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Drug Interactions between imipramine and rolapitant

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

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Interactions between your drugs

Moderate

imipramine rolapitant

Applies to: imipramine and rolapitant

MONITOR: Coadministration with rolapitant may increase the plasma concentrations of drugs that are substrates of the CYP450 2D6 isoenzyme. Rolapitant is a moderate CYP450 2D6 inhibitor, with inhibitory effect lasting at least 7 days after a single dose. When a 30 mg dose of dextromethorphan, a CYP450 2D6 probe substrate, was administered with a 180 mg dose of rolapitant on day 1 of a pharmacokinetic study, dextromethorphan peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 120% and 160%, respectively. When dextromethorphan was administered on day 8 without rolapitant, Cmax and AUC increased by 180% and 230%, respectively. The duration of CYP450 2D6 inhibition was not studied beyond 7 days and may last longer.

MANAGEMENT: Caution is advised when rolapitant is prescribed with drugs that are significantly metabolized by CYP450 2D6, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for some drugs whenever rolapitant is added to or withdrawn from therapy. Due to the prolonged duration of CYP450 2D6 inhibition by rolapitant, prolonged monitoring for adverse effects of drugs that are substrates of CYP450 2D6 may be required for at least 28 days after administration of rolapitant.

References

  1. (2015) "Product Information. Varubi (rolapitant)." Tesaro Inc.

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Drug and food interactions

Moderate

imipramine food

Applies to: imipramine

GENERALLY AVOID: Concomitant use of ethanol and a tricyclic antidepressant (TCA) may result altered TCA plasma levels and efficacy, and additive impairment of motor skills, especially driving skills. Acute ethanol ingestion may inhibit TCA metabolism, while chronic ingestion of large amounts of ethanol may induce hepatic TCA metabolism.

MANAGEMENT: Patients should be advised to avoid alcohol during TCA therapy. Alcoholics who have undergone detoxification should be monitored for decreased TCA efficacy. Dosage adjustments may be required.

References

  1. Dorian P, Sellers EM, Reed KL, et al. (1983) "Amitriptyline and ethanol: pharmacokinetic and pharmacodynamic interaction." Eur J Clin Pharmacol, 25, p. 325-31
  2. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  3. Sandoz M, Vandel S, Vandel B, Bonin B, Allers G, Volmat R (1983) "Biotransformation of amitriptyline in alcoholic depressive patients." Eur J Clin Pharmacol, 24, p. 615-21
  4. Ciraulo DA, Barnhill JG, Jaffe JH (1988) "Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers." Clin Pharmacol Ther, 43, p. 509-18
  5. Seppala T, Linnoila M, Elonen E, Mattila MJ, Makl M (1975) "Effect of tricyclic antidepressants and alcohol on psychomotor skills related to driving." Clin Pharmacol Ther, 17, p. 515-22
  6. Ciraulo DA, Barnhill JG, Jaffe JH, Ciraulo AM, Tarmey MF (1990) "Intravenous pharmacokinetics of 2-hydroxyimipramine in alcoholics and normal controls." J Stud Alcohol, 51, p. 366-72
  7. Ciraulo DA, Alderson LM, Chapron DJ, Jaffe JH, Subbarao B, Kramer PA (1982) "Imipramine disposition in alcoholics." J Clin Psychopharmacol, 2, p. 2-7
View all 7 references

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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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