Aprepitant: Drug information

For additional information see "Aprepitant: Patient drug information" and "Aprepitant: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: US

Aponvie;
Cinvanti;
Emend;
Emend BiPack;
Emend TriPack

Brand Names: Canada

Emend;
Emend Tri-Pack

Pharmacologic Category

Antiemetic;
Substance P/Neurokinin 1 Receptor Antagonist

Dosing: Adult

Dosage guidance:

Dosage form information: Dosing is for aprepitant (Emend oral, Aponvie IV, and Cinvanti IV); refer to the fosaprepitant monograph for Emend IV dosing. Concentration of oral suspension may vary (commercially available or extemporaneously compounded); use caution.

Chemotherapy-induced nausea and vomiting, prevention

Chemotherapy-induced nausea and vomiting, prevention:

Manufacturer's labeling:

Prevention of acute and delayed nausea/vomiting associated with highly-emetogenic chemotherapy:

IV (single-dose aprepitant regimen): Cinvanti: 130 mg ~30 minutes prior to chemotherapy on day 1 (in combination with a 5-HT₃ antagonist antiemetic on day 1 and oral dexamethasone on days 1 to 4).

Oral:

Capsules: 125 mg 1 hour prior to chemotherapy on day 1, followed by 80 mg once daily on days 2 and 3 (in combination with a 5-HT₃ antagonist antiemetic on day 1 and dexamethasone on days 1 to 4).

Suspension: Adults unable to swallow capsules: 3 mg/kg (maximum: 125 mg/dose) 1 hour prior to chemotherapy on day 1, followed by 2 mg/kg (maximum: 80 mg/dose) once daily on days 2 and 3 (in combination with a 5-HT₃ antagonist antiemetic on day 1 and dexamethasone on days 1 to 4).

Prevention of nausea/vomiting associated with moderately emetogenic chemotherapy:

IV (3-day aprepitant regimen): Cinvanti: 100 mg ~30 minutes prior to chemotherapy on day 1 (in combination with oral aprepitant 80 mg on days 2 and 3, a 5-HT₃ antagonist antiemetic on day 1 and dexamethasone on day 1).

Oral:

Capsules: 125 mg 1 hour prior to chemotherapy on day 1, followed by 80 mg once daily on days 2 and 3 (in combination with a 5-HT₃ antagonist antiemetic and dexamethasone on day 1).

Prevention of delayed nausea/vomiting associated with moderately emetogenic chemotherapy:

IV (single-dose aprepitant regimen): Cinvanti: 130 mg ~30 minutes prior to chemotherapy on day 1 (in combination with a 5-HT₃ antagonist antiemetic on day 1 and dexamethasone on day 1).

Guideline recommendations:

Prevention of nausea/vomiting associated with highly emetogenic chemotherapy:

Cisplatin and other highly emetogenic single agents: Administer aprepitant in combination with a 5-HT₃ antagonist antiemetic on day 1, dexamethasone on days 1 to 4, and olanzapine on days 1 to 4 (Ref).

IV (Cinvanti): 130 mg on day 1 only (single-dose aprepitant regimen) (Ref).

Oral: 125 mg prior to chemotherapy on day 1, followed by 80 mg once daily on days 2 and 3 (Ref).

Anthracycline in combination with cyclophosphamide (AC) regimens: Administer aprepitant in combination with a 5-HT₃ antagonist antiemetic on day 1, dexamethasone on day 1, and olanzapine on days 1 to 4 (Ref).

IV (Cinvanti): 130 mg on day 1 only (single-dose aprepitant regimen) (Ref).

Oral: 125 mg prior to chemotherapy on day 1, followed by 80 mg once daily on days 2 and 3 (Ref).

Multiday (4 - or 5-day) cisplatin regimens: Administer aprepitant in combination with a 5-HT₃ antagonist antiemetic and dexamethasone with or without olanzapine (Ref).

IV (Cinvanti): 130 mg on day 1 only (single-dose aprepitant regimen) (Ref).

Oral: 125 mg prior to chemotherapy on day 1, followed by 80 mg once daily on days 2 and 3 (Ref). May consider continuing 80 mg once daily until 2 days post chemotherapy (Ref).

Carboplatin AUC ≥4 doses: Administer aprepitant in combination with a 5-HT₃ antagonist antiemetic on day 1 and dexamethasone on day 1 (Ref).

IV (Cinvanti), Oral: 100 mg IV, followed by 80 mg orally on days 2 and 3 (Ref) or 125 mg orally on day 1, followed by 80 mg orally on days 2 and 3 (Ref).

High-dose chemotherapy with stem-cell or bone marrow transplant: Administer aprepitant in combination with a 5-HT₃ antagonist antiemetic and dexamethasone, with or without olanzapine (Ref).

IV (Cinvanti): 130 mg on day 1 only (single-dose aprepitant regimen) (Ref).

Oral: 125 mg prior to chemotherapy on day 1, followed by 80 mg once daily on days 2 and 3 (Ref).

Postoperative nausea and vomiting, prevention

Postoperative nausea and vomiting, prevention:

IV (Aponvie): 32 mg prior to anesthesia induction.

Oral (capsules [generic]): 40 mg within 3 hours prior to anesthesia induction. Note: The postoperative nausea and vomiting indication was removed from the Emend capsule US prescribing information; however, it remains in the labeling for generic capsule products.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

No dosage adjustment necessary.

End-stage kidney disease undergoing dialysis: No dosage adjustment necessary. Hemodialysis conducted 4 or 48 hours after dosing had no significant impact on aprepitant pharmacokinetics (a negligible amount of an aprepitant dose is recovered in the dialysate).

Dosing: Liver Impairment: Adult

Mild-to-moderate impairment (Child-Pugh class A or B): No dosage adjustment necessary.

Severe impairment (Child-Pugh class C): Use with caution; no data available; may require additional monitoring for adverse reactions.

Dosing: Adjustment for Toxicity: Adult

Hypersensitivity reactions: Discontinue aprepitant infusion and manage appropriately. Do not reinitiate.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Aprepitant: Pediatric drug information")

Dosage guidance:

Dosage form information: Concentration of oral suspension may vary (commercially available or extemporaneous compounded); use caution.

Chemotherapy-induced nausea and vomiting, prevention; highly and moderately emetogenic chemotherapy

Chemotherapy-induced nausea and vomiting (CINV), prevention; highly and moderately emetogenic chemotherapy:

Note: Use in combination with 5-HT₃ antagonist antiemetic with or without dexamethasone depending upon patient age, chemotherapy emetogenic potential, and drug-interaction profile (refer to specific protocols or guidelines) (Ref).

Oral:

Infants ≥6 months and Children <12 years, weighing 6 to <30 kg: Oral: Oral suspension (Emend): Oral: 3 mg/kg 1 hour prior to chemotherapy on day 1, then 2 mg/kg/dose once daily on days 2 and 3.

Note: For commercially available product (25 mg/mL), may round dose: For doses ≤25 mg, round to nearest 2.5 mg (0.1 mL) or for doses >25 mg, round to the nearest 5 mg (0.2 mL).

Children <12 years weighing ≥30 kg, Children ≥12 years and Adolescents: Oral: Capsules, Oral suspension (Emend): Oral: 125 mg 1 hour prior to chemotherapy on day 1, followed by 80 mg once daily on days 2 and 3.

IV: Limited data available (Ref):

Children ≥6 to <12 years: IV: 3 mg/kg/dose on day 1; maximum dose: 100 mg/dose followed by oral aprepitant on days 2 and 3.

Children ≥12 to Adolescents <18 years: IV: 100 mg on day 1 followed by oral aprepitant on days 2 and 3.

Cyclic vomiting syndrome, prophylaxis

Cyclic vomiting syndrome, prophylaxis : Limited data available:

Note: Prophylaxis is recommended for patients experiencing frequent symptoms (eg, monthly) or severe symptoms (eg, requiring hospitalization, lasting >2 days, resulting in significant school/work absences) (Ref).

Children ≥4 years and Adolescents (Ref):

<40 kg: Oral: 40 mg twice weekly.

40 to 60 kg: Oral: 80 mg twice weekly.

>60 kg: Oral: 125 mg twice weekly.

Cyclic vomiting syndrome, abortive therapy

Cyclic vomiting syndrome, abortive therapy: Limited data available:

Note: Administer during prodromal phase at least 30 minutes prior to onset of vomiting and continue for a total of 3 days (Ref).

Children ≥4 years and Adolescents (Ref):

<15 kg: Oral: 80 mg on day 1 followed by 40 mg on days 2 and 3.

15 to 20 kg: Oral: 80 mg on day 1 followed by 80 mg on days 2 and 3.

>20 kg: Oral: 125 mg on day 1 followed by 80 mg on days 2 and 3.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Infants ≥6 months, Children, and Adolescents:

Mild, moderate, or severe impairment: No dosage adjustment necessary.

Dialysis-dependent end-stage renal disease (ESRD): No dosage adjustment necessary. Aprepitant is not removed by hemodialysis (<0.2% of a dose is recovered in the dialysate).

Dosing: Liver Impairment: Pediatric

Infants ≥6 months, Children, and Adolescents: Oral:

Mild to moderate impairment: No dosage adjustment necessary.

Severe impairment: Use with caution; no data available; may require additional monitoring for adverse reactions.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions may be reported in combination with other antiemetic agents. Reported adverse reactions are for adults with highly emetogenic cancer chemotherapy or moderately emetogenic cancer chemotherapy, unless otherwise noted as reported for postoperative nausea and vomiting (PONV) or in children and adolescents.

>10%:

Hematologic & oncologic: Neutropenia (children and adolescents: 13%; adults: <3%)

Nervous system: Fatigue (children and adolescents: 5%; adults: 13% [PONV: 6%])

1% to 10%:

Cardiovascular: Flushing (<3%), hypotension (PONV: 6%), palpitations (<3%), peripheral edema (<3%)

Dermatologic: Alopecia (<3%), hyperhidrosis (<3%), skin rash (<3%)

Endocrine & metabolic: Decreased serum sodium (<3%), dehydration (3%), hot flash (<3), hypokalemia (<3%), weight loss (<3%)

Gastrointestinal: Abdominal pain (6%), constipation (PONV: 8% to 9%), decreased appetite (children and adolescents: 5%; adults: <3%), diarrhea (children and adolescents: 6%; adults: 9%), dysgeusia (<3%), dyspepsia (7%), eructation (<3%), flatulence (<3%), gastritis (<3%), gastroesophageal reflux disease (<3%), hiccups (children and adolescents: 4%; adults: 5%), oral candidiasis (<3%), xerostomia (<3%)

Genitourinary: Proteinuria (<3%)

Hematologic & oncologic: Anemia (<3%), febrile neutropenia (<3%), thrombocytopenia (<3%)

Hepatic: Increased serum alanine aminotransferase (3%), increased serum alkaline phosphatase (<3%), increased serum aspartate aminotransferase (<3%)

Nervous system: Anxiety (<3%), asthenia (7%), dizziness (children and adolescents: 5%; adults: <3% [PONV: <1%]), headache (children and adolescents: 9%; adults [PONV]: 4%), malaise (<3%), peripheral neuropathy (<3%)

Neuromuscular & skeletal: Musculoskeletal pain (<3%)

Renal: Increased blood urea nitrogen (<3%)

Respiratory: Cough (children and adolescents: 5%; adults: <3%), dyspnea (<3%), oropharyngeal pain (<3%), pharyngitis (<3%)

<1%: Dermatologic: Urticaria (PONV: <1%)

Postmarketing (any indication):

Dermatologic: Pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis

Hypersensitivity: Anaphylactic shock, anaphylaxis, angioedema, hypersensitivity reaction

Contraindications

Hypersensitivity to aprepitant or any component of the formulation; concurrent use with pimozide

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Canadian labeling: Additional contraindications (not in the US labeling): Concurrent use with astemizole, cisapride, or terfenadine.

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity: Hypersensitivity reactions, including anaphylactic reactions, have been reported. Symptoms have included dyspnea, erythema, eye swelling, flushing, hypotension, pruritus, syncope, and wheezing.

Concurrent drug therapy issues:

• Drug-drug interactions: A clinically significant decrease in INR or PT may occur with concurrent warfarin therapy.

Dosage form specific issues:

• Aprepitant IV: The IV aprepitant formulations are an emulsion that also contains the excipients alcohol, egg lecithin, soybean oil, and sucrose. Cinvanti product contains alcohol; use with caution in infants.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Emend BiPack: 80 mg

Emend TriPack: 80 mg & 125 mg

Generic: 40 mg, 80 mg, 125 mg, 80 mg & 125 mg

Emulsion, Intravenous:

Aponvie: 32 mg/4.4 mL (4.4 mL) [contains alcohol, usp, egg phospholipids (egg lecithin), soybean oil]

Cinvanti: 130 mg/18 mL (18 mL) [contains alcohol, usp, egg phospholipids (egg lecithin), soybean oil]

Miscellaneous, Oral:

Generic: 80 mg & 125 mg (3 ea)

Suspension Reconstituted, Oral:

Emend: 125 mg/5 mL (1 ea)

Generic Equivalent Available: US

May be product dependent

Pricing: US

Capsules (Aprepitant Oral)

40 mg (per each): $109.94

80 mg (per each): $203.76 - $203.79

125 mg (per each): $318.39

Capsules (Emend BiPack Oral)

80 mg (per each): $262.53

Capsules (Emend TriPack Oral)

80 & 125 mg (per each): $309.74

Emulsion (Aponvie Intravenous)

32MG/4.4ML (per mL): $16.21

Emulsion (Cinvanti Intravenous)

130 mg/18 mL (per mL): $29.71

Misc (Aprepitant Oral)

80 & 125 mg (per each): $240.41

Suspension (reconstituted) (Emend Oral)

125 mg/5 mL (per each): $410.20

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Emend: 80 mg, 125 mg

Miscellaneous, Oral:

Emend Tri-Pack: 80 mg & 125 mg (3 ea)

Administration: Adult

IV: Administration information is for aprepitant IV (Aponvie, Cinvanti); refer to fosaprepitant IV (Emend IV) monograph for fosaprepitant administration information.

Aponvie: IV injection: Inject over 30 seconds prior to anesthesia induction. Flush infusion line with NS before and after administration.

Cinvanti:

IV injection: Inject over 2 minutes approximately one-half hour (30 minutes) prior to chemotherapy. Flush infusion line with NS before and after administration.

IV infusion: Infuse over 30 minutes approximately one-half hour (30 minutes) prior to chemotherapy. Use only non-DEHP tubing for administration of the IV infusion (not necessary if administering as an IV push).

Oral:

Prevention of chemotherapy-induced nausea/vomiting: Administer with or without food. First dose should be given 1 hour prior to chemotherapy; subsequent doses should be given 1 hour prior to chemotherapy or in the morning (if no chemotherapy is administered on days 2 and 3). Swallow capsules whole.

Oral suspension: Dose should be prepared by a health care provider and dispensed to patient or caregiver in an oral dispenser. Administer by placing the dispenser in the patient's mouth along the inner cheek and slowly dispensing the medicine.

Prevention of postoperative nausea/vomiting (oral): Administer within 3 hours prior to induction; follow health care provider instructions about food/drink restrictions prior to surgery. Swallow capsules whole.

Administration: Pediatric

Oral:

Indication-specific details:

Chemotherapy-induced nausea/vomiting (CINV), prevention: May be administered without regard to food. Administer first dose 1 hour prior to chemotherapy; subsequent dose should be given 1 hour prior to chemotherapy or in the morning (ie, if no chemotherapy is administered on days 2 and 3).

Cyclic vomiting syndrome: May be administered without regard to food. For abortive therapy, administer during prodromal phase at least 30 minutes prior to onset of vomiting (Ref).

Product-specific details:

Capsule: Swallow whole.

Oral suspension: Remove cap from oral syringe. Slowly administer suspension along the inner cheek.

IV:

Chemotherapy-induced nausea/vomiting (CINV), prevention: Administer dose 30 minutes prior to chemotherapy on day 1.

IV injection: Administration IV undiluted (7.2 mg/mL) over 2 minutes was reported in a pediatric CINV trial. Flush infusion line with NS before and after administration (Ref).

IV infusion: Administration over 30 minutes has been used by some centers in pediatric patients who do not tolerate aprepitant 2 minute injection based on experience in adult patients (Ref).

Use: Labeled Indications

IV (Aponvie): Postoperative nausea and vomiting: Prevention of postoperative nausea and vomiting in adults.

IV (Cinvanti):

Prevention of chemotherapy-induced nausea and vomiting:

Prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic chemotherapy, including high-dose cisplatin, as single-dose aprepitant regimen (in combination with other antiemetics) in adults.

Prevention of delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic chemotherapy as a single-dose aprepitant regimen (in combination with other antiemetics) in adults.

Prevention of nausea and vomiting associated with initial and repeat courses of moderately emetogenic chemotherapy as a 3-day aprepitant regimen (in combination with other antiemetics) in adults.

Oral:

Prevention of chemotherapy-induced nausea and vomiting (Emend oral and generic capsules):

Prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic chemotherapy, including high-dose cisplatin (in combination with other antiemetics) in patients ≥12 years of age (capsules) and in patients ≥6 months of age (oral suspension).

Prevention of nausea and vomiting associated with initial and repeat courses of moderately emetogenic chemotherapy (in combination with other antiemetics) in patients ≥12 years (capsules) and in patients ≥6 months (oral suspension).

Postoperative nausea and vomiting (generic capsules): Prevention of postoperative nausea and vomiting (PONV) in adults. Note: The PONV indication was removed from the Emend capsule US prescribing information (in September 2019); however, it remains in the labeling for generic aprepitant capsules.

Limitations of use: Aprepitant has not been studied for the management of existing nausea and vomiting. Chronic, continuous administration (oral aprepitant) is not recommended (has not been studied and chronic use may alter aprepitant's drug interaction profile).

Medication Safety Issues

Sound-alike/look-alike issues:

Aprepitant may be confused with fosaprepitant, fosnetupitant, netupitant, rolapitant

Aprepitant IV (Cinvanti) may be confused with fosaprepitant IV (Emend for injection)

Emend (aprepitant) oral capsule/suspension formulations may be confused with Emend for injection (fosaprepitant)

Metabolism/Transport Effects

Substrate of CYP1A2 (Minor), CYP2C19 (Minor), CYP3A4 (Major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits CYP3A4 (Moderate);

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Abemaciclib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Abemaciclib. Management: Monitor for increased abemaciclib toxicities if combined with moderate CYP3A4 inhibitors. Consider reducing the abemaciclib dose in 50 mg decrements if necessary. Risk C: Monitor

Acalabrutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Acalabrutinib. Management: Reduce acalabrutinib dose to 100 mg once daily with concurrent use of a moderate CYP3A4 inhibitor. Monitor patient closely for both acalabrutinib response and evidence of adverse effects with any concurrent use. Risk D: Consider Therapy Modification

Acrivastine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Acrivastine. Risk C: Monitor

ALfentanil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of ALfentanil. Management: If use of alfentanil and moderate CYP3A4 inhibitors is necessary, consider dosage reduction of alfentanil until stable drug effects are achieved. Frequently monitor patients for respiratory depression and sedation when these agents are combined. Risk D: Consider Therapy Modification

Alfuzosin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Alfuzosin. Risk C: Monitor

Alitretinoin (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Alitretinoin (Systemic). Risk C: Monitor

ALPRAZolam: CYP3A4 Inhibitors (Moderate) may increase serum concentration of ALPRAZolam. Management: Consider alternatives to this combination when possible. If combined, consider an alprazolam dose reduction and monitor for increased alprazolam effects and toxicities (eg, sedation, lethargy). Risk D: Consider Therapy Modification

Amiodarone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Amiodarone. Risk C: Monitor

AmLODIPine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of AmLODIPine. Risk C: Monitor

Apixaban: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Apixaban. Risk C: Monitor

ARIPiprazole Lauroxil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of ARIPiprazole Lauroxil. Risk C: Monitor

ARIPiprazole: CYP3A4 Inhibitors (Moderate) may increase serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy, indication, or dosage form. Consult full interaction monograph for specific recommendations. Risk C: Monitor

Atogepant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Atogepant. Risk C: Monitor

Atorvastatin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Atorvastatin. Risk C: Monitor

Avanafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Avanafil. Management: The maximum avanafil dose is 50 mg per 24-hour period when used together with a moderate CYP3A4 inhibitor. Patients receiving such a combination should also be monitored more closely for evidence of adverse effects (eg, hypotension, syncope, priapism). Risk D: Consider Therapy Modification

Avapritinib: Aprepitant may increase serum concentration of Avapritinib. Management: Consider use of an alternative NK1 receptor antagonist that is not a moderate CYP3A4 inhibitor (eg, fosaprepitant, rolapitant, or netupitant-palonsetron) in place of aprepitant to avoid this potential interaction. Risk D: Consider Therapy Modification

Axitinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Axitinib. Risk C: Monitor

Barnidipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Barnidipine. Risk C: Monitor

Bedaquiline: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Bedaquiline. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Bedaquiline. Risk C: Monitor

Benidipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Benidipine. Risk C: Monitor

Benzhydrocodone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Benzhydrocodone. Specifically, the concentration of hydrocodone may be increased. Risk C: Monitor

Blonanserin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Blonanserin. Risk C: Monitor

Bortezomib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Bortezomib. Risk C: Monitor

Bosutinib: Aprepitant may increase serum concentration of Bosutinib. Risk C: Monitor

Brexpiprazole: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Brexpiprazole. Management: The brexpiprazole dose should be reduced to 25% of usual if used together with both a moderate CYP3A4 inhibitor and a strong or moderate CYP2D6 inhibitor, or if a moderate CYP3A4 inhibitor is used in a CYP2D6 poor metabolizer. Risk C: Monitor

Brigatinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Brigatinib. Management: Avoid concurrent use of brigatinib with moderate CYP3A4 inhibitors when possible. If such a combination cannot be avoided, reduce the dose of brigatinib by approximately 40% (ie, from 180 mg to 120 mg, from 120 mg to 90 mg, or from 90 mg to 60 mg). Risk D: Consider Therapy Modification

Bromocriptine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Bromocriptine. Management: The bromocriptine dose should not exceed 1.6 mg daily with use of a moderate CYP3A4 inhibitor. The Cycloset brand specifically recommends this dose limitation, but other bromocriptine products do not make such specific recommendations. Risk D: Consider Therapy Modification

Budesonide (Oral Inhalation): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Budesonide (Oral Inhalation). Risk C: Monitor

Budesonide (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Budesonide (Systemic). Management: Avoid the concomitant use of CYP3A4 inhibitors and oral budesonide. If patients receive both budesonide and CYP3A4 inhibitors, they should be closely monitored for signs and symptoms of corticosteroid excess. Risk D: Consider Therapy Modification

Budesonide (Topical): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Budesonide (Topical). Risk X: Avoid

Buprenorphine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Buprenorphine. Risk C: Monitor

BusPIRone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of BusPIRone. Risk C: Monitor

Cabozantinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cabozantinib. Risk C: Monitor

Cannabis: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cannabis. More specifically, tetrahydrocannabinol and cannabidiol serum concentrations may be increased. Risk C: Monitor

Capivasertib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Capivasertib. Management: If capivasertib is combined with moderate CYP3A4 inhibitors, reduce the capivasertib dose to 320 mg twice daily for 4 days, followed by 3 days off. Monitor patients closely for adverse reactions. Risk D: Consider Therapy Modification

Cariprazine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cariprazine. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Cariprazine. Management: Cariprazine dose adjustments are recommended and depend upon whether a patient is initiating a moderate CYP3A4 inhibitor or cariprazine, as well as cariprazine indication. See full mono for details. Some non-US labels contraindicate this combination. Risk D: Consider Therapy Modification

Cilostazol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cilostazol. Management: Decrease the dose of cilostazol to 50 mg twice daily when combined with moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification

Cisapride: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cisapride. Management: Consider alternatives to this combination. Prescribing information for some moderate CYP3A4 inhibitors state coadministration with cisapride is contraindicated, while some others recommend monitoring and dose titration. Risk D: Consider Therapy Modification

Clindamycin (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Clindamycin (Systemic). Risk C: Monitor

Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor

CloZAPine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of CloZAPine. Risk C: Monitor

Cobimetinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cobimetinib. Management: Avoid this combination when possible. If concurrent short term (14 days or less) use cannot be avoided, reduce the cobimetinib dose from 60 mg to 20 mg daily. Avoid concomitant use in patients already receiving reduced cobimetinib doses. Risk D: Consider Therapy Modification

Codeine: CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Codeine. Risk C: Monitor

Colchicine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Colchicine. Management: Avoidance, dose reduction, or increased monitoring for colchicine toxicity may be needed and will depend on brand, indication for colchicine use, renal/hepatic function, and use of a P-gp inhibitor. See full monograph for details. Risk D: Consider Therapy Modification

Copanlisib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Copanlisib. Risk C: Monitor

CycloSPORINE (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of CycloSPORINE (Systemic). Risk C: Monitor

CYP3A4 Inducers (Moderate): May decrease serum concentration of Aprepitant. Risk C: Monitor

CYP3A4 Inducers (Strong): May decrease serum concentration of Aprepitant. Risk X: Avoid

CYP3A4 Inhibitors (Moderate): May increase serum concentration of Aprepitant. Risk X: Avoid

CYP3A4 Inhibitors (Strong): May increase serum concentration of Aprepitant. Risk X: Avoid

Dabrafenib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Dabrafenib. Risk C: Monitor

Dapoxetine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Dapoxetine. Management: The dose of dapoxetine should be limited to 30 mg per day when used together with a moderate inhibitor of CYP3A4. Risk D: Consider Therapy Modification

Daridorexant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Daridorexant. Management: Limit the daridorexant dose to 25 mg, no more than once per night, when combined with moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification

Darifenacin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Darifenacin. Risk C: Monitor

Dasatinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Dasatinib. Risk C: Monitor

Delamanid: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Delamanid. Risk C: Monitor

DexAMETHasone (Systemic): Aprepitant may increase serum concentration of DexAMETHasone (Systemic). Management: Reduce dexamethasone dose 50% with aprepitant. Aprepitant labeling incorporates this recommendation into the dose provided for dexamethasone; further reduction is not necessary. No dose adjustment may be needed with single, low-dose aprepitant for PONV. Risk D: Consider Therapy Modification

DiazePAM: CYP3A4 Inhibitors (Moderate) may increase serum concentration of DiazePAM. Risk C: Monitor

Diazoxide Choline: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Diazoxide Choline. Risk C: Monitor

Dienogest: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Dienogest. Risk C: Monitor

Disopyramide: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Disopyramide. Risk C: Monitor

Dofetilide: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Dofetilide. Risk C: Monitor

Domperidone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Domperidone. Risk X: Avoid

DroNABinol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of DroNABinol. Risk C: Monitor

Ebastine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ebastine. Risk C: Monitor

Elacestrant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Elacestrant. Risk X: Avoid

Elbasvir and Grazoprevir: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Elbasvir and Grazoprevir. Risk C: Monitor

Eletriptan: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Eletriptan. Risk X: Avoid

Elexacaftor, Tezacaftor, and Ivacaftor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Elexacaftor, Tezacaftor, and Ivacaftor. Management: When combined with moderate CYP3A4 inhibitors, elexacaftor/tezacaftor/ivacaftor should be given in the morning, every other day. Ivacaftor alone should be given in the morning, every other day on alternate days. Risk D: Consider Therapy Modification

Eliglustat: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Eliglustat. Management: Reduce eliglustat dose to 84 mg daily in CYP2D6 EMs when used with moderate CYP3A4 inhibitors. Avoid use of moderate CYP3A4 inhibitors in CYP2D6 IMs or PMs. Use in CYP2D6 EMs or IMs also taking strong or moderate CYP2D6 inhibitors is contraindicated. Risk D: Consider Therapy Modification

Ensartinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ensartinib. Risk X: Avoid

Entrectinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Entrectinib. Management: Avoid moderate CYP3A4 inhibitors if possible. If needed, reduce entrectinib dose to 50 mg/day if starting dose 200 mg; to 100 mg/day if starting dose 300 mg; to 200 mg if starting dose 400 mg or 600 mg. Risk D: Consider Therapy Modification

Eplerenone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Eplerenone. Management: If coadministered with moderate CYP3A4 inhibitors, the max dose of eplerenone is 25 mg daily if used for heart failure; if used for hypertension initiate eplerenone 25 mg daily, titrate to max 25 mg twice daily. Risk D: Consider Therapy Modification

Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): Aprepitant may increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

Erlotinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Erlotinib. Risk C: Monitor

Eszopiclone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Eszopiclone. Risk C: Monitor

Etravirine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Etravirine. Risk C: Monitor

Everolimus: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Everolimus. Risk C: Monitor

Felodipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Felodipine. Risk C: Monitor

FentaNYL: CYP3A4 Inhibitors (Moderate) may increase serum concentration of FentaNYL. Management: Consider fentanyl dose reductions when combined with a moderate CYP3A4 inhibitor. Monitor for respiratory depression and sedation. Upon discontinuation of a CYP3A4 inhibitor, consider a fentanyl dose increase; monitor for signs and symptoms of withdrawal. Risk D: Consider Therapy Modification

Fexinidazole: CYP3A4 Inhibitors (Moderate) may decrease active metabolite exposure of Fexinidazole. Management: Avoid use of fexinidazole and moderate CYP3A4 inhibitors when possible. If combined, monitor for reduced fexinidazole efficacy. Risk D: Consider Therapy Modification

Finerenone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Finerenone. Risk C: Monitor

Flibanserin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Flibanserin. Management: Use of flibanserin with moderate CYP3A4 inhibitors is contraindicated. If starting flibanserin, start 2 weeks after the last dose of the CYP3A4 inhibitor. If starting a CYP3A4 inhibitor, start 2 days after the last dose of flibanserin. Risk X: Avoid

Fluticasone (Nasal): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Fluticasone (Nasal). Risk C: Monitor

Fluticasone (Oral Inhalation): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Fluticasone (Oral Inhalation). Risk C: Monitor

Fosaprepitant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Fosaprepitant. Risk X: Avoid

Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification

Gepirone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Gepirone. Management: Reduce the gepirone dose by 50% if combined with moderate CYP3A4 inhibitors. Monitor for QTc interval prolongation with combined use. Risk D: Consider Therapy Modification

Gepotidacin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Gepotidacin. Risk C: Monitor

Gilteritinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Gilteritinib. Risk C: Monitor

Glasdegib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Glasdegib. Risk C: Monitor

Grapefruit Juice: May increase serum concentration of Aprepitant. Risk X: Avoid

GuanFACINE: CYP3A4 Inhibitors (Moderate) may increase serum concentration of GuanFACINE. Management: Reduce the extended-release guanfacine dose 50% when combined with a moderate CYP3A4 inhibitor. Monitor for increased guanfacine toxicities when these agents are combined. Risk D: Consider Therapy Modification

Halofantrine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Halofantrine. Risk C: Monitor

Hormonal Contraceptives: Aprepitant may decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration with aprepitant, and to continue back-up contraception for 28 days after discontinuing aprepitant to ensure contraceptive reliability. Risk D: Consider Therapy Modification

HYDROcodone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of HYDROcodone. Risk C: Monitor

Ibrutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ibrutinib. Management: When treating B-cell malignancies, decrease ibrutinib to 280 mg daily when combined with moderate CYP3A4 inhibitors. When treating graft versus host disease, monitor patients closely and reduce the ibrutinib dose as needed based on adverse reactions. Risk D: Consider Therapy Modification

Ifosfamide: Aprepitant may increase adverse/toxic effects of Ifosfamide. Specifically, the risk for ifosfamide induced encephalopathy may be increased. Aprepitant may increase active metabolite exposure of Ifosfamide. Specifically, concentrations of the active and toxic metabolites of ifosfamide may increase. Risk C: Monitor

Iloperidone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Iloperidone. Risk C: Monitor

Irinotecan Products: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Irinotecan Products. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Irinotecan Products. Specifically, the serum concentration of SN-38 may be increased. Risk C: Monitor

Isradipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Isradipine. Risk C: Monitor

Ivabradine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ivabradine. Risk X: Avoid

Ivacaftor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ivacaftor. Management: Ivacaftor dose reductions may be required; consult full drug interaction monograph content for age- and weight-specific dosage recommendations. Risk D: Consider Therapy Modification

Ivosidenib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ivosidenib. Management: Avoid use of moderate CYP3A4 inhibitors with ivosidenib whenever possible. If combined, monitor for increased ivosidenib toxicities, including QTc prolongation. Risk D: Consider Therapy Modification

Ixabepilone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ixabepilone. Risk C: Monitor

Lapatinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lapatinib. Risk C: Monitor

Larotrectinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Larotrectinib. Risk C: Monitor

Lemborexant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lemborexant. Risk X: Avoid

Leniolisib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Leniolisib. Risk C: Monitor

Lercanidipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lercanidipine. Risk C: Monitor

Levamlodipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Levamlodipine. Risk C: Monitor

Levomethadone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Levomethadone. Risk C: Monitor

Levomilnacipran: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Levomilnacipran. Risk C: Monitor

Lidocaine (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lidocaine (Systemic). CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Lidocaine (Systemic). Specifically, concentrations of monoethylglycinexylidide (MEGX) may be increased. Risk C: Monitor

Lomitapide: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lomitapide. Risk X: Avoid

Lonafarnib: May increase serum concentration of Aprepitant. Aprepitant may increase serum concentration of Lonafarnib. Risk X: Avoid

Lovastatin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lovastatin. Risk C: Monitor

Lumateperone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lumateperone. Management: Limit the lumateperone dose to 21 mg once daily when used with a moderate CYP3A4 inhibitor. Risk D: Consider Therapy Modification

Lurasidone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lurasidone. Management: Reduce the lurasidone dose by half when initiating therapy with a moderate CYP3A4 inhibitor. If initiating lurasidone in a patient already receiving a moderate CYP3A4 inhibitor, start lurasidone at 20 mg/day with a max dose of 80 mg/day. Risk D: Consider Therapy Modification

Lurbinectedin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lurbinectedin. Management: Avoid concomitant use of lurbinectedin and moderate CYP3A4 inhibitors when possible. If combined, reduce the lurbinectedin dose by 50%. Risk D: Consider Therapy Modification

Macitentan: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Macitentan. Risk C: Monitor

Manidipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Manidipine. Risk C: Monitor

Maraviroc: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Maraviroc. Risk C: Monitor

Mavacamten: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Mavacamten. Management: Start mavacamten at 5 mg/day if stable on a moderate CYP3A4 inhibitor, and reduce the mavacamten dose by one dose level if initiating a moderate CYP3A4 inhibitor. Avoid initiating moderate CYP3A4 inhibitors in patients on mavacamten 2.5 mg/day. Risk D: Consider Therapy Modification

Mavorixafor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Mavorixafor. Risk C: Monitor

Meperidine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Meperidine. Risk C: Monitor

Methadone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Methadone. Management: If coadministration with moderate CYP3A4 inhibitors is necessary, consider methadone dose reductions until stable effects are achieved. Monitor patients closely for respiratory depression and sedation. Risk D: Consider Therapy Modification

MethylPREDNISolone: Aprepitant may increase serum concentration of MethylPREDNISolone. Management: Decrease oral methylprednisolone dose by 50%, and decrease intravenous methylprednisolone dose by 25%, with aprepitant. No dose adjustment is required when used with only a single 40 mg oral dose or 32 mg injectable dose of aprepitant. Risk D: Consider Therapy Modification

Methysergide: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Methysergide. Risk X: Avoid

Midazolam: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Midazolam. Management: Avoid concomitant use of nasal midazolam and moderate CYP3A4 inhibitors. Consider alternatives to use with oral midazolam whenever possible and consider using lower midazolam doses. Monitor patients for sedation and respiratory depression if combined. Risk D: Consider Therapy Modification

Midostaurin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Midostaurin. Risk C: Monitor

Mirodenafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Mirodenafil. Risk C: Monitor

Mitapivat: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Mitapivat. Management: When coadministered with moderate CYP3A4 inhibitors, doses of mitapivat should not exceed 20 mg twice daily. Additionally, patients should be monitored for changes in hemoglobin response and increased mitapivat adverse effects. Risk D: Consider Therapy Modification

Mobocertinib: CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Mobocertinib. CYP3A4 Inhibitors (Moderate) may increase serum concentration of Mobocertinib. Management: Avoid use of moderate CYP3A4 inhibitors with mobocertinib when possible. If combined, the mobocertinib dose should be reduced by approximately 50% (ie, from 160 mg to 80 mg, 120 mg to 40 mg, or 80 mg to 40 mg). Monitor QTc interval closely. Risk D: Consider Therapy Modification

Naldemedine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Naldemedine. Risk C: Monitor

Nalfurafine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Nalfurafine. Risk C: Monitor

Naloxegol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Naloxegol. Management: The use of naloxegol and moderate CYP3A4 inhibitors should be avoided. If concurrent use is unavoidable, reduce naloxegol dose to 12.5 mg once daily and monitor for signs of opiate withdrawal (eg, hyperhidrosis, chills, diarrhea, anxiety, irritability). Risk D: Consider Therapy Modification

Neratinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Neratinib. Risk C: Monitor

NIFEdipine (Topical): CYP3A4 Inhibitors (Moderate) may increase serum concentration of NIFEdipine (Topical). Risk C: Monitor

NIFEdipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of NIFEdipine. Risk C: Monitor

NiMODipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of NiMODipine. Risk C: Monitor

Nirogacestat: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Nirogacestat. Risk X: Avoid

Nisoldipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Nisoldipine. Risk X: Avoid

Nitrendipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Nitrendipine. Risk C: Monitor

Olaparib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Olaparib. Management: Avoid use of moderate CYP3A4 inhibitors with olaparib, if possible. If such concurrent use cannot be avoided, the dose of olaparib tablets should be reduced to 150 mg twice daily and the dose of olaparib capsules should be reduced to 200 mg twice daily. Risk D: Consider Therapy Modification

Oliceridine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Oliceridine. Risk C: Monitor

Olmutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Olmutinib. Risk C: Monitor

Omaveloxolone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Omaveloxolone. Management: Avoid this combination if possible. If coadministration is required, decrease the omaveloxolone dose to 100 mg daily and monitor closely for adverse reactions. If adverse reactions occur, decrease omaveloxolone to 50 mg daily. Risk D: Consider Therapy Modification

OxyCODONE: CYP3A4 Inhibitors (Moderate) may increase serum concentration of OxyCODONE. Serum concentrations of the active metabolite Oxymorphone may also be increased. Risk C: Monitor

PACLitaxel (Conventional): CYP3A4 Inhibitors (Moderate) may increase serum concentration of PACLitaxel (Conventional). Risk C: Monitor

PACLitaxel (Protein Bound): CYP3A4 Inhibitors (Moderate) may increase serum concentration of PACLitaxel (Protein Bound). Risk C: Monitor

Pacritinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pacritinib. Risk C: Monitor

Palbociclib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Palbociclib. Risk C: Monitor

Palovarotene: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Palovarotene. Management: Avoid concomitant use of palovarotene and moderate CYP3A4 inhibitors when possible. If combined, decrease palovarotene dose by 50% as described in the full interaction monograph. Monitor for palovarotene toxicities when combined. Risk D: Consider Therapy Modification

Panobinostat: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Panobinostat. Risk C: Monitor

PAZOPanib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of PAZOPanib. Risk C: Monitor

Pemigatinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pemigatinib. Management: If combined use cannot be avoided, reduce the pemigatinib dose from 13.5 mg daily to 9 mg daily, or from 9 mg daily to 4.5 mg daily. Resume prior pemigatinib dose after stopping the moderate inhibitor once 3 half-lives of the inhibitor has passed. Risk D: Consider Therapy Modification

Pexidartinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pexidartinib. Management: If combined use cannot be avoided, pexidartinib dose should be reduced as follows: reduce pexidartinib doses of 500 mg or 375 mg daily to 125 mg twice daily; reduce pexidartinib 250 mg daily to 125 mg once daily. Risk D: Consider Therapy Modification

Pimavanserin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pimavanserin. Risk C: Monitor

Pimecrolimus: CYP3A4 Inhibitors (Moderate) may decrease metabolism of Pimecrolimus. Risk C: Monitor

Pimozide: Aprepitant may increase serum concentration of Pimozide. Risk X: Avoid

Piperaquine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Piperaquine. Risk C: Monitor

Pirtobrutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pirtobrutinib. Risk C: Monitor

PONATinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of PONATinib. Risk C: Monitor

Pralsetinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pralsetinib. Management: If this combo cannot be avoided, decrease pralsetinib dose from 400 mg daily to 300 mg daily; from 300 mg daily to 200 mg daily; and from 200 mg daily to 100 mg daily. Risk D: Consider Therapy Modification

Prazepam: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Prazepam. Risk C: Monitor

Praziquantel: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Praziquantel. Risk C: Monitor

QUEtiapine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of QUEtiapine. Risk C: Monitor

Quinidine (Non-Therapeutic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Quinidine (Non-Therapeutic). Risk C: Monitor

QuiNIDine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of QuiNIDine. Risk C: Monitor

QuiNINE: CYP3A4 Inhibitors (Moderate) may increase serum concentration of QuiNINE. Risk C: Monitor

Ranolazine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ranolazine. Management: Limit the ranolazine dose to a maximum of 500 mg twice daily in patients concurrently receiving moderate CYP3A4 inhibitors. Monitor for increased ranolazine effects and toxicities during concomitant use. Risk D: Consider Therapy Modification

Red Yeast Rice: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Red Yeast Rice. Risk C: Monitor

Regorafenib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Regorafenib. CYP3A4 Inhibitors (Moderate) may decrease active metabolite exposure of Regorafenib. Risk C: Monitor

Repotrectinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Repotrectinib. Risk X: Avoid

Rifabutin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Rifabutin. Risk C: Monitor

Rimegepant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Rimegepant. Management: If taking rimegepant for the acute treatment of migraine, avoid a second dose of rimegepant within 48 hours when used concomitantly with moderate CYP3A4 inhibitors. No dose adjustment needed if using rimegepant for prevention of episodic migraine. Risk D: Consider Therapy Modification

Rivaroxaban: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Rivaroxaban. This warning is more specifically for drugs that are inhibitors of both CYP3A4 and P-glycoprotein. For erythromycin, refer to more specific erythromycin-rivaroxaban monograph recommendations. Risk C: Monitor

Roflumilast-Containing Products: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Roflumilast-Containing Products. Risk C: Monitor

Rupatadine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Rupatadine. Risk C: Monitor

Ruxolitinib (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ruxolitinib (Systemic). Risk C: Monitor

Salmeterol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Salmeterol. Risk C: Monitor

SAXagliptin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of SAXagliptin. Risk C: Monitor

Selpercatinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Selpercatinib. Management: Avoid combination if possible. If use is necessary, reduce selpercatinib dose as follows: from 120 mg twice/day to 80 mg twice/day, or from 160 mg twice/day to 120 mg twice/day. Risk D: Consider Therapy Modification

Selumetinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Selumetinib. Management: Avoid concomitant use when possible. If combined, selumetinib dose reductions are recommended and vary based on body surface area and selumetinib dose. For details, see the full drug interaction monograph or selumetinib prescribing information. Risk D: Consider Therapy Modification

Sertindole: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Sertindole. Risk X: Avoid

Sildenafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Sildenafil. Risk C: Monitor

Silodosin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Silodosin. Risk C: Monitor

Simeprevir: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Simeprevir. Risk X: Avoid

Simvastatin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Simvastatin. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Simvastatin. Risk C: Monitor

Sirolimus (Conventional): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Sirolimus (Conventional). Management: Monitor for increased serum concentrations of sirolimus if combined with a moderate CYP3A4 inhibitor. Lower initial sirolimus doses or sirolimus dose reductions will likely be required. Risk D: Consider Therapy Modification

Sirolimus (Protein Bound): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Sirolimus (Protein Bound). Management: Reduce the dose of protein bound sirolimus to 56 mg/m² when used concomitantly with a moderate CYP3A4 inhibitor. Risk D: Consider Therapy Modification

Solifenacin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Solifenacin. Risk C: Monitor

Sonidegib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Sonidegib. Management: Avoid concomitant use of sonidegib and moderate CYP3A4 inhibitors when possible. When concomitant use cannot be avoided, limit CYP3A4 inhibitor use to less than 14 days and monitor for sonidegib toxicity (particularly musculoskeletal adverse reactions). Risk D: Consider Therapy Modification

Sparsentan: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Sparsentan. Risk C: Monitor

SUFentanil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of SUFentanil. Risk C: Monitor

SUNItinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of SUNItinib. Risk C: Monitor

Suvorexant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Suvorexant. Management: The recommended dose of suvorexant is 5 mg daily in patients receiving a moderate CYP3A4 inhibitor. The dose can be increased to 10 mg daily (maximum dose) if necessary for efficacy. Risk D: Consider Therapy Modification

Suzetrigine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Suzetrigine. Management: Reduce suzetrigine dose as follows: initiate with 100 mg for 1 dose; then 12 hours after first dose, give 50 mg every 12 hours for doses 2, 3, and 4; then 50 mg every 24 hours for dose 5 and thereafter. Risk D: Consider Therapy Modification

Tacrolimus (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor

Tacrolimus (Topical): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tacrolimus (Topical). Risk C: Monitor

Tadalafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tadalafil. Risk C: Monitor

Tamsulosin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tamsulosin. Risk C: Monitor

Tazemetostat: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tazemetostat. Management: Avoid when possible. If combined, reduce tazemetostat dose from 800 mg twice daily to 400 mg twice daily, from 600 mg twice daily to 400 mg in AM and 200 mg in PM, or from 400 mg twice daily to 200 mg twice daily. Risk D: Consider Therapy Modification

Temsirolimus: CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Temsirolimus. Specifically, concentrations of sirolimus may be increased. Risk C: Monitor

Tetrahydrocannabinol and Cannabidiol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tetrahydrocannabinol and Cannabidiol. Risk C: Monitor

Tetrahydrocannabinol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tetrahydrocannabinol. Risk C: Monitor

Tezacaftor and Ivacaftor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tezacaftor and Ivacaftor. Management: If combined with moderate CYP3A4 inhibitors, give tezacaftor/ivacaftor in the morning, every other day; give ivacaftor in the morning, every other day on alternate days. Tezacaftor/ivacaftor dose depends on age and weight; see full Lexi-Interact monograph Risk D: Consider Therapy Modification

Thiotepa: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Thiotepa. CYP3A4 Inhibitors (Moderate) may decrease active metabolite exposure of Thiotepa. Risk C: Monitor

Ticagrelor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ticagrelor. CYP3A4 Inhibitors (Moderate) may decrease active metabolite exposure of Ticagrelor. Risk C: Monitor

Tilidine: CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Tilidine. CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tilidine. Risk C: Monitor

Tofacitinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tofacitinib. Risk C: Monitor

Tolterodine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tolterodine. Risk C: Monitor

Tolvaptan: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tolvaptan. Management: Avoid this combination with Samsca brand of tolvaptan. Reduce dose for Jynarque brand: 90 mg AM and 30 mg PM, reduce to 45 mg AM and 15 mg PM; 60 mg AM and 30 mg PM, reduce to 30 mg AM and 15 mg PM; 45 mg AM and 15 mg PM, reduce to 15 mg AM and PM. Risk D: Consider Therapy Modification

Toremifene: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Toremifene. Risk C: Monitor

Trabectedin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Trabectedin. Risk C: Monitor

TraMADol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of TraMADol. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of TraMADol. Risk C: Monitor

TraZODone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of TraZODone. Risk C: Monitor

Tretinoin (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tretinoin (Systemic). Risk C: Monitor

Triamcinolone (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Triamcinolone (Systemic). Risk C: Monitor

Triazolam: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Triazolam. Management: Consider triazolam dose reduction in patients receiving concomitant moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification

Ubrogepant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ubrogepant. Management: Use an initial ubrogepant dose of 50 mg and avoid a second dose for 24 hours when used with moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification

Udenafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Udenafil. Risk C: Monitor

Valbenazine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Valbenazine. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Valbenazine. Risk C: Monitor

Vamorolone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vamorolone. Risk C: Monitor

Vanzacaftor, Tezacaftor, and Deutivacaftor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vanzacaftor, Tezacaftor, and Deutivacaftor. Management: Age- and weight-specific dose reductions of vanzacaftor, tezacaftor, and deutivacaftor are recommended. Please see full Interact monograph or labeling for details. Risk D: Consider Therapy Modification

Vardenafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vardenafil. Management: Limit Levitra (vardenafil) dose to a single 5 mg dose within a 24-hour period if combined with moderate CYP3A4 inhibitors. Avoid concomitant use of Staxyn (vardenafil) and moderate CYP3A4 inhibitors. Combined use is contraindicated outside of the US. Risk D: Consider Therapy Modification

Vemurafenib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vemurafenib. Risk C: Monitor

Venetoclax: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Venetoclax. Management: Reduce the venetoclax dose by at least 50% in patients requiring concomitant treatment with moderate CYP3A4 inhibitors. Resume the previous venetoclax dose 2 to 3 days after discontinuation of moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification

Vilazodone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vilazodone. Risk C: Monitor

VinBLAStine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of VinBLAStine. Risk C: Monitor

VinCRIStine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of VinCRIStine. Risk C: Monitor

Vindesine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vindesine. Risk C: Monitor

Vinflunine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vinflunine. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Vinflunine. Risk C: Monitor

Vitamin K Antagonists: Aprepitant may decrease serum concentration of Vitamin K Antagonists. Risk C: Monitor

Voclosporin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Voclosporin. Management: Decrease the voclosporin dose to 15.8 mg in the morning and 7.9 mg in the evening when combined with moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification

Vorapaxar: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vorapaxar. Risk C: Monitor

Zanubrutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Zanubrutinib. Management: Decrease the zanubrutinib dose to 80 mg twice daily during coadministration with a moderate CYP3A4 inhibitor. Further dose adjustments may be required for zanubrutinib toxicities, refer to prescribing information for details. Risk D: Consider Therapy Modification

Zopiclone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Zopiclone. Risk C: Monitor

Zuranolone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Zuranolone. Risk C: Monitor

Food Interactions

Aprepitant serum concentration may be increased when taken with grapefruit juice. Management: Avoid concurrent use.

Reproductive Considerations

Efficacy of hormonal contraceptive may be reduced during treatment and for 1 month following the last aprepitant dose; alternative or backup contraception (eg, condoms, spermicides) should be used during treatment with aprepitant and for 1 month following the last aprepitant dose.

Pregnancy Considerations

The injection formulation contains ethanol; avoid use in patients who are pregnant.

Breastfeeding Considerations

It is not known if aprepitant is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. The injection formulation contains ethanol.

Monitoring Parameters

In patients receiving concurrent warfarin, monitor INR/PT for 2 weeks (particularly at 7 to 10 days) following aprepitant administration. Monitor patients with severe hepatic impairment for adverse reactions. Monitor for signs/symptoms of hypersensitivity reaction.

Mechanism of Action

Aprepitant prevents acute and delayed vomiting by inhibiting the substance P/neurokinin 1 (NK₁) receptor; augments the antiemetic activity of 5-HT₃ receptor antagonists and corticosteroids to inhibit acute and delayed phases of chemotherapy-induced emesis.

Pharmacokinetics (Adult Data Unless Noted)

Distribution: V_d: IV, Oral: ~70 L; crosses the blood-brain barrier

Protein binding: IV: >99%; Oral: >95%

Metabolism: Extensively hepatic via CYP3A4 (major); CYP1A2 and CYP2C19 (minor); forms 7 metabolites (weakly active)

Bioavailability: ~60% to 65%

Half-life elimination: Terminal: IV, Oral: ~9 to 13 hours

Time to peak, plasma: Pediatric: Capsule: ~4 hours; Suspension ~6 hours; Adults: 40 mg: ~3 hours; 125 mg followed by 80 mg for 2 days: ~4 hours

Excretion: Primarily via metabolism

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Kidney impairment: Following a single oral aprepitant 240 mg dose in patients with severe kidney impairment (CrCl <30 mL/minute/1.73 m²) and end-stage kidney disease requiring hemodialysis, the AUC of total aprepitant (unbound and protein bound) decreased by 21% and C_max decreased by 32% compared with healthy subjects. In patients with end-stage kidney disease undergoing hemodialysis, the AUC of total aprepitant decreased by 42% and C_max decreased by 32%.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Emend;
(AR) Argentina: Emend;
(AT) Austria: Aprepitant accord | Aprepitant ratiopharm | Aprepitant sandoz | Emend;
(AU) Australia: Aprepitant apotex | Emend;
(BD) Bangladesh: Apridex | Emend | Emestop | Vomend;
(BE) Belgium: Aprepitant sandoz | Aprepitant teva | Emend;
(BR) Brazil: Emend;
(CL) Chile: Emend;
(CN) China: Emend | Ou ke ping;
(CO) Colombia: Emend | Lemid;
(CZ) Czech Republic: Aprepitant accord | Aprepitant sandoz | Aprepitant teva;
(DE) Germany: Aprepilor | Aprepitant al | Aprepitant beta | Aprepitant heumann | Aprepitant stada | Aprepitant zentiva | Emend;
(EC) Ecuador: Alfenil | Emend;
(EE) Estonia: Aprepitant sandoz;
(EG) Egypt: Emend;
(ES) Spain: Aprepitant accord | Aprepitant sandoz | Emend;
(FI) Finland: Aprepitant stada | Emend;
(FR) France: Aprepitant accord | Aprepitant arrow | Aprepitant biogaran | Aprepitant cristers | Aprepitant Dci | Aprepitant eg | Aprepitant evolgen | Aprepitant mylan | Aprepitant reddy pharma | Aprepitant sandoz | Aprepitant teva | Aprepitant zentiva | Emend;
(GB) United Kingdom: Aprepitant accord | Aprepitant mylan | Aprepitant zentiva | Emend;
(GR) Greece: Emend | Inepitant;
(HK) Hong Kong: Emend;
(HR) Croatia: Emend;
(HU) Hungary: Aprepitant pharmacenter | Aprepitant q pharm;
(IE) Ireland: Aprepitant accord | Emend;
(IL) Israel: Emend;
(IN) India: Amitant | Aprecap | Aprelief | Apretero | Aprifast | Apriset | Apristar | Emetant | Fixpritant | Fosup;
(IT) Italy: Aprepitant accord | Aprepitant teva | Atanto | Emend;
(JO) Jordan: Emend;
(JP) Japan: Aprepitant nk | Emend;
(KR) Korea, Republic of: Emend;
(KW) Kuwait: Emend;
(LB) Lebanon: Aprepitant biogaran;
(LT) Lithuania: Aprepitant sandoz;
(LV) Latvia: Aprepitant sandoz | Emend;
(MX) Mexico: Aprepitant sandoz | Emend | Iramenol;
(MY) Malaysia: Emend;
(NL) Netherlands: Aprepitant Aurobindo | Aprepitant CF | Aprepitant sandoz | Aprepitant teva | Aprepitant Xiromed | Emend;
(NO) Norway: Emend;
(PE) Peru: Emend;
(PH) Philippines: Emend;
(PK) Pakistan: Aprefold | Apreon | Aprep | Aprewin | Aprimark | Apritus | G tant | Nautant | Pitantwel | Repitant;
(PL) Poland: Aprepitant sandoz | Aprepitant stada | Aprepitant teva;
(PR) Puerto Rico: Aponvie | Cinvanti | Emend;
(PT) Portugal: Aprepitant generis | Aprepitant teva;
(QA) Qatar: Emend | Emend Tri-Pack;
(RO) Romania: Emend;
(RU) Russian Federation: Aprepitant psk | Emend;
(SA) Saudi Arabia: Emend | Enevom;
(SE) Sweden: Aprepitant 2care4 | Aprepitant ebb | Aprepitant Medical Valley | Aprepitant stada | Emend;
(SG) Singapore: Emend;
(SI) Slovenia: Aprepitant teva | Emend;
(SK) Slovakia: Aprepitant stada | Aprepitant teva;
(TN) Tunisia: Emend;
(TR) Turkey: Emend;
(TW) Taiwan: Aprevitae;
(UA) Ukraine: Emend;
(UY) Uruguay: Sulatan;
(VE) Venezuela, Bolivarian Republic of: Emend;
(ZA) South Africa: Aprepitant 125 eurolab | Aprepitant 80 eurolab | Aprepitant combipack eurolab

Aponvie (aprepitant) [prescribing information]. San Diego, CA: Heron Therapeutics Inc; March 2024.
Aprepitant capsules [prescribing information]. Basking Ridge, NJ: Torrent Pharma Inc; September 2022.
Cinvanti (aprepitant) injection [prescribing information]. San Diego, CA: Heron Therapeutics Inc; March 2024.
Cinvanti (aprepitant) injectable emulsion for intravenous (IV) use administration via IV push, Heron Therapeutics [data on file, January 2019].
Cristofori F, Thapar N, Saliakellis E, et al. Efficacy of the neurokinin-1 receptor antagonist aprepitant in children with cyclical vomiting syndrome. Aliment Pharmacol Ther. 2014;40(3):309-317. doi:10.1111/apt.12822 [PubMed 24898244]
Emend (aprepitant) capsules and oral suspension [prescribing information]. Rahway, NJ: Merck Sharp & Dohme LLC; May 2022.
Gan TJ, Diemunsch P, Habib AS, et al; Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting [published corrections appear in Anesth Analg. 2015;120(2):494; Anesth Analg. 2014;118(3):689]. Anesth Analg. 2014;118(1):85-113. doi:10.1213/ANE.0000000000000002. [PubMed 24356162]
Herrstedt J, Clark-Snow R, Ruhlmann CH, et al. 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting. ESMO Open. 2024;9(2):102195. doi:10.1016/j.esmoop.2023.102195 [PubMed 38458657]
Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: ASCO guideline update. J Clin Oncol. 2020;38(24):2782-2797. doi:10.1200/JCO.20.01296 [PubMed 32658626]
Kanukollu S, Spatz K, Lavery JA, Bender JG, Mauguen A, Mathew S. Safety and tolerability of intravenous aprepitant and fosaprepitant in children with cancer: a retrospective, single-center review. Pediatr Blood Cancer. 2024;71(4):e30882. doi:10.1002/pbc.30882 [PubMed 38267822]
Li BUK. Managing cyclic vomiting syndrome in children: beyond the guidelines. Eur J Pediatr. 2018;177(10):1435-1442. doi:10.1007/s00431-018-3218-7 [PubMed 30076469]
Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008;47(3):379-393. doi:10.1097/MPG.0b013e318173ed39 [PubMed 18728540]
Patel P, Robinson PD, Cohen M, et al. Prevention of acute and delayed chemotherapy-induced nausea and vomiting in pediatric cancer patients: a clinical practice guideline. Pediatr Blood Cancer. 2022;69(12):e30001. doi:10.1002/pbc.30001 [PubMed 36221901]
Refer to manufacturer's labeling.

Topic 9305 Version 461.0

خرید پکیج

Aprepitant: Drug information