Fosaprepitant, in combination with a 5-HT3 antagonist class of antiemetics and dexamethasone, is indicated for the:
- prevention of acute and delayed nausea and vomiting due to highly emetogenic cancer chemotherapy
- prevention of nausea and vomiting due to treatment with moderately emetogenic cancer chemotherapy
| VIAL SIZE | 0.9% SODIUM CHLORIDE for INJECTION | FINAL CONCENTRATION |
| 150 mg | 5 mL | 30 mg/mL |
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Available as 150 mg lyophilized powder for reconstitution single-use vials
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Store vials in the fridge at 2°C to 8°C
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Reconstitute 150 mg vial with 5 mL 0.9% NaCl; inject slowly along the vial wall and swirl gently to prevent foaming. DO NOT SHAKE.
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Diluted solution is stable for 24 hours at room temperature
- Solutions Compatible: 0.9% NaCl, D5W
- Y-site Compatible: dexamethasone, methylprednisolone sodium succinate, ondansetron, granisetron
- Incompatible: lactated ringers, calcium or magnesium containing solutions
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Push | NO |
| IV Intermittent Infusion |
YES Give 30-90 minutes prior to chemotherapy |
| IV Continuous Infusion | NO |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Children:
Use in combination with a 5-HT3 antagonist and with or without dexamethasone
Infants ≥6 months weighing ≥6 kg and Children <2 years:
- Single-dose regimen: Note: Use only with single-day chemotherapy regimens. IV: 5 mg/kg once; MAXIMUM DOSE: 150 mg/dose
- Three-day regimen: Note: may be used with single-day or multi-day chemotherapy regimens.
- Day 1: IV: 3 mg/kg once; MAXIMUM DOSE: 115 mg/dose;
- Day 2 and 3: IV: 2 mg/kg once daily for 2 doses; MAXIMUM DOSE: 80 mg/dose
Children 2 to <12 years:
- Single-dose regimen: Note: use only with single-day chemotherapy regimens. IV: 4 mg/kg once; MAXIMUM DOSE: 150 mg/dose
- Three-day regimen: Note: may be used with single-day or multiday chemotherapy regimens.
- Day 1: IV: 3 mg/kg once; MAXIMUM DOSE: 115 mg/dose on day 1 only; administer approximately 90 minutes prior to chemotherapy
- Day 2 and 3: IV: 2 mg/kg once daily for 2 doses; MAXIMUM DOSE: 80 mg/dose; administer approximately 90 minutes prior to chemotherapy
Children ≥12 years and Adolescents ≤17 years:
- Single-dose regimen: Note: Use only with single-day chemotherapy regimens. IV: 150 mg once
- Three-day regimen: Note: may be used with single-day or multiday chemotherapy regimens.
- Day 1: IV: 115 mg once; administer approximately 60 minutes prior to chemotherapy
- Day 2 and 3: IV: 80 mg once daily for 2 doses; administer approximately 60 minutes prior to chemotherapy
Adults:
- IV: 150 mg once on day 1 only (infusion should be completed approximately 30 minutes prior to chemotherapy). Administer in combination with a 5-HT3 antagonist and dexamethasone.
- Immediate hypersensitivity reactions including anaphylaxis, flushing, erythema, and dyspnea have occurred during infusion of fosaprepitant. Discontinue infusion and administer appropriate therapy.
- Irritation at the infusion site including pain, thrombophlebitis, and vasculitis
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Fosaprepitant is the pro-drug of aprepitant
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Fosaprepitant 150 mg IV is equivalent to aprepitant 125 mg PO
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Possible adverse effects: fatigue, weakness, diarrhea, dyspepsia, elevated ALT, and peripheral neuropathy
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Many potentially significant drug interactions: may necessitate dose adjustment of corticosteroids and other medications metabolized by CYP3A4 and CYP2C9
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Avoid administering with ifosfamide due to risk of neurotoxicity
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Coadministration of fosaprepitant with warfarin results in decreased prothrombin time (INR). The INR should be closely monitored following initiation of fosaprepitant.
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The efficacy of hormonal contraceptives during and for 28 days after fosaprepitant administration may be reduced
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Fosaprepitant is not removed by hemodialysis