Adult Dosing
Prevention of Nausea and Vomiting Associated with Highly Emetogenic Chemotherapy (HEC)
Single Dose
- Day 1: 150 mg IV over 20-30 minutes, initiated 30 minutes prior to chemotherapy treatment. Use with corticosteriod and 5-HT3 antagonist in moderate to high emetogenic chemotherapy
- Day 2-3: Convert to oral formulation (aprepitant) at 80 mg PO qam
3-Day Dose
- Day 1: 115 mg IV over 15 minutes, initiated 30 minutes prior to chemotherapy. Use with corticosteriod and 5-HT3 antagonist in moderate to high emetogenic chemotherapy
- Day 2-3: Convert to oral formulation (aprepitant) at 80 mg PO qam
Prevention of Nausea and Vomiting Associated with Moderately Emetogenic Chemotherapy (MEC)
- Day 1: 115 mg IV over 15 minutes, initiated 30 minutes prior to chemotherapy. Use with corticosteriod and 5-HT3 antagonist in moderate to high emetogenic chemotherapy
- Day 2-3: Convert to oral formulation (aprepitant) at 80 mg PO qam
- Note: Administer with corticosteroid and 5-HT3 antagonist if patient is taking moderate-highly emetogenic chemotherapy
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
See Supplemental Patient Information
- Dose-dependent inhibitor of CYP3A4; use with caution in patients receiving concomitant medications metabolized through CYP3A4
- Immediate hypersensitivity reactions including flushing, erythema, dyspnea, and anaphylaxis have occurred during infusion. Patients have generally responded to discontinuation; not recommended to reinitiate the infusion in patients who experience these symptoms during first- time use
- Coadministration with warfarin may result in significant decrease in International Normalized Ratio (INR) of prothrombin time
- Monitor patient for antiemetic efficacy
- Not recommended for chronic continuous administration
- Avoid coadministration of other antiemetics
- May reduce efficacy of hormonal contraceptives; advise patients to use alternative or back-up methods of contraception during treatment
Cautions: Use cautiously in
- Severe hepatic impairment
- Concurrent use with any agents metabolized by CYP3A4
Supplemental Patient Information
- Instruct patients to stop using fosaprepitant and contact their doctor right away if they experience an allergic reaction
- Patients on chronic warfarin therapy should be instructed to have their clotting status closely monitored in the 2-week period, particularly at 7-10 days, following initiation of fosaprepitant with each chemotherapy cycle
- Advise patients to use alternative or back-up methods of contraception during treatment as administration of fosaprepitant may reduce the efficacy of hormonal contraceptives
Pregnancy Category:B
Breastfeeding: Safety Unknown; excreted in the milk of rats; because of the potential for possible serious adverse reactions in nursing infants a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
