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

Dosing Recommendations

Aprepitant or fosaprepitant should be used in conjunction with a serotonin (5-HT3) antagonist with or without a corticosteroid, typically dexamethasone.[1] For single-day chemotherapy regimens in infants 6 months of age and weighing at least 6 kg to children up to 2 years of age, fosaprepitant should be infused through a central venous catheter at a dose of 5 mg/kg given over 60 minutes. For patients 2 years of age up to 12 years, a dose of 4 mg/kg should be infused over 60 minutes. The maximum dose for both age groups is 150 mg. For adolescents 12 years of age and older, as well as adults, a dose of 150 mg should be infused over 30 minutes.

For multi-day chemotherapy regimens, the manufacturer recommends that fosaprepitant be used on day 1 of chemotherapy, followed by aprepitant solution or capsules on days 2 and 3. In the 6 months to 12 years age group, a dose of 3 mg/kg (maximum dose 115 mg) should be infused over 60 minutes, followed by aprepitant given orally at a dose of 2 mg/kg (maximum dose 80 mg). In patients 12 to 17 years of age, a fosaprepitant dose of 115 mg should be infused over 30 minutes on day 1 of chemotherapy, followed by an oral dose of 80 mg on days 2 and 3. Patients should be monitored for signs of a hypersensitivity and infusion site reactions during and after the infusion.