Classes
DEA Class; Rx
Common Brand Names; Emend IV
- NK1 Receptor Antagonists;
- Antiemetic Agents
Description
Selective substance P (NK1) antagonist, fosaprepitant is prodrug of aprepitant
Used for prevention of chemotherapy-induced nausea/vomiting (CINV) due to highly and moderately emetogenic regimens; IV aprepitant (Aponvie) used for prevention of post-operative nausea/voming (PONV)
For CINV use with in combination with a 5HT3 antagonist and a corticosteroid: oral aprepitant is a 3-day regimen; IV aprepitant or IV fosaprepitant are given as a single dose
Indications
Indicated for chemotherapy-induced nausea/vomiting prophylaxis (CINV prophylaxis).
Indicated in combination with other antiemetic agents for prevention of
- Acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy (HEC) including high-dose cisplatin
- Delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy (MEC)
Contraindications
Hypersensitivity
Concomitant pimozide
Adverse Effects
In an active-controlled clinical trial in patients receiving MEC, incidence of adverse effects of aprepitant (plus ondansetron and dexamethasone) were similar to ondansetron and dexamethasone alone
- Chemotherapy likely contributes to most of the following adverse effects
- Fatigue (15%)
- Diarrhea (13%)
- Neutropenia (8%)
- Asthenia (4%)
- 1-10%
- Neutropenia (8%)
- Asthenia (4%)
- Anemia (3%)
- Peripheral neuropathy (3%)
- Infusion-site reactions (2.2%); standard therapy (0.6%)
- Leukopenia (2%)
- Dyspepsia (2%)
- UTI (2%)
- Pain in extremity (2%)
Warnings
—
Pregnancy and Lactation
Data are Insufficient on use in pregnant females to inform of drug associated risk
Unknown if excreted in milk
Determine whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother
Maximum Dosage
125 mg/day PO (Day 1) and 80 mg/day PO (Days 2 and 3); 150 mg/day fosaprepitant IV (Day 1) (Emend products).
130 mg/day aprepitant IV emulsion (Cinvanti) (Day 1) for CINV prophylaxis.
32 mg/day aprepitant IV emulsion (Aponvie) for PONV prophylaxis.
125 mg/day PO (Day 1) and 80 mg/day PO (Days 2 and 3); 150 mg/day fosaprepitant IV (Day 1) (Emend products).
130 mg/day aprepitant IV emulsion (Cinvanti) (Day 1) for CINV prophylaxis.
32 mg/day aprepitant IV emulsion (Aponvie) for PONV prophylaxis.
125 mg/day PO (Day 1) and 80 mg/day PO (Days 2 and 3); 150 mg/day fosaprepitant IV (Day 1) for a single-dose CINV regimen; 115 mg/day fosaprepitant IV (Day 1) for a multiple-dose CINV regimen; safety and efficacy of the IV aprepitant emulsion have not been established.
12 years: 125 mg/day PO (Day 1) and 80 mg/day PO (Days 2 and 3); 150 mg/day fosaprepitant IV (Day 1) for a single-dose CINV regimen; 115 mg/day fosaprepitant IV (Day 1) for a multiple-dose CINV regimen; safety and efficacy of the IV aprepitant emulsion have not been established.
2 to 11 years: 3 mg/kg/day PO (Max: 125 mg/day – Day 1) and 2 mg/kg/day PO (Max: 80 mg/day – Days 2 and 3); 4 mg/kg/day fosaprepitant IV (Max: 150 mg/day – Day 1) for a single-dose CINV regimen; 3 mg/kg/day fosaprepitant IV (Max: 115 mg/day – Day 1) for a multiple-dose CINV regimen; safety and efficacy of the IV aprepitant emulsion have not been established.
1 year: 3 mg/kg/day PO (Max: 125 mg/day – Day 1) and 2 mg/kg/day PO (Max: 80 mg/day – Days 2 and 3); 5 mg/kg/day fosaprepitant IV (Max: 150 mg/day – Day 1) for a single-dose CINV regimen; 3 mg/kg/day fosaprepitant IV (Max: 115 mg/day – Day 1) for a multiple-dose CINV regimen; safety and efficacy of the IV aprepitant emulsion have not been established.
6 to 11 months: 3 mg/kg/day PO (Day 1) and 2 mg/kg/day PO (Days 2 and 3); 5 mg/kg/day fosaprepitant IV (Day 1) for a single-dose CINV regimen; 3 mg/kg/day fosaprepitant IV (Day 1) for a multiple-dose CINV regimen; safety and efficacy of the IV aprepitant emulsion have not been established.
1 to 5 months: Safety and efficacy have not been established for any dosage form.
How supplied
Fosaprepitant
injection, powder for reconstitution
- 150mg/vial
