Recommendations and considerations for drug interactions1

Drug interactions* with AKYNZEO®

Agents Interaction Exposure Recommendation/consideration
Dexamethasone Yes Dexamethasone Lower dexamethasone dosage
Midazolam Yes Midazolam or other benzodiazepines Consider potential effects of increased plasma concentrations
Chemotherapeutic agents metabolized by CYP3A4 Yes Agents include docetaxel, paclitaxel, etoposide, irinotecan, cyclophosphamide, ifosfamide, imatinib, vinorelbine, vinblastine, and vincristine Caution and careful monitoring
Strong CYP3A4 inducers (eg, rifampin) Yes AKYNZEO Avoid use with AKYNZEO
Strong CYP3A4 inhibitors (eg, ketoconazole) Yes AKYNZEO No dosage adjustment for a single dose of AKYNZEO
CYP3A4 substrates Yes CYP3A4 substrate Avoid use with AKYNZEO for 1 week if feasible. If not, consider dose reduction of CYP3A4 substrates
Serotonergic drugs Yes Potential for serotonin syndrome Caution and careful monitoring for symptoms of serotonin syndrome
If symptoms occur, discontinue AKYNZEO and initiate supportive treatment
Oral contraceptives No
CYP2C9 substrates (eg, warfarin) Not studied–predicted not to substantially increase exposure Monitor INR and adjust dosage as needed to maintain target INR range
  • CINV=chemotherapy-induced nausea and vomiting; INR=international normalized ratio.
  • *Drug interactions shown here are based on in vitro or in vivo studies of AKYNZEO Capsules, netupitant, fosnetupitant, or palonosetron. Please see the full Prescribing Information for AKYNZEO for data supporting these recommendations.