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Aprepitant and fosaprepitant drug interactions: a systematic review
Priya Patel1,2, J Steven Leeder3,4, Micheline Piquette-Miller1
1Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
British Journal of Clinical Pharmacology
|May 5, 2017
Summary
Aprepitant and fosaprepitant can cause significant drug interactions, affecting chemotherapy side effect management. Healthcare providers should consider these interactions when prescribing antiemetic therapy to ensure patient safety.
Area of Science:
- Pharmacology
- Oncology
- Clinical Pharmacy
Background:
- Aprepitant and fosaprepitant are widely used to prevent chemotherapy-induced nausea and vomiting.
- These antiemetics are known to affect cytochrome P450 enzyme activity.
- Altered cytochrome P450 activity can lead to significant drug-drug interactions.
Purpose of the Study:
- To systematically review and evaluate clinically significant pharmacokinetic drug interactions involving aprepitant and fosaprepitant.
- To describe adverse events associated with drug interactions involving these antiemetics.
Main Methods:
- A systematic literature review was conducted up to September 11, 2016.
- Pharmacokinetic drug interactions were assessed for clinical significance using FDA guidance.
- Adverse events were evaluated for probability of being due to drug interactions using the Drug Interaction Probability Scale.
Main Results:
- 64 publications met the inclusion criteria from 4377 identified articles.
- Clinically significant pharmacokinetic interactions were identified with several drugs, including bosutinib, cabazitaxel, cyclophosphamide, dexamethasone, methylprednisolone, midazolam, oxycodone, and tolbutamide.
- Adverse events were linked to interactions with alcohol, anthracyclines, ifosfamide, oxycodone, quetiapine, SSRIs/SNRIs, and warfarin.
Conclusions:
- The potential for drug interactions with aprepitant and fosaprepitant is clinically relevant.
- Consideration of these drug interactions is crucial when selecting antiemetic regimens for patients undergoing chemotherapy.
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