Drug Detail:Fosaprepitant (Fosaprepitant [ fos-a-prep-i-tan-t ])
Drug Class: NK1 receptor antagonists
Usual Adult Dose for Nausea/Vomiting - Chemotherapy Induced
Day 1: 150 mg IV over 20 to 30 minutes, completing the infusion about 30 minutes before chemotherapy
ADDITIONAL MEDICATIONS:
Highly Emetogenic Cancer Chemotherapy (HEC):
- Dexamethasone:
- Day 1: 12 mg orally 30 minutes prior to chemotherapy
- Day 2: 8 mg orally in the morning
- Days 3 and 4: 8 mg orally twice a day (morning and evening)
- A 5-HT3 (serotonin) antagonist:
- Day 1: The manufacturer product information for the selected 5-HT3 antagonist should be consulted for the recommended dosage.
Moderately Emetogenic Cancer Chemotherapy (MEC):
- Dexamethasone:
- Day 1: 12 mg orally 30 minutes prior to chemotherapy
- A 5-HT3 antagonist:
- Day 1: The manufacturer product information for the selected 5-HT3 antagonist should be consulted for the recommended dosage.
Comments:
- This drug should be administered with dexamethasone and a 5-HT3 antagonist as specified above.
- A 50% dosage reduction of dexamethasone on Days 1 and 2 (with HEC) and on Day 1 (with MEC) is recommended to account for a drug interaction with this drug.
Uses: In combination with other antiemetic drugs, for the prevention of:
- acute and delayed nausea and vomiting associated with initial and repeat courses of HEC (including high-dose cisplatin)
- delayed nausea and vomiting associated with initial and repeat courses of MEC
Usual Pediatric Dose for Nausea/Vomiting - Chemotherapy Induced
At Least 6 kg:
Single-Dose Regimen for Use with Single-Day Regimens of HEC or MEC:
6 months to less than 2 years: 5 mg/kg IV over 60 minutes
- Maximum dose: 150 mg/dose
2 to less than 12 years: 4 mg/kg IV over 60 minutes
- Maximum dose: 150 mg/dose
12 to 17 years: 150 mg IV over 30 minutes
3-Day Dosage Regimen for Use with Single- or Multi-Day Regimens of HEC or MEC:
6 months to less than 12 years:
- Day 1: 3 mg/kg IV over 60 minutes
- Maximum dose: 115 mg/dose
- Days 2 and 3: 2 mg/kg IV over 60 minutes
- Maximum dose: 80 mg/dose
12 to 17 years:
- Day 1: 115 mg IV over 30 minutes
- Days 2 and 3: 80 mg IV over 30 minutes
ADDITIONAL MEDICATIONS:
6 months to 17 years:
For Use with Single-Day Regimens of HEC or MEC:
- If a corticosteroid (e.g., dexamethasone) is coadministered: 50% of the recommended corticosteroid dose should be administered on Days 1 and 2
- Dexamethasone should be administered 30 minutes prior to chemotherapy on Day 1.
- A 5-HT3 antagonist: The manufacturer product information for the selected 5-HT3 antagonist should be consulted for the recommended dosage.
For Use with Multi-Day Regimens of HEC OR MEC:
- If a corticosteroid (e.g., dexamethasone) is coadministered: 50% of the recommended corticosteroid dose should be administered on Days 1 through 4
- Dexamethasone should be administered 30 minutes prior to chemotherapy on Day 1.
- A 5-HT3 antagonist: The manufacturer product information for the selected 5-HT3 antagonist should be consulted for the recommended dosage.
Comments:
- This drug should be administered with a 5-HT3 antagonist (with or without a corticosteroid) as specified above.
- For use with single-day chemotherapy regimens:
- This drug may be administered as a single-dose regimen infused through a central venous catheter on Day 1, or as a 3-day regimen consisting of this drug as an IV infusion through a central venous catheter on Days 1, 2, and 3. Aprepitant capsules or oral suspension may be used on Days 2 and 3 instead of this drug.
- This drug should be administered on Day 1 over 60 minutes (6 months to less than 12 years) or 30 minutes (12 to 17 years), completing the infusion about 30 minutes before chemotherapy.
- For use with multi-day chemotherapy regimens:
- This drug should be administered as an IV infusion through a central venous catheter on Days 1, 2, and 3. Aprepitant capsules or oral suspension may be used on Days 2 and 3 instead of this drug.
- This drug should be administered over 60 minutes (6 months to less than 12 years) or 30 minutes (12 to 17 years), completing the infusion about 30 minutes before chemotherapy.
Uses: In combination with other antiemetic drugs, for the prevention of:
- acute and delayed nausea and vomiting associated with initial and repeat courses of HEC (including high-dose cisplatin)
- delayed nausea and vomiting associated with initial and repeat courses of MEC
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Mild to moderate liver dysfunction (Child-Pugh score 5 to 9): No adjustment recommended
Severe liver dysfunction (Child-Pugh score greater than 9): Data not available; additional monitoring for adverse reactions may be needed.
Precautions
CONTRAINDICATIONS:
- Hypersensitivity to the active component or any of the ingredients
- Coadministration with pimozide
Safety and efficacy have not been established in patients younger than 6 months; this drug is not recommended for use in pediatric patients weighing less than 6 kg.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- Adults: Administer as an IV infusion over 20 to 30 minutes.
- Pediatric patients: Administer as an IV infusion through a central venous catheter.
- Complete the infusion about 30 minutes prior to chemotherapy (as appropriate).
- Monitor patients during and after infusion; if a hypersensitivity reaction or severe infusion site reaction occurs, discontinue the infusion and administer appropriate medical therapy.
- Do not restart this drug in patients who have had symptoms of hypersensitivity with previous use.
Storage requirements:
- Lyophilized powder (vials): Store refrigerated at 2C to 8C (36F to 46F).
- Reconstituted final drug solution (bag): Stable for 24 hours at ambient room temperature (at/below 25C [77F])
Reconstitution/preparation techniques:
- This drug must be reconstituted and then diluted before administration.
- The manufacturer product information should be consulted.
IV compatibility:
- Compatible: 0.9% Sodium Chloride Injection, USP
- Incompatible: Any solutions containing divalent cations (e.g., Ca++, Mg++), including Lactated Ringer's Solution and Hartmann's Solution
- This drug should not be mixed or reconstituted with solutions for which physical and chemical compatibility have not been established.
General:
- Limitations of Use: This drug has not been studied for the treatment of established nausea and vomiting.
Monitoring:
- General: For adverse reactions in patients with severe liver dysfunction (when this drug is administered)
- Hematologic: INR in patients on chronic warfarin (in the 2-week period [especially at 7 to 10 days] after initiation of this drug with each chemotherapy cycle)
- Hypersensitivity: For hypersensitivity reactions (during and after infusion)
Patient advice:
- Read the US FDA-approved patient labeling (Patient Information).
- Seek immediate medical attention if signs/symptoms of a hypersensitivity reaction (e.g., hives, rash, itching, skin peeling/sores, flushing, difficulty in breathing/swallowing, dizziness, rapid/weak heartbeat, feeling faint) occur.
- Seek medical attention if new or worsening sign/symptoms of an infusion site reaction (e.g., erythema, edema, pain, necrosis, vasculitis, or thrombophlebitis at/near the infusion site) develop.
- If on chronic warfarin therapy: Follow instructions from your health care provider regarding blood draws to monitor your INR during the 2-week period (especially at 7 to 10 days) after initiation of this drug with each chemotherapy cycle.
- Patients of childbearing potential using hormonal contraceptives: Use effective alternative or backup methods of contraception (e.g., condoms, spermicides) during therapy and for 1 month after the last dose.
Frequently asked questions
- What is the difference between Cinvanti and Emend?
