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Drug Interactions between Cinvanti and Dexone

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

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Interactions between your drugs

Moderate

dexAMETHasone aprepitant

Applies to: Dexone (dexamethasone) and Cinvanti (aprepitant)

ADJUST DOSE: Coadministration with aprepitant or its prodrug, fosaprepitant, may increase the plasma concentrations of some corticosteroids. The mechanism is decreased clearance due to inhibition of CYP450 3A4 activity by aprepitant. According to the product labeling, coadministration of aprepitant (125 mg on day 1 and 80 mg/day on days 2 through 5) and dexamethasone (20 mg orally on day 1 and 8 mg on days 2 through 5) resulted in an increase in the area under the plasma concentration-time curve (AUC) of dexamethasone by 2.2-fold on days 1 and 5. Similarly, aprepitant (125 mg on day 1 and 80 mg/day on days 2 and 3) increased the AUC of methylprednisolone (125 mg intravenously on day 1 and 40 mg orally on days 2 and 3) by 1.34-fold on day 1 and 2.5-fold on day 3. In contrast, coadministration with a single 40 mg dose of aprepitant increased the AUC of oral dexamethasone (20 mg) by just 45%, indicating a weaker inhibition of CYP450 3A4 during low-dose, single administration. The effect of aprepitant on the pharmacokinetics of CYP450 3A4 substrates is also expected to be smaller when the substrates are administered intravenously as opposed to orally, and may be altered following prolonged administration.

MANAGEMENT: Oral dexamethasone and methylprednisolone dosage should be reduced by approximately 50% when coadministered with the aprepitant 125 mg/80 mg regimen, and intravenous methylprednisolone dosage should be reduced by approximately 25%. The daily dosage of dexamethasone administered in clinical chemotherapy-induced nausea and vomiting studies with aprepitant was reduced to account for the drug interaction. No dosage adjustment for the corticosteroid is necessary during coadministration with aprepitant in a single 40 mg dose for prevention of postoperative nausea and vomiting. Chronic, continuous use of aprepitant for prevention of nausea and vomiting is not recommended, as it has not been studied and the drug interaction profile may change during long-term use.

References

  1. "Product Information. Emend (aprepitant)." Merck & Co., Inc (2003):
  2. "Product Information. Emend for Injection (fosaprepitant)." Merck & Co., Inc (2008):

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

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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