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Posaconazole

Interaction with Aprepitant

Monitor therapy
QT risk: Posaconazole Aprepitant

Effect: Posaconazole may increase the plasma concentrations of aprepitant.

Clinical management: Caution should be exercised upon coadministration of these drugs. Monitor for increased toxicity of aprepitant.

Probable mechanism: Inhibition of the cytochrome P450 (CYP) 3A4-mediated biotransformation by posaconazole.

Summary: Although not studied for posaconazole, coadministration of ketoconazole (400 mg/day for 10 days, a strong CYP3A4-inhibitor) and aprepitant (125 mg single dose on day 5) increased the AUC and half-life of aprepitant by five-fold and three-fold, respectively. Coadministration with the CYP3A4-inhibitor posaconazole could result in similar effects.

References

QT effect

Posaconazole: Conditional QT risk

Substantial evidence reports that this drug causes QT prolongation and has a risk of TdP, but only under certain known conditions (e.g. excessive dose, drug interaction, etc.).

References

Aprepitant: QT risk not available