Fosaprepitant and Aprepitant for Chemotherapy-Induced Nausea and Vomiting in Children

Marcia L. Buck, PharmD, FCCP, FPPAG, BCPPS


Pediatr Pharm. 2018;24(6) 

In This Article

Abstract and Introduction


The Food and Drug Administration (FDA) has recently extended approval for fosaprepitant (Emend® for injection) to include children 6 months of age and older for prevention of chemotherapy-induced nausea and vomiting (CINV) associated with highly or moderately emetogenic chemotherapy (HEC or MEC).[1] Fosaprepitant is a prodrug of aprepitant that can be given intravenously; it was introduced in the US in 2008. Aprepitant was first approved by the FDA in 2003, with the oral capsule and suspension formulations of the drug approved for use in children in 2015. A review of aprepitant use in children was published in Pediatric Pharmacotherapy (volume 21, issue 5) later that year.

The safety and efficacy of aprepitant has continued to be demonstrated in controlled trials to reduce nausea and emesis in children receiving HEC or MEC.[2–6] In a recent systematic review and meta-analyses published by Okumura and colleagues in the British Journal of Clinical Pharmacology, the authors found a 52% relative risk reduction of CINV with the combination of aprepitant, ondansetron, and dexamethasone.[6] Based on these studies, the 2016 update of the Multinational Association for Supportive Care in Cancer (MASCC) consensus statement on prevention of acute CINV recommended that aprepitant be included as a standard component in prophylactic antiemetic regimens for HEC and for MEC in children unable to receive dexamethasone.[5] The 2017 update of the Pediatric Oncology Group of Ontario guidelines for prevention of CINV also recommends aprepitant for all children 6 months of age and older receiving MEC or HEC.[6] As the use of aprepitant has become more widespread, fosaprepitant has become a valuable alternative for children who are unable to take the oral medications.