Ketoconazole increases the AUC of aprepitant 5-fold. The manufacturer recommends caution when aprepitant is used with ketoconazole or other strong inhibitors of CYP3A4, such as itraconazole. Fosaprepitant, a prodrug of aprepitant, would be expected to interact similarly.
The lowest dose of aprepitant may be appropriate. Counsel patients about adverse effects (e.g. hiccups, fatigue, constipation, headache).
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