Drug Interactions between aprepitant and polatuzumab vedotin

MONITOR: Coadministration with inhibitors of CYP450 3A4 may increase exposure to unconjugated monomethyl auristatin E (MMAE), the anti-mitotic and cytotoxic component of polatuzumab vedotin. MMAE is a substrate for CYP450 3A4. Concomitant use of polatuzumab vedotin with ketoconazole, a potent CYP450 3A4 inhibitor, is predicted to increase unconjugated MMAE exposure (AUC) by 45% according to the product labeling. No data are available for other, less potent CYP450 3A4 inhibitors.

MANAGEMENT: Caution is advised when polatuzumab vedotin is used concomitantly with CYP450 3A4 inhibitors. Patients should be monitored for development or exacerbation of toxicities such as peripheral neuropathy, myelosuppression, opportunistic infections, tumor lysis syndrome and hepatotoxicity, and the dosing of polatuzumab vedotin adjusted or withheld as necessary in accordance with the product labeling.