title: Effect of netupitant, a highly selective NK₁ receptor antagonist, on the pharmacokinetics of palonosetron and impact of the fixed dose combination of netupitant and palonosetron when coadministered with ketoconazole, rifampicin, and oral contraceptives.
abstract: OBJECTIVE
  Neurokinin-1 receptor antagonists (NK1 RAs) are commonly coadministered with a 5-HT3 RA such as palonosetron to prevent nausea and vomiting induced by chemotherapy. Netupitant, a new highly selective NK1 RA, is both a substrate for and a moderate inhibitor of CYP3A4. Three studies were designed to evaluate the potential drug-drug interaction of netupitant with palonosetron and of the fixed dose combination of netupitant and palonosetron, NEPA, with an inhibitor (ketoconazole), an inducer (rifampicin) and a substrate (oral contraceptives) of CYP3A4.
  
  
  METHODS
  Study 1 was a three-way crossover in 18 healthy subjects receiving netupitant alone, palonosetron alone, and the combination of both antiemetics. Studies 2 and 3 were two-way crossover trials where healthy subjects received NEPA (the fixed dose combination of netupitant and palonosetron). In study 2, 36 subjects received NEPA alone (day 1) and in combination with ketoconazole or rifampicin. In study 3, 24 healthy women received ethinylestradiol/levonorgestrel alone or in combination with NEPA (day 1).
  
  
  RESULTS
  There were no significant pharmacokinetic interactions between netupitant and palonosetron. Ketoconazole increased netupitant area under curve (AUC) by 140 % and C max by 25 %. Rifampicin decreased netupitant AUC by 83 % and C max by 62 %. NEPA did not significantly affect exposure to ethinylestradiol, while systemic exposure to levonorgestrel increased by 40 %, but this was not considered clinically relevant.
  
  
  CONCLUSIONS
  There were no clinically relevant interactions between netupitant and palonosetron, or between NEPA and oral contraceptives. The coadministration of NEPA with inhibitors or inducers of CYP3A4 may require dose adjustments. Treatments were well tolerated.
authors.affiliation: Corporate Clinical Development, Helsinn Healthcare, SA, Lugano, Switzerland, sca@helsinn.com.
authors.forename: Selma
authors.initials: S
authors.lastname: Calcagnile
authors.forename: Corinna
authors.initials: C
authors.lastname: Lanzarotti
authors.forename: Giorgia
authors.initials: G
authors.lastname: Rossi
authors.forename: Anders
authors.initials: A
authors.lastname: Henriksson
authors.forename: Klaus Peter
authors.initials: KP
authors.lastname: Kammerer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Timmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D019540:Area Under Curve; D003276:Contraceptives, Oral / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D018592:Cross-Over Studies; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007546:Isoquinolines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D007654:Ketoconazole / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D008875:Middle Aged; D064729:Neurokinin-1 Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D000077924:Palonosetron; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D011812:Quinuclidines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D016032:Randomized Controlled Trials as Topic; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D055815:Young Adult; D010879:Piperazines; D044482:Benzeneacetamides
chemical_list: D000932:Antiemetics; D003276:Contraceptives, Oral; D007546:Isoquinolines; D007654:Ketoconazole; D064729:Neurokinin-1 Receptor Antagonists; D000077924:Palonosetron; D011725:Pyridines; D011812:Quinuclidines; D012293:Rifampin; C508854:netupitant; D010879:Piperazines; D044482:Benzeneacetamides