Aprepitant (Aponvie, Emend)

PONV prophylaxis - Single 32 mg IV over 2 min within 30 min before induction; the long half-life covers 24-48 h, useful for delayed PONV.

Long duration - 9-13 h half-life gives superior 24-48 h antiemetic coverage compared with ondansetron.

Multimodal - Combine with dexamethasone and a 5-HT3 antagonist for high-risk patients.

CYP3A4 inhibition - Moderate inhibitor; can raise levels of midazolam and dexamethasone, consider reducing the dexamethasone dose.

Warfarin - Reduces INR; monitor anticoagulation.

Drug Interactions - CYP3A4 inhibitor and inducer; reduces efficacy of hormonal contraceptives; interacts with dexamethasone and midazolam.

Pediatric Implications - IV emulsion (Aponvie) not established in children; oral/IV aprepitant is approved for CINV in children 6 months and older (weight-based).

Obstetric Implications - Limited data; avoid unless clearly needed.

Absolute:

Concurrent pimozide

Relative:

Severe hepatic impairment

Caution:

Warfarin therapy

Hormonal contraceptives

CYP3A4 substrate drugs

Central and peripheral neurokinin-1 (substance P) receptor antagonism in the vomiting center.

Hepatic (CYP3A4)

Hepatic and fecal

Aponvie: 32 mg/4.4 mL IV injectable emulsion, single-dose for PONV prevention.

Emend: 40, 80, 125 mg oral capsules (40 mg is the oral PONV dose).

Cinvanti (IV aprepitant) and fosaprepitant (Emend IV) are used for chemotherapy-induced nausea and vomiting.