Drug interactions between fosaprepitant and Miradon
| Results for the following 2 drugs: |
|---|
| fosaprepitant |
| Miradon (anisindione) |
Interactions between your selected drugs
anisindione ↔ fosaprepitant
Applies to:Miradon (anisindione) and fosaprepitant
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.
See also...
Drug Interaction Classification
The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
Do not stop taking any medications without consulting your healthcare provider.
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