Long COVID Patterns in the RECOVER-Adult Study
November 21, 2025
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Brand Name :
Aponvie, Cinvanti,Emend PO
Synonyms :
aprepitant
Class :
Antiemetic Agents; NK1 Receptor Antagonists
Brand Name :
Aponvie, Cinvanti,Emend PO
Synonyms :
aprepitant
Class :
Antiemetic Agents; NK1 Receptor Antagonists
Dosage Forms & Strengths
Oral suspension (Emend PO)
125mg/pouch (Mixing pouch with 4.6 mL drinking water produces 25mg/mL suspension)
7.2mg/mL (130mg/18mL) (Cinvanti)
7.2mg/mL (32mg/4.4mL single-dose vial) (Aponvie)
40mg
80mg
125mg
Chemotherapy Induced Vomiting And NauseaÂ
Indicated in combination with other antiemetic agents to prevent nausea and vomiting caused by emetogenic cancer chemotherapy
:
Highly emetogenic cancer chemotherapy (HEC)
Day 1: 125 mg taken orally one hour before chemotherapy, 12 mg dexamethasone taken orally 30 minutes before chemotherapy, and a 5-HT3 antagonist.
Days 2-3: Dexamethasone 8 mg taken orally every morning together with 80 mg taken orally one hour before chemotherapy
Day 4: Take 8 mg of dexamethasone orally in the morning.
Moderately emetogenic cancer chemotherapy (MEC)
Day 1: 125 mg taken orally one hour before chemotherapy, 12 mg of dexamethasone taken orally 30 minutes before chemotherapy, and a 5-HT3 antagonist.
Days 2-3: 80 mg taken orally one hour before chemotherapy
Intravenous emulsion (aprepitant - Cinvanti)
Indicated with other antiemetics to avoid
Nausea and vomiting, both immediate and delayed, are common reactions to high-dose cisplatin and other highly emetogenic cancer chemotherapy (HEC) regimens.
Delayed nausea and vomiting from single-dose moderately emetogenic cancer chemotherapy (MEC).
Initial and recurrent 3-day MEC regimens cause nausea and vomiting.
Highly emetogenic cancer chemotherapy (HEC)
Day 1: 130 mg intravenously injected over 30 minutes or as an intravenous push over 2 minutes; complete infusion or injection 30 minutes before treatment, as well as dexamethasone 12 mg orally and a 5-HT3 antagonist
Day 2: 8 mg dexamethasone orally in the morning
Days 3 and 4: Dexamethasone 8 mg orally twice a day (morning and evening)
Moderately emetogenic cancer chemotherapy (MEC)
Single dose regimen:
Day 1: Dexamethasone 12 mg orally, a 5-HT3 antagonist, and 130 mg intravenously administered over 30 minutes or as an intravenous push over 2 minutes; complete infusion or injection 30 minutes before treatment.
3-day regimen including oral aprepitant:
Day 1: Dexamethasone 12 mg orally, a 5-HT3 antagonist, and 100 mg intravenously administered over 30 minutes or as an intravenous push over 2 minutes; complete infusion or injection 30 minutes before treatment.
Days 2-3: 80 mg orally one hour before chemotherapy
Postoperative Vomiting and Nausea
Intravenous emulsion (aprepitant – Aponvie)
Indicated for preventing postoperative nausea and vomiting (PONV) in adults
Before induction of anesthesia, administer 32 mg intravenously over 30 seconds.
Dose Adjustments
Renal Impairment
Severe (CrCl <30 mL/min): AUC of total aprepitant (unbound and protein-bound) reduced by 21%, and Cmax dropped by 32% as compared to healthy participants (CrCl >80 mL/min).
ESRD patients receiving hemodialysis: AUC of total aprepitant was reduced by 42%, while Cmax was reduced by 32%.
Hepatic Impairment
Mild to moderate (Child-Pugh score 5 to 9): No dosage modification is required. Severe (Child-Pugh score >9): Safety and efficacy are unknown.
Dosage Forms & Strengths
Oral suspension (Emend PO)
125mg/pouch (Mixing pouch with 4.6 mL drinking water produces 25mg/mL suspension)
7.2mg/mL (130mg/18mL) (Cinvanti)
7.2mg/mL (32mg/4.4mL single-dose vial) (Aponvie)
40mg
80mg
125mg
Chemotherapy Induced Vomiting And NauseaÂ
<6 months: Safety and efficacy not established
≥6 months to less than 12 years:
Day 1: 3 mg/kg taken orally one hour before chemotherapy
Days 2 and 3: 2 mg/kg orally, one hour before chemotherapy.
Administer dexamethasone and a 5-HT3 antagonist simultaneously.
Capsule
<12 years or weight <30 kg: Safety and efficacy not established.
≥12 years or <12 years and weight ≥30 kg:
Day 1: 125 mg taken orally one hour before chemotherapy, 12 mg taken orally 30 minutes before, and a 5-HT3 antagonist.
Days 2 and 3: 80 mg taken orally one hour before treatment and 8 mg of dexamethasone taken orally every morning.
Day 4: Take 8 mg of dexamethasone in the morning.
refer adult dosing
may enhance the serum concentration of CYP3A4 Inhibitor
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
aprepitant: they may diminish the serum concentration of hormonal contraceptives
aprepitant: they may diminish the serum concentration of hormonal contraceptives
aprepitant: they may diminish the serum concentration of hormonal contraceptives
aprepitant: they may diminish the serum concentration of hormonal contraceptives
may enhance the concentration of serum when combined with methylprednisolone
aprepitant: they may diminish the serum concentration of hormonal contraceptives
aprepitant: they may diminish the serum concentration of hormonal contraceptives
aprepitant: they may diminish the serum concentration of hormonal contraceptives
aprepitant: they may diminish the serum concentration of hormonal contraceptives
may diminish the serum concentration of Hormonal Contraceptives
may diminish the metabolism of each other when combined
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the concentration of serum when combined with aprepitant
may enhance the concentration of serum when combined with aprepitant
may enhance the concentration of serum when combined with aprepitant
may enhance the concentration of serum when combined with aprepitant
may enhance the concentration of serum when combined with aprepitant
aprepitant: they may enhance the serum concentration of CYP3A Inhibitors
aprepitant: they may enhance the serum concentration of CYP3A Inhibitors
aprepitant: they may enhance the serum concentration of CYP3A Inhibitors
aprepitant: they may enhance the serum concentration of CYP3A Inhibitors
aprepitant: they may enhance the serum concentration of CYP3A Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 Inhibitors
It may enhance the effect when combined with irinotecan liposomal by affecting CYP3A4 metabolism
It may enhance the effect when combined with cannabidiol by affecting CYP3A4 metabolism
aprepitant: they may diminish the serum concentration of CYP3A4 Inducers
aprepitant: they may diminish the serum concentration of CYP3A4 Inducers
aprepitant: they may diminish the serum concentration of CYP3A4 Inducers
aprepitant: they may diminish the serum concentration of CYP3A4 Inducers
aprepitant: they may diminish the serum concentration of CYP3A4 Inducers
It may diminish the effect when combined with griseofulvin by CYP3A4 metabolism
may enhance the concentration of serum when combined with ergot derivatives
may enhance the concentration of serum when combined with ergot derivatives
may enhance the concentration of serum when combined with ergot derivatives
may enhance the concentration of serum when combined with ergot derivatives
may enhance the concentration of serum when combined with ergot derivatives
It may enhance the levels when combined with tamsulosin by affecting CYP3A4 metabolism
Combining tegafur with aprepitant can reduce tegafur’s metabolism
When domeperidone and aprepitant is used together, this leads to reduction in the domeperidone’s metabolism
When aprepitant is used together with fluconazole, this leads to reduction in the aprepitant metabolism
aprepitant: it may reduce the metabolism of cerivastatin
the metabolism of digitoxin can be diminished when combined with aprepitant
When aprepitant is used together with oliceridine, this leads to enhanced concentration serum of oliceridine
Actions and Spectrum:
The mechanism of action of aprepitant involves blocking the binding of substance P, a neurokinin neurotransmitter, to the NK1 receptors in the brain. Substance P is known to play a role in regulating nausea and vomiting in the brainstem. By inhibiting the activation of NK1 receptors, aprepitant helps to prevent the signals that trigger nausea and vomiting from being transmitted to the brain. aprepitant has a broad spectrum of activity against both acute and delayed CINV caused by moderately and highly emetogenic (nausea-inducing) chemotherapy, as well as for PONV. It is commonly used with other antiemetic medications, such as 5-HT3 receptor antagonists and corticosteroids, to provide a multi-faceted approach to preventing nausea and vomiting associated with chemotherapy or surgery.
Frequency defined
>10%
Neutropenia (13%)
1-10%
Diarrhea (6%)
Cough (5%)
Hemoglobin decreased (5%)
Hiccups (4%)
Headache (9%)
Decreased appetite (5%)
Fatigue (5%)
Dizziness (5%)
Black box warning:
None
Contraindications/caution:
Contraindications:
Caution:
Dizziness and Fatigue: aprepitant can cause dizziness and fatigue in some patients. Patients should be cautious when engaging in activities that require alertness, such as driving or operating heavy machinery until they know how aprepitant affects them.
Pregnancy consideration: Insufficient data available
Lactation: Excretion of the drug in human breast milk is unknown
Pregnancy category:
Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.
Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.
Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.
Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.
Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.
Category N: There is no data available for the drug under this category
Pharmacology:
aprepitant is a selective antagonist of the neurokinin-1 (NK1) receptor, a receptor in the central nervous system (CNS) and peripheral tissues. aprepitant works by binding to and blocking the NK1 receptors in areas of the brain that regulate nausea and vomiting, particularly the vomiting centre in the brainstem’s medulla.
The binding of aprepitant to NK1 receptors prevents the binding of substance P, a neurotransmitter that plays a vital role in initiating and maintaining nausea and vomiting. Substance P is released in response to various stimuli, including chemotherapy-induced emetogenic (nausea-inducing) agents, and it acts on NK1 receptors to transmit signals that trigger the vomiting reflex. By blocking the NK1 receptors, aprepitant helps to inhibit the signals that trigger nausea and vomiting, making it effective in preventing chemotherapy-induced nausea and vomiting (CINV).
Pharmacodynamics:
aprepitant’s antagonism of NK1 receptors results in several pharmacodynamic effects, including:
Pharmacokinetics:
Absorption
aprepitant is rapidly absorbed after oral administration. The absolute oral bioavailability of aprepitant is approximately 60-65%. The rate and extent of absorption may be influenced by food, with a higher exposure observed when taken with food, particularly high-fat meals. aprepitant is available in oral capsule form.
Distribution
aprepitant is extensively distributed in the body, with a high volume of distribution indicating extensive tissue distribution. It is approximately 95% bound to plasma proteins, mainly to albumin.
Metabolism
aprepitant undergoes extensive metabolism in the liver primarily by the cytochrome P450 enzyme system, primarily CYP3A4. It is metabolized to several active and inactive metabolites, including hydroxyaprepitant, which is the primary active metabolite. These metabolites are further metabolized to glucuronide conjugates. aprepitant itself has minimal pharmacological activity.
Elimination and Excretion
aprepitant and its metabolites are primarily excreted in feces via the bile, with a small portion excreted in urine. The elimination half-life of the aprepitant is approximately 9 to 13 hours. Most of the dose is excreted within 120 hours after administration.
Administration:
Patient information leaflet
Generic Name: aprepitant
Why do we use aprepitant?
aprepitant is a medication primarily used to prevent chemotherapy-induced nausea and vomiting (CINV) in cancer patients undergoing highly emetogenic or moderately emetogenic chemotherapy regimens. It prevents postoperative nausea and vomiting (PONV) in specific surgical procedures. aprepitant is a neurokinin-1 (NK1) receptor antagonist that works by blocking the action of substance P, a neurotransmitter in the brain involved in developing nausea and vomiting.
The specific uses of aprepitant include:
Postoperative Nausea and Vomiting (PONV) Prevention: aprepitant is used to prevent PONV in specific surgical procedures. It may be part of a multimodal approach to prevent nausea and vomiting after surgery, combined with other antiemetic medications.
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