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Drug Interactions between Akynzeo and ramelteon

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

ramelteon netupitant

Applies to: ramelteon and Akynzeo (netupitant / palonosetron)

MONITOR: Coadministration with netupitant or its prodrug, fosnetupitant, may increase the plasma concentrations of drugs that are primarily metabolized by CYP450 3A4. The mechanism is decreased clearance due to inhibition of CYP450 3A4 activity by netupitant and its desmethyl metabolite. When a single 7.5 mg oral dose of midazolam, a CYP450 3A4 probe substrate, was administered with netupitant 300 mg, mean midazolam peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 36% and 126%, respectively. When a 500 mg dose of erythromycin, another CYP450 3A4 substrate, was coadministered with netupitant 300 mg, the mean Cmax and AUC of erythromycin were increased by 92% and 56%, respectively, although the systemic exposure of erythromycin was highly variable.

MANAGEMENT: Caution is advised when netupitant or fosnetupitant is used concomitantly with drugs that undergo metabolism by CYP450 3A4, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for some drugs whenever netupitant or fosnetupitant is added to or withdrawn from therapy. The inhibitory effect on CYP450 3A4 can last for 6 days after administration of a single dose of netupitant or fosnetupitant.

References

  1. Cerner Multum, Inc. "Australian Product Information."
  2. (2014) "Product Information. Akynzeo (netupitant-palonosetron)." Eisai Inc
  3. (2018) "Product Information. Akynzeo for Injection (fosnetupitant-palonosetron)." Helsinn Therapeutics Inc

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Drug and food interactions

Moderate

ramelteon food

Applies to: ramelteon

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of ramelteon. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

ADJUST DOSING INTERVAL: Administration of ramelteon with or immediately after a high-fat/heavy meal may delay the onset of hypnotic effects. In study subjects, administration of a 16 mg dose of ramelteon with a high-fat meal decreased the peak plasma drug concentration (Cmax) by 22% and delayed the median time to reach peak plasma drug concentration (Tmax) by approximately 45 minutes compared to administration in a fasted state.

MANAGEMENT: Patients receiving ramelteon should be advised to avoid the consumption of alcohol. For faster sleep onset, ramelteon should not be administered with or immediately after a high-fat/heavy meal.

References

  1. (2005) "Product Information. Rozerem (ramelteon)." Takeda Pharmaceuticals America

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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