Aprepitant

Prevention of Nausea, Vomiting with highly emetogenic Chemotherapy
1. Typically used in combination with 5-HT3 Antagonists and Dexamethasone 20 mg daily

Blocks the neurokinin-1 receptor (a tachykinin)
Cross the blood brain barrier to inhibit CNS substance-P activity
Effects
1. Antiemetic (synergistic with 5-HT3 Antagonists)
2. Anxiolysis and Antidepressant properties

Typically administered with 5-HT3 Antagonists and Dexamethasone before Chemotherapy
Oral (Emend) before Chemotherapy
1. Adult: 125 mg orally 1 hour before Chemotherapy, then 80 mg orally daily in AM on days 2 and 3
2. Child (age >6 months): 3 mg/kg (up to 125 mg), then 2 mg/kg (up to 80 mg) orally daily in AM on days 2 and 3
IV before Chemotherapy
1. Fosaprepitant (Aprepitant prodrug)
  1. Adult: 150 mg infused over 20 to 30 minutes
  2. Child: 3 mg/kg (up to 125 mg) IV over 20 to 30 minutes, followed by oral Emend on days 2, 3 (see dose above)
2. Cinvanti
  1. Adult: 130 mg IV over 2 minutes (or infused over 30 min) OR 100 mg IV followed by oral Emend on days 2, 3

Consider with Dexamethasone prior to neurosurgery
Post-op Vomiting prophylaxis
1. Oral (Emend): 40 mg orally given 3 hours or less prior to Anesthesia
2. IV (Aponvie): 32 mg IV at Anesthesia induction

May affect drugs metabolized by CYP3A4
CYP2C9 Inducer
Pimozide
1. Avoid with NK1 Receptor Antagonist
Oral Contraceptives (OCP)
1. Aprepitant may reduce OCP efficacy (use second form of Contraception)
Warfarin
1. Aprepitant may affect INR