of aprepitant in patients chronically taking a strong CYP3A4 inducer may decrease the efficacy of aprepitant [see Clinical Pharmacology ( 12.3 )].

Increased chemotherapeutic agent exposure may increase risk of adverse reactions. Monitor for chemotherapy-related adverse effects.

Intervention Avoid concomitant use of aprepitant Examples Moderate inhibitor: diltiazem Strong inhibitors: ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir Strong CYP3A4 Inducers Clinical Impact Substantially decreased exposure of aprepitant in patients chronically taking a strong CYP3A4 inducer may decrease the efficacy of aprepitant [see Clinical Pharmacology ( 12.3 )].

Intervention Avoid concomitant use of aprepitant Examples Moderate inhibitor: diltiazem Strong inhibitors: ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir Strong CYP3A4 Inducers Clinical Impact Substantially decreased exposure of aprepitant in patients chronically taking a strong CYP3A4 inducer may decrease the efficacy of aprepitant [see Clinical Pharmacology ( 12.3 )].

Increased midazolam exposure may increase risk of adverse reactions with 3-day aprepitant regimen; dose reduction may be warranted.

Strong CYP3A4 inhibitor significantly increases aprepitant exposure, increasing risk of adverse reactions. Avoid concomitant use.

Intervention Avoid concomitant use of aprepitant Examples Moderate inhibitor: diltiazem Strong inhibitors: ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir Strong CYP3A4 Inducers Clinical Impact Substantially decreased exposure of aprepitant in patients chronically taking a strong CYP3A4 inducer may decrease the efficacy of aprepitant [see Clinical Pharmacology ( 12.3 )].

May decrease plasma concentrations of COCs and potentially diminish effectiveness or increase breakthrough bleeding.

Decreased hormonal exposure during and for 28 days after aprepitant. Use alternative contraception methods during treatment and for 1 month after.

Strong CYP3A4 inducer substantially decreases aprepitant exposure, which may decrease efficacy. Avoid concomitant use.

Strong CYP3A4 inducer substantially decreases aprepitant exposure, which may decrease efficacy. Avoid concomitant use.

Intervention Avoid concomitant use of aprepitant Examples Moderate inhibitor: diltiazem Strong inhibitors: ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir Strong CYP3A4 Inducers Clinical Impact Substantially decreased exposure of aprepitant in patients chronically taking a strong CYP3A4 inducer may decrease the efficacy of aprepitant [see Clinical Pharmacology ( 12.3 )].

Increased triazolam exposure may increase risk of adverse reactions with 3-day aprepitant regimen; monitor for benzodiazepine-related adverse reactions.

Intervention Avoid concomitant use of aprepitant Examples Moderate inhibitor: diltiazem Strong inhibitors: ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir Strong CYP3A4 Inducers Clinical Impact Substantially decreased exposure of aprepitant in patients chronically taking a strong CYP3A4 inducer may decrease the efficacy of aprepitant [see Clinical Pharmacology ( 12.3 )].

Increased chemotherapeutic agent exposure may increase risk of adverse reactions. Monitor for chemotherapy-related adverse effects.

Increased chemotherapeutic agent exposure may increase risk of adverse reactions. Monitor for chemotherapy-related adverse effects.

CYP2C9 inducer that decreases warfarin exposure and INR; requires close INR monitoring.

CYP2C9 inducer that decreases warfarin effect and INR; requires closer INR monitoring.

Moderate CYP3A4 inhibitor causing significant increase in colchicine plasma concentration. Monitor for toxicity signs.

Deferasirox may induce CYP3A4 resulting in decreased aprepitant concentration. Monitor for reduced effectiveness.

Induces CYP3A4 and may decrease plasma concentrations of desogestrel and ethinyl estradiol, potentially diminishing contraceptive effectiveness and increasing breakthrough bleeding.

Increased dexamethasone exposure. Reduce oral dose by approximately 50%.

Increased docetaxel exposure possible; no dosage adjustment needed but monitor for adverse reactions.

May decrease systemic concentrations of hormonal contraceptives and diminish effectiveness or increase breakthrough bleeding.

May decrease plasma concentrations of etonogestrel and diminish contraceptive effectiveness or increase breakthrough bleeding.

CYP3A4 enzyme inducer that may decrease plasma concentrations of etonogestrel and ethinyl estradiol, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

Induces CYP3A4, may decrease plasma concentrations of CHCs and potentially diminish effectiveness or increase breakthrough bleeding.

Increased etoposide exposure possible; no dosage adjustment needed but monitor for adverse reactions.

Aprepitant induces CYP3A4 and may decrease plasma concentrations of COCs, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

Induces CYP3A4, may decrease plasma concentrations of COCs and diminish effectiveness or increase breakthrough bleeding.

Metabolic enzyme inducer that may decrease plasma concentrations of levonorgestrel and ethinyl estradiol, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

Increased methylprednisolone exposure. Reduce oral dose by 50% on Days 1-2 (HEC) or Day 1 (MEC); reduce IV dose by 25%.

Moderate CYP3A inhibitor increasing plasma naldemedine concentrations; monitor for adverse reactions.

Moderate CYP3A4 inhibitor that may increase nimodipine plasma concentration and blood pressure lowering effect. Blood pressure monitoring and dose reduction of nimodipine may be necessary.

Enzyme inducer that may decrease plasma concentrations of CHCs and potentially diminish effectiveness or increase breakthrough bleeding.

May decrease systemic concentrations of norethindrone and potentially diminish contraceptive effectiveness or increase breakthrough bleeding.

Enzyme inducer that may decrease plasma concentrations of COCs and potentially diminish contraceptive effectiveness or increase breakthrough bleeding.

May decrease plasma concentrations of COCs and diminish contraceptive effectiveness or increase breakthrough bleeding.

Enzyme inducer that may decrease plasma concentrations of norethindrone and ethinyl estradiol, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

May decrease plasma concentrations and efficacy of contraceptive; may increase breakthrough bleeding.

Increased paclitaxel exposure possible; no dosage adjustment needed but monitor for adverse reactions.

Metabolic enzyme inducer that may decrease systemic concentrations of estrogen and/or progestin, potentially diminishing contraceptive effectiveness.

Moderate CYP3A inhibitor; recommended suvorexant dose is 5 mg, may increase to 10 mg if needed.

Increased vinorelbine exposure possible; no dosage adjustment needed but monitor for adverse reactions.