Drug interactions
Pitolisant + Rolapitant
Severity: Major
Pitolisant and Rolapitant: major interaction.
Last updated
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
Pitolisant is metabolized by CYP2D6, and rolapitant's strong inhibition can substantially raise its exposure. This increases the risk of QT prolongation and other adverse effects.
What this interaction means in plain words
Pitolisant and Rolapitant 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.
Pitolisant belongs to Central Nervous System; Rolapitant belongs to Gastrointestinal Tract.
Why it happens
Inhibition of CYP2D6 by rolapitant decreases pitolisant metabolism.
What to do
Halve the pitolisant dose when rolapitant is started, or begin at the reduced dose per labeling, with a maximum of 17.8 mg/day. Monitor ECG and adverse effects, remembering the inhibition lasts for weeks.
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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Other interactions of Rolapitant
- Pimozide + Rolapitant Contraindicated
- Rolapitant + Thioridazine Contraindicated
- Atomoxetine + Rolapitant Major
- Deutetrabenazine + Rolapitant Major
- Eliglustat + Rolapitant Major
- Flecainide + Rolapitant Major
Other interactions of Pitolisant
- Alfuzosin + Pitolisant Major
- Amiodarone + Pitolisant Major
- Amisulpride + Pitolisant Major
- Anagrelide + Pitolisant Major
- Asenapine + Pitolisant Major
- Bupropion + Pitolisant Major
Frequently asked questions
Can I take Pitolisant with Rolapitant?
MediHelp rates the interaction as major. Pitolisant and Rolapitant 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. Pitolisant is metabolized by CYP2D6, and rolapitant's strong inhibition can substantially raise its exposure. This increases the risk of QT prolongation and other adverse effects.
How serious is the interaction between Pitolisant and Rolapitant?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Halve the pitolisant dose when rolapitant is started, or begin at the reduced dose per labeling, with a maximum of 17.8 mg/day. Monitor ECG and adverse effects, remembering the inhibition lasts for weeks.
What other medicines interact with Rolapitant?
MediHelp also lists interactions of Rolapitant with, for example, Pimozide, Thioridazine, Atomoxetine. The full list is on the Rolapitant page.
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