A woman receiving aprepitant as part of antiemetic prophylax… | MyMerci
Medical EmergenciesPA
Question
A woman receiving aprepitant as part of antiemetic prophylaxis for cisplatin chemotherapy uses combined oral contraceptive. Which counseling is most accurate?
1Take both medications at exactly the same time daily
2No interaction expected; continue OC alone
3Discontinue OC permanently
4Aprepitant inhibits CYP3A4 short term but also reduces OC efficacy via enzyme induction; use a non-hormonal or backup method during therapy and for 1 month afterward✓ Correct answer
Explanation
Correct (2): Aprepitant has dose-dependent CYP3A4 modulation — modest inhibition acutely, induction over time — that reduces hormonal contraceptive efficacy. A backup non-hormonal method is advised during and 1 month after. (1) Real interaction. (3) Permanent discontinuation unnecessary. (4) Timing does not solve metabolism issue.
In-depth explanation
Memory Tip NK1 antagonist (aprepitant·fosaprepitant·rolapitant) = "NK1 = No-Konfidence in OC." Counsel about backup contraception in any female of reproductive age.
Clinical scenario
Scenario 34-year-old female on aprepitant for cisplatin-induced nausea prophylaxis. Uses combined OC. Discussing interactions.
Key concepts
NK1 receptor antagonist — Aprepitant, fosaprepitant, rolapitant; substance P inhibition for chemotherapy-induced nausea.