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

Contraindications and Warnings

Fosaprepitant and aprepitant are contraindicated in patients with a known hypersensitivity to the active drug or drug product excipients.[1] Hypersensitivity reactions, including anaphylaxis, dyspnea, hypotension, flushing, erythema, and syncope have been reported after their administration. Use of these drugs is also contraindicated in patients taking pimozide. Aprepitant inhibits CYP3A4 and may impair the metabolism of pimozide, resulting in QTc prolongation and the risk for arrhythmias.

Severe infusion site reactions, including thrombophlebitis and vasculitis, have been reported following the use of fosaprepitant. In the majority of these cases, the patient had also received anthracycline-based chemotherapy and had a possible extravasation. The infusion site should be closely monitored during and after fosaprepitant, and the infusion immediately discontinued if symptoms are noted. Most infusion site reactions have been reported within the first three exposures to the drug, with some cases lasting more than 2 weeks. Necrosis may occur as a result of these reactions, resulting in the need for surgical intervention.