Neurokinin-1 Receptor Antagonist

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
Oral (Emend) post-op Vomiting prophylaxis
1. Adult: 40 mg orally given 3 hours or less prior to Anesthesia
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

Typically administered with 5-HT3 Antagonists and Dexamethasone before Chemotherapy
Take 180 mg orally 1 to 2 hours prior to Chemotherapy

See Akynzeo
Combined 5HT-3 Antagonist (Palonosetron) with the NK1 Antagonist Netupitant
Contraindicated in severe renal disease (including ESRD) and severe hepatic disease
Oral: Take 1 capsule orally one hour before Chemotherapy
IV: Give one injectable vial diluted in 50 ml over 30 min prior to Chemotherapy