Drug interactions
Aprepitant + Dihydroergotamine intranasal
Severity: Major
Aprepitant and Dihydroergotamine intranasal: major interaction.
Last updated Sources: UK SmPC
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Intranasal dihydroergotamine is still absorbed systemically and cleared by CYP3A4, so raised levels from CYP3A4 inhibition can cause ergotism with vasospasm and ischemia. Aprepitant is a moderate CYP3A4 inhibitor, so the risk is meaningful.
What this interaction means in plain words
Aprepitant and Dihydroergotamine intranasal can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Inhibition of CYP3A4-mediated dihydroergotamine metabolism by aprepitant.
What to do
Avoid concurrent use where possible and choose another antiemetic. If unavoidable, monitor for peripheral ischemia and vasospastic symptoms.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Aprepitant
- Aprepitant + Lomitapide Contraindicated
- Aprepitant + Pimozide Contraindicated
- Aprepitant + Avapritinib Major
- Aprepitant + Bosutinib Major
- Aprepitant + Carbamazepine Major
- Aprepitant + Cobicistat Major
Frequently asked questions
Can I take Aprepitant with Dihydroergotamine intranasal?
MediHelp rates the interaction as major. Aprepitant and Dihydroergotamine intranasal can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Intranasal dihydroergotamine is still absorbed systemically and cleared by CYP3A4, so raised levels from CYP3A4 inhibition can cause ergotism with vasospasm and ischemia. Aprepitant is a moderate CYP3A4 inhibitor, so the risk is meaningful.
How serious is the interaction between Aprepitant and Dihydroergotamine intranasal?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid concurrent use where possible and choose another antiemetic. If unavoidable, monitor for peripheral ischemia and vasospastic symptoms.
What other medicines interact with Aprepitant?
MediHelp also lists interactions of Aprepitant with, for example, Lomitapide, Pimozide, Avapritinib. The full list is on the Aprepitant page.
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