# A woman receiving aprepitant as part of antiemetic prophylaxis for cisplatin chemotherapy uses combined oral contraceptive. Which counseling is most accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391810&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A woman receiving aprepitant as part of antiemetic prophylaxis for cisplatin chemotherapy uses combined oral contraceptive. Which counseling is most accurate?

## Option

1. Aprepitant can diminish oral contraceptive effectiveness for a short period; therefore, employ a barrier method throughout chemotherapy and for one week following the last dose.
2. There is no significant interaction between aprepitant and oral contraceptives, so continue using your current contraceptive without any additional precautions.
3. Aprepitant can cause a prolonged decrease in contraceptive efficacy lasting several months; as a result, you may want to stop oral contraceptives and consider another form of birth control.
4. Aprepitant 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**

**Correct answer: 4**

## 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.
- **CYP3A4 modulation** — Aprepitant inhibits acutely, induces with prolonged use; reduces OC effectiveness.
- **Triple-drug antiemetic regimen** — NK1 + 5-HT3 + dexamethasone for highly emetogenic chemotherapy.

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