evention of chemotherapy-induced nausea and vomiting is contraindicated because the risk of QT prolongation is higher with the doses required for this indication; when the injection is used at lower doses (i.e., those approved for post-operative nausea and vomiting) or when the oral formulation is used, the risk of QT prolongation is lower and caution is advised. Asenapine has been associated with QT prolongation. According to the manufacturer of asenapine, the drug should be avoided in combination with other agents also known to have this effect.
Aspirin, ASA; Oxycodone: Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor antagonists. Symptoms may occur hours to days after concomitant use, particularly after dose increases. Serotonin syndrome may occur within recommended dose ranges. If concomitant treatment is clinically warranted, careful observation of the patient is advised, especially during initiation of the second therapy and after dosage increases of either agent. Instruct patients to immediately report symptoms of agitation, hallucinations, tachycardia, fever, excessive sweating, shivering or shaking, muscle twitching or stiffness, trouble with coordination, nausea, vomiting, or diarrhea.
Atazanavir: Due to a possible risk for QT prolongation and torsade de pointes (TdP), dolasetron and atazanavir should be used together cautiously. Dolasetron has been associated with a dose-dependant prolongation in the QT, PR, and QRS intervals on an electrocardiogram. Therefore, drugs known to prolong the PR interval should be avoided in patients taking dolasetron. Dolasetron is metabolized by CYP3A4. Caution should be used in patients receiving atazanavir concurrently with drugs metabolized via CYP3A4 and known to cause QT prolongation. Atazanavir inhibits the CYP3A4 isoenzyme at clinically relevant concentrations, which may lead to increased serum concentrations of dolasetron and an increased potential for QT prolongation or other adverse effects. Serious and/or life-threatening drug interactions could potentially occur. Downward dosage adjustment of dolasetron may be necessary.
Atazanavir; Cobicistat: Due to a possible risk for QT prolongation and torsade de pointes (TdP), dolasetron and atazanavir should be used together cautiously. Dolasetron has been associated with a dose-dependant prolongation in the QT, PR, and QRS intervals on an electrocardiogram. Therefore, drugs known to prolong the PR interval should be avoided in patients taking dolasetron. Dolasetron is metabolized by CYP3A4. Caution should be used in patients receiving atazanavir concurrently with drugs metabolized via CYP3A4 and known to cause QT prolongation. Atazanavir inhibits the CYP3A4 isoenzyme at clinically relevant concentrations, which may lead to increased serum concentrations of dolasetron and an increased potential for QT prolongation or other adverse effects. Serious and/or life-threatening drug interactions could potentially occur. Downward dosage adjustment of dolasetron may be necessary. The plasma concentrations of hydrodolasetron (primary dolasetron metabolite) may be elevated when dolasetron is administered concurrently with cobicistat. Clinical monitoring for adverse effects, such as headache or cardiovascular effects, is recommended during coadministration. Cobicistat is a CYP3A4 and CYP2D6 inhibitor, while hydrodolasetron is a CYP3A4 and CYP2D6 substrate. |
