APREPITANT AND MACROLIDES

Ketoconazole, a potent CYP3A4 inhibitor, increases the AUC of aprepitant 5-fold. The manufacturer recommends caution when aprepitant is used with any potent inhibitor of CYP3A4, (such as clarithromycin and telithromycin). Fosaprepitant, a prodrug of aprepitant, would also be expected to interact with the macrolides in this way.
The lowest dose of aprepitant may be appropriate. Counsel patients about adverse effects (e.g. hiccups, fatigue, constipation, headache). Other macrolides may also interact, although it seems unlikely that they all will, see macrolides.
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