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Drug Interactions between aprepitant and cabozantinib

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

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Interactions between your drugs

Moderate

aprepitant cabozantinib

Applies to: aprepitant and cabozantinib

MONITOR: Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of cabozantinib, which is a substrate of the isoenzyme. In healthy subjects, administration of the potent CYP450 3A4 inhibitor ketoconazole (400 mg daily for 27 days) increased single-dose plasma cabozantinib systemic exposure (AUC) by 38%. In vitro, inhibition of CYP450 3A4 has been shown to reduce the formation of the XL184 N-oxide metabolite by greater than 80%; however, the clinical significance has not been established.

MANAGEMENT: Caution is advised if cabozantinib is used with moderate CYP450 3A4 inhibitors. Patients should be monitored for potentially increased side effects such as nausea, vomiting, diarrhea, anorexia, weight loss, stomatitis, gastrointestinal perforations and fistulas, palmar-plantar erythrodysesthesia syndrome, hemorrhage, wound complications, hypertension, neutropenia, and thrombocytopenia.

References (1)
  1. (2012) "Product Information. Cometriq (cabozantinib)." Exelixis Inc

Drug and food interactions

Moderate

cabozantinib food

Applies to: cabozantinib

ADJUST DOSING INTERVAL: Food may alter the oral bioavailability of cabozantinib. When healthy subjects were given a single 140 mg oral dose with a high-fat meal, cabozantinib peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 41% and 57%, respectively, relative to administration under fasting conditions. In clinical studies, patients were administered cabozantinib without food.

GENERALLY AVOID: Coadministration with grapefruit juice is likely to increase the plasma concentrations of cabozantinib, which is primarily metabolized by CYP450 3A4. However, the interaction has not been studied. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit.

MANAGEMENT: Cabozantinib should be administered at least one hour before or two hours after a meal. The consumption of grapefruit, grapefruit juice, and supplements that contain grapefruit extract should be avoided.

References (1)
  1. (2012) "Product Information. Cometriq (cabozantinib)." Exelixis Inc

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.

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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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