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Aprepitant (Emend) significantly increases sirolimus levels in patients undergoing allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 47, pages 291–293 (2012)Cite this article

Aprepitant (Emend, Merck and Co. Inc., Whitehouse Station, NJ, USA) is a potent antagonist of substance P/neurokinin-1 (NK1) receptors effective for treatment of chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy regimens. Even though the role of aprepitant in the context of hematopoietic SCT (HSCT) has not been clearly defined, national antiemetic guidelines recommend addition of this drug to standard antiemetic regimens.1, 2 Aprepitant is both a substrate and a moderate inhibitor of human cytochrome P450 (CYP450), specifically CYP3A4. Use of aprepitant in the context of SCT presents multiple opportunities for drug interactions.3, 4

Sirolimus and tacrolimus are immunosuppressive agents used for prevention of GVHD5, 6 that are also substrates for CYP3A4 isoenzyme and P-glycoprotein.7, 8 Drugs known to inhibit CYP3A4, such as aprepitant, have the potential to increase the bioavailability of these two agents, leading to overt toxicity.

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Acknowledgements

We acknowledge our transplant coordinators and transplant nurses for their dedicated care of our patients, and all the members of the Hematopoietic Cell Transplant Team for their constant support of the program. We also thank clinical research associates and statistical assistants for their support on data management and collections. We also thank Dr Sandra Thomas for her critical reading of the manuscript.

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Authors and Affiliations

  1. Department of Pharmacy, City of Hope, Duarte, CA, USA

    S Shayani, H Chan & S Keuylian

  2. Division of Biostatistics, City of Hope, Duarte, CA, USA

    J M Palmer & T Stiller

  3. Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA

    P Parker, S Thomas, V Pullarkat, A Nademanee, S J Forman & R Nakamura

Authors
  1. S Shayani
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  2. J M Palmer
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  9. A Nademanee
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  11. R Nakamura
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Correspondence to R Nakamura.

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Shayani, S., Palmer, J., Stiller, T. et al. Aprepitant (Emend) significantly increases sirolimus levels in patients undergoing allogeneic hematopoietic SCT. Bone Marrow Transplant 47, 291–293 (2012). https://doi.org/10.1038/bmt.2011.42

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