fosaprepitant

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion*	24 hr

Drug-drug:

May significantly ↑ levels of pimozide, which can ↑ risk of torsades de pointes; concurrent use contraindicated.
May ↑ levels and risk of toxicity of CYP3A4 substrates, including docetaxel, paclitaxel, etoposide, irinotecan, ifosfamide, imatinib, vinorelbine, vinblastine, vincristine, midazolam, triazolam, and alprazolam; concurrent use should be undertaken with caution.
Moderate or strong CYP3A4 inhibitors, including ketoconazole, itraconazole, nefazodone, clarithromycin, ritonavir, nelfinavir, and diltiazem, may ↑ levels and risk of toxicity.
Strong CYP3A4 inducers, including rifampin, carbamazepine, and phenytoin, may ↓ levels and effectiveness.
↑levels and risk of toxicity of dexamethasone (regimen reflects a 50% dose ↓); a similar effect occurs with methylprednisolone (↓ IV dose by 25%, ↓ PO dose by 50% when used concurrently).
May ↓ the effects of warfarin (carefully monitor INR for 2 wk), oral contraceptives (use alternate method), and phenytoin.

Route/Dosage ⬆ ⬇

Prevention of Acute and Delayed Nausea and Vomiting Associated with Highly Emetogenic Chemotherapy

IV (Adults ): Emend or Focinvez: 150 mg given 30 min prior to chemotherapy on Day 1 only.
IV (Children 12–17 yr and ≥6 kg): Single-day chemotherapy regimen (Emend or Focinvez): 150 mg given 30 min prior to chemotherapy on Day 1 only; Multiday chemotherapy regimen (Emend): 115 mg given 30 min prior to chemotherapy on Day 1, then 80 mg once daily (as IV fosaprepitant or aprepitant oral capsules) for 2 days (Days 2 and 3); Multiday chemotherapy regimen (Focinvez): 115 mg given 30 min prior to chemotherapy on Day 1, then 80 mg once daily (as aprepitant oral capsules) for 2 days (Days 2 and 3).
IV (Children 2–<12 yr and ≥6 kg): Single-day chemotherapy regimen (Emend or Focinvez): 4 mg/kg (max dose = 150 mg) given 30 min prior to chemotherapy on Day 1 only; Multiday chemotherapy regimen (Emend): 3 mg/kg (max dose = 115 mg) given 30 min prior to chemotherapy on Day 1, then 2 mg/kg (max dose = 80 mg) (as IV fosaprepitant or aprepitant oral suspension) once daily for 2 days (Days 2 and 3); Multiday chemotherapy regimen (Focinvez): 3 mg/kg (max dose = 115 mg) given 30 min prior to chemotherapy on Day 1, then 2 mg/kg (max dose = 80 mg) (as aprepitant oral suspension) once daily for 2 days (Days 2 and 3).
IV (Children 6 mo-<2 yr and ≥6 kg): Single-day chemotherapy regimen (Emend or Focinvez): 5 mg/kg (max dose = 150 mg) given 30 min prior to chemotherapy on Day 1 only; Multiday chemotherapy regimen (Emend): 3 mg/kg (max dose = 115 mg) given 30 min prior to chemotherapy on Day 1, then 2 mg/kg (max dose = 80 mg) (as IV fosaprepitant or aprepitant oral suspension) once daily for 2 days (Days 2 and 3); Multiday chemotherapy regimen (Focinvez): 3 mg/kg (max dose = 115 mg) given 30 min prior to chemotherapy on Day 1, then 2 mg/kg (max dose = 80 mg) (as aprepitant oral suspension) once daily for 2 days (Days 2 and 3).

Prevention of Delayed Nausea and Vomiting Associated with Moderately Emetogenic Chemotherapy

IV (Adults ): Emend or Focinvez: 150 mg given 30 min prior to chemotherapy on Day 1 only.
IV (Children 12–17 yr and ≥6 kg): Single-day chemotherapy regimen (Emend or Focinvez): 150 mg given 30 min prior to chemotherapy on Day 1 only; Multiday chemotherapy regimen (Emend): 115 mg given 30 min prior to chemotherapy on Day 1, then 80 mg (as IV fosaprepitant or aprepitant oral capsules) once daily for 2 days (Days 2 and 3); Multiday chemotherapy regimen (Focinvez): 115 mg given 30 min prior to chemotherapy on Day 1, then 80 mg (as aprepitant oral capsules) once daily for 2 days (Days 2 and 3).
IV (Children 2–<12 yr and ≥6 kg): Single-day chemotherapy regimen (Emend or Focinvez): 4 mg/kg (max dose = 150 mg) given 30 min prior to chemotherapy on Day 1 only; Multiday chemotherapy regimen (Emend): 3 mg/kg (max dose = 115 mg) given 30 min prior to chemotherapy on Day 1, then 2 mg/kg (max dose = 80 mg) (as IV fosaprepitant or aprepitant oral suspension) once daily for 2 days (Days 2 and 3); Multiday chemotherapy regimen (Focinvez): 3 mg/kg (max dose = 115 mg) given 30 min prior to chemotherapy on Day 1, then 2 mg/kg (max dose = 80 mg) (as aprepitant oral suspension) once daily for 2 days (Days 2 and 3).
IV (Children 6 mo-<2 yr and ≥6 kg): Single-day chemotherapy regimen (Emend or Focinvez): 5 mg/kg (max dose = 150 mg) given 30 min prior to chemotherapy on Day 1 only; Multiday chemotherapy regimen (Emend): 3 mg/kg (max dose = 115 mg) given 30 min prior to chemotherapy on Day 1, then 2 mg/kg (max dose = 80 mg) (as IV fosaprepitant or aprepitant oral suspension) once daily for 2 days (Days 2 and 3); Multiday chemotherapy regimen (Focinvez): 3 mg/kg (max dose = 115 mg) given 30 min prior to chemotherapy on Day 1, then 2 mg/kg (max dose = 80 mg) (as aprepitant oral suspension) once daily for 2 days (Days 2 and 3).

Availability ⬆ ⬇

(Generic available)

Lyophilized powder for injection (Emend): 150 mg/vial
Solution for injection (Focinvez): 3 mg/mL

Assessment ⬆ ⬇

Assess nausea, vomiting, appetite, bowel sounds, and abdominal pain prior to and following administration.
Monitor hydration, nutritional status, and intake and output. Patients with severe nausea and vomiting may require IV fluids in addition to antiemetics.
Assess for rash periodically during therapy. May cause SJS. Discontinue therapy if severe rash or if rash accompanied by fever, general malaise, fatigue, muscle or joint aches, blisters, skin peeling, sores, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia occurs.
Monitor for signs and symptoms of infusion site reaction (erythema, edema, pain, thrombophlebitis). Treat symptomatically.
Monitor for signs and symptoms of hypersensitivity reactions (flushing, erythema, dyspnea, hypotension, syncope) periodically during therapy. If symptoms occur, discontinue therapy and treat symptoms; do not reinitiate therapy if symptoms occur with first use.

Lab Test Considerations:

May cause mild, transient ↑ in alkaline phosphatase, AST, ALT, and BUN.
- May cause proteinuria, erythrocyturia, leukocyturia, hyperglycemia, hyponatremia, and ↑ leukocytes.
- May cause ↓ hemoglobin and WBC.

Implementation ⬆ ⬇

For chemotherapy, fosaprepitant is given as part of a regimen that includes a corticosteroid and a 5-HT₃ antagonist.

IV Administration:

Intermittent Infusion: Emend: Inject 5 mL of 0.9% NaCl for injection into vial. Swirl gently; avoid shaking or jetting saline into vial. Diluent: Prepare an infusion bag of 145 mL 0.9% NaCl. Withdraw entire volume from vial, and transfer to infusion bag for a total volume of 150 mL. Concentration: 1 mg/mL. Gently invert bag 2–3 times. Solution is stable for 24 hr at room temperature. Inspect solution for particulate matter. Do not administer solutions that are discolored or contain particulate matter.
Focinvez
Bring to room temperature if refrigerated. Determine volume to be administered from the ready-to-use vial based on appropriate dose. Administer the entire vial (50 mL) to adults. For ≥12 yr, calculate volume as follows:mL to administer = recommended dose (mg) / 3 (mg/mL). For 6 mo–<12 yr, calculate volume as follows:mL to administer = recommended dose (mg/kg) x weight (kg) / 3 (mg/mL). Discard any unused portion.Concentration: 3 mg/mL.Vial may be inverted and hung from IV pole. Do not administer if solution is discolored, cloudy, or contains particulate matter. Solution is stable for 24 hr at room temperature.
Rate: Emend: Infuse over 20–30 min, 30 min prior to chemotherapy.
Focinvez
Infuse over 20–30 min (≥18 yr); 30 min (12–17 yr); or 60 min (6 mo–<12 yr), 30 min prior to chemotherapy.
Incompatible with solutions containing divalent cations (calcium, magnesium) including LR.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take fosaprepitant as directed. Direct patient to read the Patient Package Insert before starting therapy and each time Rx renewed in case of changes.
Instruct patient to notify health care professional if nausea and vomiting occur prior to administration.
Advise patient to notify health care professional immediately if symptoms of hypersensitivity reaction (hives, rash, itching, redness of the face/skin, difficulty in breathing or swallowing) occur.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Advise patient and family to use general measures to decrease nausea (begin with sips of liquids and small, nongreasy meals; provide oral hygiene; remove noxious stimuli from environment).
Rep: Caution patient that fosaprepitant may decrease effectiveness of oral contraceptives. Advise patient to use alternate nonhormonal methods of contraception during and for 1 mo following treatment. Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes ⬆ ⬇

Decreased nausea and vomiting associated with chemotherapy.
Prevention of postoperative nausea and vomiting.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

0591- Actavis Pharma, Inc.
- 0591-4385- Fosaprepitant
  - 0591-4385-79- 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 CARTON (0591-4385-79)

43598- Dr. Reddy's Laboratories Inc.,
- 43598-859- Fosaprepitant
  - 43598-859-11- 1 VIAL in 1 CARTON (43598-859-11) > 1 mL in 1 VIAL

60505- Apotex Corp
- 60505-6105- Fosaprepitant
  - 60505-6105-1- 1 VIAL, SINGLE-DOSE in 1 CARTON (60505-6105-1) > 5 mL in 1 VIAL, SINGLE-DOSE

63323- Fresenius Kabi USA, LLC
- 63323-972- Fosaprepitant
  - 63323-972-10- 1 VIAL, SINGLE-DOSE in 1 CARTON (63323-972-10) > 10 mL in 1 VIAL, SINGLE-DOSE

67457- Mylan Institutional LLC
- 67457-889- fosaprepitant
  - 67457-889-10- 1 VIAL, SINGLE-DOSE in 1 CARTON (67457-889-10) > 5 mL in 1 VIAL, SINGLE-DOSE

68001- BluePoint Laboratories
- 68001-421- Fosaprepitant
  - 68001-421-22- 1 VIAL, SINGLE-DOSE in 1 CARTON (68001-421-22) > 5 mL in 1 VIAL, SINGLE-DOSE

69097- Cipla USA Inc.
- 69097-830- fosaprepitant
  - 69097-830-37- 1 VIAL, SINGLE-DOSE in 1 CARTON (69097-830-37) > 5 mL in 1 VIAL, SINGLE-DOSE

69539- MSN LABORATORIES PRIVATE LIMITED
- 69539-034- Fosaprepitant
  - 69539-034-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (69539-034-01) > 5 mL in 1 VIAL, SINGLE-DOSE

71288- Meitheal Pharmaceuticals Inc.
- 71288-418- FOSAPREPITANT
  - 71288-418-10- 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-418-10) > 5 mL in 1 VIAL, SINGLE-DOSE

71839- BE Pharmaceuticals Inc.
- 71839-104- fosaprepitant
  - 71839-104-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (71839-104-01) > 5 mL in 1 VIAL, SINGLE-DOSE

72205- Novadoz Pharmaceuticals LLC
- 72205-026- Fosaprepitant
  - 72205-026-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (72205-026-01) > 5 mL in 1 VIAL, SINGLE-DOSE

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇