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Interactions between Emend for Injection and Vilazodone

1 drug interaction and 13 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

fosaprepitant vilazodone

Applies to: Emend for Injection (fosaprepitant) and vilazodone
Monitor

Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of vilazodone, which is primarily metabolized by the isoenzyme. According to the product labeling, concomitant use of vilazodone with potent CYP450 3A4 inhibitors such as ketoconazole can increase vilazodone plasma concentrations by approximately 50%. No data are available for less potent inhibitors such as aprepitant, diltiazem, erythromycin, and verapamil.

Management

When used with moderate CYP450 3A4 inhibitors, the maintenance dosage of vilazodone should be reduced to 20 mg/day in patients who develop intolerable adverse events.

References (1)
  1. (2011) "Product Information. Viibryd (vilazodone)." Trovis Pharmaceuticals LLC

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

vilazodone Food/Lifestyle

Applies to: vilazodone
Generally avoid

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

Adjust dosing interval

Food enhances the oral bioavailability of vilazodone. According to the product labeling, vilazodone blood concentrations in the fasted state can be decreased by approximately 50% compared to the fed state, which may result in diminished effectiveness in some patients. The absolute bioavailability of vilazodone is 72% with food. In study subjects, administration with food (high-fat or light meal) increased vilazodone peak plasma concentration (Cmax) by approximately 147% to 160% and systemic exposure (AUC) by approximately 64% to 85%.

Management

Patients receiving vilazodone should be advised to avoid consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how vilazodone affects them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities. Vilazodone should be taken with food. Administration without food may result in inadequate drug concentrations and diminished effectiveness.

References (1)
  1. (2011) "Product Information. Viibryd (vilazodone)." Trovis Pharmaceuticals LLC

Disease interactions

12 potential interactions Applies to: 10 conditions, including Depression, Bipolar Disorder, Seizures, Mania, and Liver Disease.

Bipolar Disorder

Major:

vilazodone

Vilazodone has a major potential interaction with Bipolar Disorder.

Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider. Changing the therapeutic regimen (including discontinuing the medication) should be considered in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.

Moderate:

vilazodone

Vilazodone has a moderate potential interaction with Bipolar Disorder.

Therapy with vilazodone may cause activation of mania and hypomania and should be used with caution in patients with personal or family history of mania, hypomania, bipolar disorder, and other mood disorders.

Bleeding Disorder

Moderate:

vilazodone

Vilazodone has a moderate potential interaction with Bleeding Disorder.

Some antidepressants should be administered with caution in patients with an increased risk for hemorrhage. Patients should be advised to immediately report any signs and symptoms suggestive of bleeding complications, including ecchymosis, hematoma, epistaxis, and petechia.

Dehydration

Moderate:

vilazodone

Vilazodone has a moderate potential interaction with Dehydration.

Treatment with vilazodone may cause hyponatremia, in many cases secondary to development of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Caution should be used when treating patients with hyponatremia or at greater risk of developing hyponatremia such as elderly patients, patients taking diuretics or those who are volume-depleted.

Depression

Major:

vilazodone

Vilazodone has a major potential interaction with Depression.

Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider. Changing the therapeutic regimen (including discontinuing the medication) should be considered in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.

Moderate:

vilazodone

Vilazodone has a moderate potential interaction with Depression.

Therapy with vilazodone may cause activation of mania and hypomania and should be used with caution in patients with personal or family history of mania, hypomania, bipolar disorder, and other mood disorders.

Glaucoma, Narrow Angle

Moderate:

vilazodone

Vilazodone has a moderate potential interaction with Glaucoma, Narrow Angle.

Some antidepressants exert mydriatic activity that can induce increased intraocular pressure and result in angle-closure (narrow-angle) glaucoma in a patient with anatomically narrow angles who does not have a patent iridectomy. Prior to initiating therapy with these agents, patients should be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure (e.g., iridectomy), if they are susceptible. The use of these drugs in patients with untreated anatomically narrow angles should be avoided.

Hyponatremia

Moderate:

vilazodone

Vilazodone has a moderate potential interaction with Hyponatremia.

Treatment with vilazodone may cause hyponatremia, in many cases secondary to development of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Caution should be used when treating patients with hyponatremia or at greater risk of developing hyponatremia such as elderly patients, patients taking diuretics or those who are volume-depleted.

Liver Disease

Moderate:

Emend for Injection

The fosaprepitant in Emend for Injection has a moderate potential interaction with Liver Disease.

There are no clinical or pharmacokinetic data in patients with severe liver dysfunction (Child-Pugh score greater than 9); therefore, caution and additional monitoring for adverse reactions are recommended when using fosaprepitant in these patients.

Mania

Moderate:

vilazodone

Vilazodone has a moderate potential interaction with Mania.

Therapy with vilazodone may cause activation of mania and hypomania and should be used with caution in patients with personal or family history of mania, hypomania, bipolar disorder, and other mood disorders.

Seizures

Moderate:

vilazodone

Vilazodone has a moderate potential interaction with Seizures.

Therapy with vilazodone should be administered cautiously in patients with epilepsy or a history of seizure disorder.

SIADH

Moderate:

vilazodone

Vilazodone has a moderate potential interaction with SIADH.

Treatment with vilazodone may cause hyponatremia, in many cases secondary to development of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Caution should be used when treating patients with hyponatremia or at greater risk of developing hyponatremia such as elderly patients, patients taking diuretics or those who are volume-depleted.

More resources

Emend for Injection

A total of 471 drugs are known to interact with Emend for Injection.

vilazodone

A total of 453 drugs are known to interact with vilazodone.

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.