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Fosaprepitant

    Brands

    DEA Class; Rx

    Common Brand Names; Emend IV

    • NK1 Receptor Antagonists; 
    • Antiemetic Agents

    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

    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)

    Hypersensitivity

    Concomitant pimozide

    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%)

    —

    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

    Adults

    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.

    Geriatric

    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.

    Adolescents

    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.

    Children

    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.

    Infants

    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.

    Fosaprepitant

    injection, powder for reconstitution

    • 150mg/vial