APREPITANT AND CORTICOSTEROIDS

In the short-term, aprepitant increases the AUC of dexamethasone (by about 60%) and methylprednisolone (by up to 2.5-fold). Fosaprepitant, a prodrug of aprepitant, would be expected to interact similarly.
The manufacturer recommends that the usual dose of dexamethasone should be reduced by about 50% when given with aprepitant. In clinical studies a dexamethasone regimen of 12 mg on day one and 8 mg on days 2 to 4 was used, and this is the recommended regimen. They also recommend that the usual dose of intravenous methylprednisolone is reduced by 25%, and the usual oral dose by 50%, in the presence of aprepitant. However, the manufacturer also notes that during continuous treatment with methylprednisolone, levels would be expected to decrease over the following 2 weeks.
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