Drug interactions between Coumadin and Emend
Results for the following 2 drugs: |
|
|---|---|
| Coumadin (warfarin) | |
| Emend (aprepitant) | |
Interactions between your selected drugs
warfarin ⇔ aprepitant
Applies to: Coumadin (warfarin) and Emend (aprepitant)
MONITOR: Coadministration of aprepitant or its prodrug, fosaprepitant, during warfarin therapy may result in clinically significant decreases in the INR or prothrombin time. The likely mechanism is aprepitant induction of CYP450 2C9, the isoenzyme responsible for metabolic clearance of the biologically more active S(-) enantiomer of warfarin. According to the product labeling, healthy subjects stabilized on chronic warfarin therapy given aprepitant (125 mg on day 1 and 80 mg/day on days 2 and 3) had a 34% decrease in S(-) warfarin trough concentration accompanied by a 14% decrease in the INR five days after completion of aprepitant dosing. There was no effect on the systemic exposure (AUC) of R(+) and S(-) warfarin determined on day 3. It is not known if the interaction occurs with other oral anticoagulants, although at least one other coumarin derivative is known to be metabolized by CYP450 2C9.
MANAGEMENT: In patients treated with warfarin, the INR should be closely monitored in the 2-week period, particularly at 7 to 10 days, following initiation of the 3-day regimen of aprepitant or fosaprepitant with each chemotherapy cycle or following a single 40 mg dose of aprepitant for the prevention of postoperative nausea and vomiting. The same precaution may be applicable during therapy with other oral anticoagulants, although clinical data are lacking.
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