drug–drug interactions
Drug–drug interactions
of the main antiemetic agents
The most important drug–drug interactions of antiemetics
used in the management of CINV are discussed
Snežana Bošnjak MD PhD
Department of Supportive Oncology,
Institute for Oncology and Radiology
of Serbia, Belgrade, Serbia
Sandra Vezmar Kovacevic
MSc pharm PhD
Department of Pharmacokinetics
and Clinical pharmacy, University
of Belgrade – Faculty of Pharmacy,
Belgrade, Serbia
Chemotherapy-induced nausea
and vomiting (CINV) is a common
and feared side effect of cancer
treatment. CINV occurs acutely
within the first 24 h of treatment
but it may also be delayed and
present after 24–120 h. The
introduction of serotonin (5-HT)
type 3 receptor antagonists (5-
HT3 RAs), neurokinin 1 RAs for
substance P (NK1 RAs), olanzapine
and their concomitant use with
dexamethasone in combined
antiemetic protocols reduced the
incidence of acute and delayed
CINV significantly, especially
after highly and moderately
emetogenic chemotherapy. 1–3
Nevertheless, antiemetic drugs
are also associated with drug–
drug interactions (DDIs), which
occur when the effects of one
drug are modified by the prior
or concurrent administration of
another drug. 4 If the effect of
a drug is antagonised or
potentiated (additively or
synergistically), the interaction
is pharmacodynamic.
Pharmacokinetic DDIs are
characterised by alterations
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