Vincristine CYP3A4/5/7 substrate

Aprepitant may be affected by paroxetine, CYP2C9 substrates (eg, phenytoin, tolbutamide, warfarin), CYP3A4 substrates (eg, alprazolam, cisapride, dexamethasone, docetaxel, etoposide, ifosfamide, imatinib, irinotecan, methylprednisolone, midazolam, paclitaxel, pimozide, triazolam, vinblastine, vincristine, vinorelbine), and oral contraceptives. 

Aprepitant is a substrate, a moderate inhibitor, and an inducer of CYP3A4. Aprepitant is also an inducer of CYP2C9. Use aprepitant with caution in patients receiving concomitant medicinal products, including chemotherapy agents that are primarily metabolized through CYP3A4 (docetaxel, paclitaxel, etoposide, irinotecan, ifosfamide, imatinib, vinorelbine, vinblastine, and vincristine). 

VINCRISTINE CICLOSPORIN High doses of cidosporin (7.5-1 Omg/kg per day intravenously) tend to t plasma concentrations of vincristine and t risk of neurotoxicity and musculoskeletal pain Due to a combination, to varying degrees, of inhibition of CYP3A4 metabolism and P-gp inhibition. Vinblastine and vincristine are known substrates of P-gp Monitor for neurotoxicity and myelosuppression. The dose-limiting effect of all is myelosuppression. Monitor blood counts and clinically watch for and ask patients to report infections... 

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