Nightmares and hallucinations with aprepitant and opium powder: a suspected drug–drug interaction

• Published in: British journal of clinical pharmacology Vol. 85; no. 2; pp. 454 - 456
• Main Authors: Narjoux, Grégoire, Clarenne, Justine, Azzouz, Brahim, Zeller, Pauline‐Saraï, Slimano, Florian, Bouché, Olivier
• Format: Journal Article
• Language: English
• Published: England Wiley 01.02.2019; John Wiley and Sons Inc
• Subjects: Adenocarcinoma - drug therapy; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - adverse effects; aprepitant; Aprepitant - pharmacology; Aprepitant - therapeutic use; Arthralgia - drug therapy; Camptothecin - adverse effects; Camptothecin - analogs & derivatives; Case Report; Dreams - drug effects; Drug Interactions; drug–drug interaction; Fluorouracil - adverse effects; Hallucinations - chemically induced; Humans; irinotecan; Leucovorin - adverse effects; Life Sciences; Male; Nausea - chemically induced; Nausea - prevention & control; OCT1; Opium - pharmacology; Opium - therapeutic use; opium powder; Pharmaceutical sciences; Pharmacology; Polypharmacy; Powders; Sigmoid Neoplasms - drug therapy; UGT2B7; aprepitant; irinotecan; opium powder; OCT1; drug-drug interaction; UGT2B7
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1111/bcp.13810

Polypharmacy of elderly oncology patients and fragmented medication management are well‐known risk factors for drug–drug interactions (DDIs). These interactions can occur among antineoplastic, ongoing chronic treatment(s) and chemotherapy‐associated treatments, like antiemetics. Clinically relevant interactions based on enzyme‐ or transporter‐inhibition phenomena of active drugs can increase the frequency of their DDIs. We describe a strongly suspected elderly cancer patient's DDI between aprepitant and opium powder in the context of an irinotecan‐based regimen manifested by nightmares and visual hallucinations. We discuss this DDI's hypothetical pharmacological mechanisms and management.