APREPITANT AND PROTEASE INHIBITORS

Ketoconazole increases the AUC of aprepitant 5-fold. The manufacturer recommends caution when aprepitant is used with any potent inhibitor of CYP3A4, such as the protease inhibitors ritonavir and nelfinavir. Fosaprepitant, a prodrug of aprepitant, would also be expected to interact with the protease inhibitors in this way.
The lowest dose of aprepitant may be appropriate. Counsel patients about adverse effects (e.g. hiccups, fatigue, constipation, headache).