Drug interactions
Aprepitant + Dihydroergotamine
Severity: Major
Aprepitant and Dihydroergotamine: 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
Dihydroergotamine is metabolized by CYP3A4, and inhibition can raise its levels and risk of ergotism, including peripheral and cerebral ischemia. Aprepitant is a moderate CYP3A4 inhibitor, so the risk is real though less than with strong inhibitors.
What this interaction means in plain words
Aprepitant and Dihydroergotamine 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.
Aprepitant belongs to Gastrointestinal Tract; Dihydroergotamine belongs to Central Nervous System.
Why it happens
Inhibition of CYP3A4-mediated dihydroergotamine metabolism by aprepitant.
What to do
Avoid the combination where possible and use an alternative antiemetic. If used together, monitor for numbness, coldness of extremities, vasospasm and severe headache.
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
Other interactions of Dihydroergotamine
- Almotriptan + Dihydroergotamine Contraindicated
- Clarithromycin + Dihydroergotamine Contraindicated
- Dihydroergotamine + Dopamine Contraindicated
- Dihydroergotamine + Dronedarone Contraindicated
- Dihydroergotamine + Efavirenz Contraindicated
- Dihydroergotamine + Eletriptan Contraindicated
Frequently asked questions
Can I take Aprepitant with Dihydroergotamine?
MediHelp rates the interaction as major. Aprepitant and Dihydroergotamine 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. Dihydroergotamine is metabolized by CYP3A4, and inhibition can raise its levels and risk of ergotism, including peripheral and cerebral ischemia. Aprepitant is a moderate CYP3A4 inhibitor, so the risk is real though less than with strong inhibitors.
How serious is the interaction between Aprepitant and Dihydroergotamine?
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 the combination where possible and use an alternative antiemetic. If used together, monitor for numbness, coldness of extremities, vasospasm and severe headache.
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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