Home Drug Guide Aprepitant

Drug Guide

Generic Name

Aprepitant

Brand Names Emend, Cinvanti, Aponvie

Classification

Therapeutic: Antiemetic

Pharmacological: Neurokinin-1 (NK1) receptor antagonist

FDA Approved Indications

  • Prevention of chemotherapy-induced nausea and vomiting (CINV) including prophylaxis of acute and delayed nausea and vomiting

Mechanism of Action

Aprepitant blocks substance P/neurokinin-1 (NK1) receptors in the brain's vomiting center and in the gastrointestinal tract, preventing nausea and vomiting signals.

Dosage and Administration

Adult: 125 mg on day 1, then 80 mg once daily on days 2 and 3 for CINV prevention.

Pediatric: Dosing varies; consult specific guidelines based on age and weight.

Geriatric: No specific dosage adjustment necessary but monitor for increased sensitivity.

Renal Impairment: No dose adjustment necessary.

Hepatic Impairment: Reduce dose in moderate to severe hepatic impairment.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; high protein binding.

Metabolism: Primarily hepatic via CYP3A4 and CYP1A2.

Excretion: Metabolites excreted in urine and feces.

Half Life: Approximately 9-13 hours.

Contraindications

  • Hypersensitivity to aprepitant or any component of the formulation.

Precautions

  • Use cautiously with medications that are substrates, inhibitors, or inducers of CYP3A4 or CYP2C9.
  • Monitor for interactions, especially with warfarin and hormonal contraceptives.

Adverse Reactions - Common

  • Fatigue (Common)
  • Nausea (Common)
  • Hiccups (Less common)

Adverse Reactions - Serious

  • Serious skin reactions, including Stevens-Johnson syndrome (Rare)
  • Anaphylaxis (Rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) increase aprepitant levels.
  • CYP3A4 inducers (e.g., rifampin) decrease efficacy.
  • Warfarin: monitor INR closely.
  • Hormonal contraceptives: reduce effectiveness.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess for allergies, current medications, and potential drug interactions.

Diagnoses:

  • Risk for decreased drug efficacy or toxicity due to drug interactions.

Implementation: Administer as prescribed, preferably with a full glass of water.

Evaluation: Monitor effectiveness in preventing nausea and vomiting, and for adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any severe or unusual side effects.
  • Use additional contraceptive measures if hormonal contraceptives are affected.
  • Inform healthcare provider about all medications being taken.

Special Considerations

Black Box Warnings:

  • None currently,

Genetic Factors: Consider CYP3A4 genetic polymorphisms that may affect metabolism.

Lab Test Interference: May increase bleeding time tests; monitor accordingly.

Overdose Management

Signs/Symptoms: Nausea, vomiting, drowsiness.

Treatment: Supportive care, activated charcoal if ingestion was recent, and symptomatic treatment.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable as per manufacturer's instructions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.