Nefazodone Methylprednisolone

Drugs that may affect tacrolimus include nephrotoxic agents (aminoglycosides, amphotericin B, cisplatin, cyclosporine), antifungals, bromocriptine, calcium channel blockers, cimetidine, clarithromycin, danazol, diltiazem, erythromycin, methylprednisolone, metoclopramide, carbamazepine, phenobarbital, phenytoin, rifamycins, cisapride, chloramphenicol, metronidazole, nefazodone, omeprazole, protease inhibitors, macrolide antibiotics, fosphenytoin, and St. John s wort. 

Aprepitant (Emend) [Centrally Acting Antiemetic] Uses Pre-vents N/V assoc w/ emetogenic CA chemo (eg, cisplatin) (use in combo w/ other antiemetics) Action Substance P/neurokinin l(NKi) receptor antagonist Dose 125 mg PO day 1, 1 h before chemo, then 80 mg PO qAM days 2 3 Caution [B, /-] Contra Use w/ pimozide, Disp Caps SE Fatigue, asthenia, hiccups Interactions T Effects W/ clarithromycin, diltiazem, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, troleandomycin T effects OF alprazolam, astem-izole, cisapride, dexamethasone, methylprednisolone, midazolam, pimozide, terfe-nadine, triazolam, chemo agents, eg, docetaxel, etoposide, ifosfamide, imatinib, irinotecan, paclitaxel, vinblastine, vincristine, vinorelbine i effects W/ paroxetine,... 

Clinically important, potentially hazardous interactions with alprazolam, astemizole, carbamazepine, cisapride, clarithromycin, dexamethasone, diltiazem, docetaxel, ifosfamide, imatinib, irinotecan, itraconazole, ketoconazole, methylprednisolone, midazolam, nefazodone, oral contraceptives, paroxetine, phenytoin, pimozide, rifampin, ritonavir, terfenadine, tolbutamide, trabectedin, troleandomycin, vinblastine, vincristine, warfarin... 

Nefazodone inhibits the metabolism of methylprednisolone and prolongs its effects on cortisol suppression. 

In healthy subjects, nefazodone for 9 days (initial dose of 100 mg, increased to 150 mg, then 200 mg, twice daily) increased the AUC of a single 0.6-mg/kg intravenous dose of methylprednisolone by twofold and increased its half-life from 2.28 to 3.32 hours. Methylprednisolone clearance was decreased from 28.7 to 14.6 L/hour. The duration of cortisol suppression after methylprednisolone alone was 23.3 hours, which increased to more than 32 hours when nefazodone was also given. ... 

Nefazodone prohahly inhibits methylprednisolone metabolism by cytochrome P450 isoenzyme CYP3A4. ... 

At clinically relevant doses nefazodone decreases methylprednisolone clearance and signifrcantly prolongs methylprednisolone induced cortisol... 

Kotlyar M, Brewer ER, Golding M, Carson SW, Nefazodone inhibits methylprednisolone disposition and enhances its adrenal-suppressant effect, J Clin Psychopharmacol (2003) 23,652-6. 

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