Fosaprepitant Accord: Uses, Dosage & Side Effects
An NK1 receptor antagonist prodrug given intravenously to prevent chemotherapy-induced nausea and vomiting (CINV) in adults, adolescents, and children aged 6 months and older
Fosaprepitant Accord is an intravenous antiemetic medication used to prevent nausea and vomiting caused by cancer chemotherapy. It contains fosaprepitant, a prodrug that is rapidly converted in the body to aprepitant, a selective neurokinin 1 (NK1) receptor antagonist. By blocking NK1 receptors in the brain, it interrupts the signaling cascade that triggers the emetic (vomiting) reflex. Fosaprepitant Accord is used in combination with other antiemetic medicines – typically a 5-HT3 receptor antagonist (such as ondansetron) and a corticosteroid (such as dexamethasone) – and is approved for adults, adolescents, and children aged 6 months and older who are receiving highly or moderately emetogenic chemotherapy.
Quick Facts: Fosaprepitant Accord
Key Takeaways
- Fosaprepitant Accord is a prodrug that converts to aprepitant in the body and blocks NK1 receptors in the brain, preventing both the acute and delayed phases of chemotherapy-induced nausea and vomiting (CINV).
- It is always used in combination with other antiemetics – a 5-HT3 receptor antagonist (e.g., ondansetron) and a corticosteroid (e.g., dexamethasone) – as part of a triple antiemetic regimen recommended by international guidelines.
- The standard adult dose is 150 mg given as a single IV infusion over 30 minutes, approximately 30 minutes before chemotherapy; pediatric dosing is weight-based and infused over 60–90 minutes.
- Important drug interactions exist: fosaprepitant/aprepitant can reduce the effectiveness of hormonal contraceptives and may interact with drugs metabolized by CYP3A4, including many chemotherapy agents, immunosuppressants, and sedatives.
- Fosaprepitant Accord must not be used with pimozide, terfenadine, astemizole, or cisapride due to the risk of serious adverse reactions from elevated plasma levels of these drugs.
What Is Fosaprepitant Accord and What Is It Used For?
Fosaprepitant Accord contains the active substance fosaprepitant (as fosaprepitant dimeglumine), which is rapidly converted in the body to aprepitant by phosphatase enzymes. Aprepitant belongs to a class of medicines known as neurokinin 1 (NK1) receptor antagonists. In the brain, there is a specific area – the nucleus tractus solitarius and the area postrema – that controls nausea and vomiting. The neurotransmitter substance P, which binds to NK1 receptors in this region, plays a critical role in triggering the emetic reflex. Fosaprepitant Accord works by blocking the binding of substance P to these NK1 receptors, thereby reducing nausea and vomiting.
Chemotherapy-induced nausea and vomiting (CINV) is one of the most feared and distressing side effects of cancer treatment, with significant impact on patients’ quality of life and, in some cases, their willingness to continue treatment. CINV occurs in two distinct phases: the acute phase, which begins within the first 24 hours after chemotherapy administration, and the delayed phase, which can persist from 24 hours up to 5 days or more after treatment. While 5-HT3 receptor antagonists such as ondansetron are highly effective against acute CINV, they are less effective against the delayed phase. NK1 receptor antagonists like aprepitant fill this critical gap by providing superior control over delayed emesis, making the combination of an NK1 antagonist with a 5-HT3 antagonist and a corticosteroid the cornerstone of modern antiemetic therapy.
The intravenous formulation of fosaprepitant offers a distinct advantage in the oncology setting. Many cancer patients experience difficulty swallowing or have impaired gastrointestinal absorption due to their disease or prior treatments, making oral administration of aprepitant capsules unreliable. By providing an IV formulation, fosaprepitant can be administered reliably on the day of chemotherapy in a clinical setting, ensuring that the patient receives the full dose. The conversion of fosaprepitant to aprepitant occurs rapidly – typically within 30 minutes of infusion – and the resulting aprepitant levels are clinically equivalent to those achieved with oral aprepitant.
Fosaprepitant Accord is approved for use in the following patient populations and settings:
- Adults (18 years and older): Prevention of nausea and vomiting associated with highly emetogenic chemotherapy (HEC), such as cisplatin-based regimens, and moderately emetogenic chemotherapy (MEC). A single 150 mg dose is administered on Day 1 of the chemotherapy cycle.
- Children and adolescents (6 months to 17 years): Prevention of CINV associated with both HEC and MEC. The dose is based on the patient’s age and body weight, and may be administered on Day 1 only, or on Days 1, 2, and 3, depending on the chemotherapy regimen. Oral aprepitant may be prescribed for Days 2 and 3 instead of repeat IV dosing.
The international antiemetic guidelines published by the Multinational Association of Supportive Care in Cancer (MASCC), the European Society for Medical Oncology (ESMO), the American Society of Clinical Oncology (ASCO), and the National Comprehensive Cancer Network (NCCN) all recommend the inclusion of an NK1 receptor antagonist in the antiemetic regimen for patients receiving highly emetogenic chemotherapy, and consider it an important option for moderately emetogenic regimens as well. The three-drug combination of an NK1 antagonist, a 5-HT3 antagonist, and dexamethasone has been shown in randomized controlled trials to provide complete response rates (no vomiting, no rescue therapy) of 70–90% during the acute phase and 60–80% during the delayed phase, representing a significant improvement over two-drug regimens.
Fosaprepitant is not pharmacologically active itself. It serves as a water-soluble prodrug designed specifically for intravenous administration. After infusion, it is rapidly and efficiently converted to aprepitant by ubiquitous phosphatase enzymes in the bloodstream. This prodrug strategy overcomes the poor water solubility of aprepitant, which limits its suitability for IV formulation, while delivering the same active drug with equivalent clinical efficacy.
What Should You Know Before Receiving Fosaprepitant Accord?
Contraindications
There are specific situations in which Fosaprepitant Accord must not be used. Understanding these absolute contraindications is essential for safe treatment.
- Hypersensitivity: Do not receive Fosaprepitant Accord if you are allergic to fosaprepitant, aprepitant, polysorbate 80, or any of the other ingredients in the product (disodium edetate, anhydrous lactose, sodium hydroxide, hydrochloric acid).
- Pimozide: Co-administration is contraindicated because aprepitant (the active metabolite) inhibits CYP3A4, which could increase pimozide plasma levels and lead to serious or life-threatening cardiac arrhythmias, including QT prolongation and torsades de pointes.
- Terfenadine and astemizole: These antihistamines are contraindicated for the same reason – CYP3A4 inhibition by aprepitant may dangerously increase their plasma levels, leading to potentially fatal cardiac arrhythmias.
- Cisapride: The prokinetic agent cisapride is also contraindicated due to the risk of elevated drug levels and serious adverse cardiac events when combined with CYP3A4 inhibitors.
Cases of severe allergic reactions, including anaphylaxis, have been reported during or shortly after the infusion of fosaprepitant. Symptoms may include hives, rash, itching, difficulty breathing or swallowing, and a serious drop in blood pressure. If any of these symptoms occur, the infusion must be stopped immediately and appropriate medical treatment initiated. Patients who have experienced a hypersensitivity reaction to fosaprepitant or aprepitant should not receive this medication again.
Warnings and Precautions
Before and during treatment with Fosaprepitant Accord, discuss the following with your healthcare provider:
- Liver disease: The liver plays a critical role in metabolizing aprepitant (the active form of fosaprepitant). If you have liver impairment, your doctor may need to monitor your liver function during treatment. Limited data are available for patients with severe hepatic impairment (Child-Pugh score >9), and use in this population requires careful consideration.
- Infusion-site reactions: Reactions at or near the infusion site have been reported, including pain, redness, swelling, and induration (hardening). In rare cases, particularly when fosaprepitant is co-administered with vesicant chemotherapy agents (drugs that can damage tissue if they leak out of the vein), more serious local reactions including tissue necrosis have occurred. Healthcare professionals should monitor the infusion site carefully throughout the procedure.
- CYP3A4 interactions: Aprepitant is both a moderate inhibitor and an inducer of CYP3A4. This means it can affect the blood levels of many other medications. Particular caution is needed with drugs that have a narrow therapeutic index and are metabolized by CYP3A4.
- Warfarin interaction: In patients taking warfarin or other coumarin anticoagulants, aprepitant may affect the International Normalized Ratio (INR). Close monitoring of INR is recommended, particularly during the 2 weeks following each chemotherapy cycle that includes fosaprepitant.
Children and Adolescents
Fosaprepitant Accord should not be given to children under 6 months of age or weighing less than 6 kg, as it has not been studied in this population. For pediatric patients aged 6 months and older, dosing is based on age and body weight, and the infusion is administered over a longer duration (60–90 minutes) compared to adults.
Pregnancy and Breastfeeding
Fosaprepitant Accord should not be used during pregnancy unless clearly necessary and the potential benefit outweighs the risk to the fetus. There is limited clinical data on the use of fosaprepitant in pregnant women. Animal studies have not demonstrated direct teratogenic effects, but the available data are insufficient to establish safety during pregnancy. If you are pregnant, think you may be pregnant, or are planning to become pregnant, discuss this with your doctor before receiving this medication.
It is important to note that fosaprepitant/aprepitant can reduce the effectiveness of hormonal contraceptives, including oral contraceptive pills, contraceptive patches, implants, and certain hormonal intrauterine devices. Women of childbearing potential should use an alternative or additional non-hormonal method of contraception during treatment with Fosaprepitant Accord and for up to 2 months after the last dose.
It is not known whether fosaprepitant or aprepitant is excreted in human breast milk. Breastfeeding is therefore not recommended during treatment with this medication. If you are breastfeeding or planning to breastfeed, inform your healthcare provider before receiving Fosaprepitant Accord.
Driving and Operating Machinery
Some patients may experience dizziness or drowsiness after receiving Fosaprepitant Accord. If you experience these symptoms, you should not drive, operate machinery, or engage in other activities requiring mental alertness until the effects have resolved. It is your responsibility to assess whether you are fit to perform these tasks, and you should be aware that the side effects of the medication can affect your ability to do so safely.
Sodium Content
Fosaprepitant Accord contains less than 1 mmol sodium (23 mg) per dose and is therefore considered essentially sodium-free. This is relevant for patients on sodium-restricted diets.
How Does Fosaprepitant Accord Interact with Other Drugs?
Drug interactions with Fosaprepitant Accord are mediated through its active metabolite aprepitant, which has complex effects on the cytochrome P450 enzyme system. Aprepitant is a moderate inhibitor of CYP3A4 (during the first few days), a mild inducer of CYP3A4 (from approximately day 5 onward), and an inducer of CYP2C9. These dual effects mean that some drugs may initially have increased levels followed by decreased levels, while others may be consistently affected in one direction. It is essential to inform your doctor about all medications you are taking.
Major Interactions (Contraindicated or Avoid)
| Interacting Drug | Effect | Clinical Significance |
|---|---|---|
| Pimozide | Increased pimozide levels via CYP3A4 inhibition; risk of QT prolongation | Contraindicated – never combine |
| Terfenadine, Astemizole | Increased drug levels; risk of fatal cardiac arrhythmias | Contraindicated – never combine |
| Cisapride | Increased cisapride levels; risk of serious cardiac events | Contraindicated – never combine |
| Hormonal contraceptives (pills, patches, implants) | Reduced contraceptive efficacy via CYP3A4 induction | Use alternative non-hormonal contraception during treatment and for 2 months after |
| Ergot alkaloid derivatives (ergotamine, dihydroergotamine) | Increased ergot derivative levels; risk of ergotism | Avoid combination |
Clinically Significant Interactions (Monitor Closely)
| Interacting Drug | Effect | Clinical Significance |
|---|---|---|
| Warfarin, acenocoumarol | Decreased INR via CYP2C9 induction; altered anticoagulation | Monitor INR closely for 2 weeks after each cycle |
| Dexamethasone (oral) | Increased dexamethasone levels via CYP3A4 inhibition (~2-fold) | Reduce oral dexamethasone dose by ~50% when given with fosaprepitant |
| Cyclosporine, tacrolimus, sirolimus, everolimus | Potential increase in immunosuppressant levels via CYP3A4 inhibition | Monitor drug levels; adjust dose as needed |
| Midazolam, triazolam | Increased benzodiazepine levels; enhanced sedation | Use with caution; monitor for excessive sedation |
| Fentanyl, alfentanil | Potential increase in opioid levels via CYP3A4 inhibition | Monitor for respiratory depression and sedation |
| Irinotecan, etoposide, vinorelbine, ifosfamide | Altered chemotherapy levels via CYP3A4 modulation | Caution advised; monitor for toxicity |
| Rifampicin, phenytoin, carbamazepine | Strong CYP3A4 inducers decrease aprepitant levels | Reduced efficacy of fosaprepitant; avoid if possible |
| Ketoconazole, itraconazole, voriconazole, posaconazole | CYP3A4 inhibitors increase aprepitant levels | Use with caution; monitor for increased side effects |
| St. John’s wort | Strong CYP3A4 inducer; may reduce aprepitant levels | Avoid combination; reduced antiemetic efficacy |
| Tolbutamid | Decreased tolbutamide levels via CYP2C9 induction | Monitor blood glucose; adjust diabetes medication if needed |
The interaction profile of fosaprepitant/aprepitant is particularly important in the oncology setting, where patients typically receive multiple medications concurrently. Your oncology team will carefully review your complete medication list, including over-the-counter products, herbal remedies, and traditional medicines, before administering Fosaprepitant Accord. Dose adjustments of concomitant medications may be necessary to maintain both safety and efficacy.
Women using hormonal contraceptives should be aware that the effectiveness of their birth control may be reduced during treatment with Fosaprepitant Accord and for up to 2 months afterward. This applies to oral contraceptive pills, transdermal patches, subdermal implants, and certain hormonal intrauterine devices that release hormones. An alternative or additional non-hormonal method of contraception (such as condoms or a copper IUD) should be used during this period.
What Is the Correct Dosage of Fosaprepitant Accord?
Fosaprepitant Accord is always prepared and administered by a healthcare professional in a clinical setting. The powder must be reconstituted and then diluted before use. The reconstituted and diluted solution is given as an intravenous infusion and must not be administered as a bolus injection. Your doctor will determine the appropriate dosing schedule based on your age, weight, and the type of chemotherapy you are receiving.
Adults (18 Years and Older)
Standard Adult Dose – Single-Day Regimen
Dose: 150 mg fosaprepitant administered as a single intravenous infusion over approximately 30 minutes
Timing: Infusion should begin approximately 30 minutes before the start of chemotherapy on Day 1
Combination therapy: Given together with a 5-HT3 receptor antagonist (e.g., ondansetron) and a corticosteroid (e.g., dexamethasone). Note that the oral dexamethasone dose should be reduced by approximately 50% when co-administered with fosaprepitant.
Children and Adolescents (6 Months to 17 Years)
Pediatric Dosing – Age and Weight Based
Dose: Based on the patient’s age and body weight, as determined by the prescribing physician. The recommended dose is calculated in mg/kg for children under 12 years, and as a fixed mg dose for those 12 years and older.
Schedule: Depending on the chemotherapy regimen:
- Single-day chemotherapy: Fosaprepitant Accord is given on Day 1 only
- Multi-day chemotherapy: Fosaprepitant Accord may be given on Days 1, 2, and 3, or oral aprepitant may be prescribed on Days 2 and 3 instead
Infusion duration: 60–90 minutes, starting 60–90 minutes before chemotherapy begins
Maximum dose: Must not exceed the maximum doses specified in the prescribing information
Preparation and Administration
The preparation of Fosaprepitant Accord for infusion is carried out by trained healthcare professionals using aseptic technique. The process involves the following steps:
- Reconstitution: 5 mL of 0.9% sodium chloride solution for injection is injected into the vial along the inside wall to prevent foaming. The vial is swirled gently – shaking must be avoided.
- Dilution: An infusion bag is prepared with 145 mL of 0.9% sodium chloride solution. The entire reconstituted volume is withdrawn from the vial and transferred to the infusion bag, giving a total volume of 150 mL at a final concentration of 1 mg/mL.
- Administration: For adults, the entire 150 mL is infused. For pediatric patients, the volume to be infused is calculated based on the recommended dose.
The reconstituted and diluted solution is stable for 48 hours when stored at 20–25°C. The solution should be inspected visually for particulate matter and discoloration before administration.
Special Populations
Hepatic Impairment
No dose adjustment is required for patients with mild to moderate hepatic impairment. There is limited data for patients with severe hepatic impairment (Child-Pugh score >9); use with caution in this population.
Renal Impairment
No dose adjustment is required for patients with renal impairment, including those with end-stage renal disease receiving hemodialysis.
Elderly Patients
No dose adjustment is required based on age alone. The standard adult dose of 150 mg applies to elderly patients. However, as with all medications, clinical monitoring should be appropriate to the patient’s overall health status.
What Are the Side Effects of Fosaprepitant Accord?
Like all medicines, Fosaprepitant Accord can cause side effects, although not everyone experiences them. The side effects listed below have been reported during clinical trials and post-marketing surveillance. It is important to remember that many of these effects may also be attributable to the chemotherapy itself or to other concomitant medications. Your healthcare team will monitor you for adverse effects and provide appropriate management.
Stop the infusion and contact a doctor immediately if you experience any of the following: hives, rash, itching, difficulty breathing or swallowing, or a sudden serious drop in blood pressure. These may be signs of a severe allergic reaction. Also report any severe reactions at or near the infusion site, particularly pain, swelling, redness, or signs of tissue damage (necrosis), which have been reported especially when fosaprepitant is given alongside vesicant chemotherapy agents.
Common Side Effects
- Constipation
- Indigestion (dyspepsia)
- Headache
- Fatigue
- Decreased appetite
- Hiccups
- Elevated liver enzymes in blood tests
Uncommon Side Effects
- Dizziness, drowsiness
- Acne, skin rash
- Anxiety
- Belching, nausea, vomiting, heartburn, abdominal pain, dry mouth, flatulence
- Increased painful or burning urination
- Weakness, general feeling of being unwell
- Facial or skin flushing, hot flashes
- Rapid or irregular heartbeat, elevated blood pressure
- Fever with increased risk of infection, decreased red blood cell count
- Pain, redness, and itching at the infusion site; vein inflammation at the infusion site
Rare Side Effects
- Difficulty thinking, lack of energy, taste changes
- Sun sensitivity, increased sweating, oily skin, skin ulcers, itchy rash, Stevens-Johnson syndrome / toxic epidermal necrolysis (severe skin reactions)
- Euphoria (extreme feeling of happiness), disorientation
- Bacterial infection, fungal infection
- Severe constipation, stomach ulcer, inflammation of the small and large intestine, mouth sores, abdominal distension
- Frequent urge to urinate, increased urine volume, presence of sugar or blood in urine
- Chest discomfort, swelling, altered gait
- Cough, mucus in the back of the throat, throat irritation, sneezing, sore throat
- Watery and itchy eyes
- Tinnitus (ringing in the ears)
- Muscle spasms, muscle weakness
- Increased thirst
- Slow heartbeat, cardiovascular disease
- Decreased white blood cell count, low sodium levels in the blood, weight loss
- Hardening at the infusion site
Not Known Frequency
- Severe allergic reactions (anaphylaxis) – including hives, difficulty breathing, swallowing, or serious blood pressure drop
- Severe infusion-site reactions including tissue necrosis, particularly with vesicant chemotherapy agents
If you experience any side effects, even those not listed here, inform your doctor, pharmacist, or nurse. Side effect reporting after a medicine has been authorized is important because it allows continued monitoring of the benefit-risk balance of the medicine. Healthcare professionals and patients alike are encouraged to report any suspected adverse reactions to their national pharmacovigilance authority.
How Should Fosaprepitant Accord Be Stored?
Proper storage is essential to ensure the safety and efficacy of Fosaprepitant Accord. As this is a hospital-administered medication, storage is typically managed by pharmacy staff, but understanding the requirements is important for quality assurance.
- Unopened vials: Store in a refrigerator at 2°C to 8°C. Keep the vial in the outer carton to protect from light.
- Reconstituted and diluted solution: Stable for up to 48 hours when stored at 20–25°C. The solution should be inspected visually before administration and should not be used if particles or discoloration are observed.
- Expiry date: Do not use after the expiry date stated on the carton and vial after “EXP.” The expiry date refers to the last day of the stated month.
- Disposal: Any unused medicinal product or waste material should be disposed of in accordance with local requirements for pharmaceutical waste. Medicines should not be disposed of via wastewater or household waste.
Keep all medicines out of the sight and reach of children. If you notice any changes in the appearance of the powder or the reconstituted solution, do not use the product and inform your pharmacist.
What Does Fosaprepitant Accord Contain?
Active Substance
The active substance is fosaprepitant. Each vial contains fosaprepitant dimeglumine, equivalent to 150 mg of fosaprepitant. After reconstitution with 5 mL of 0.9% sodium chloride and dilution with a further 145 mL of 0.9% sodium chloride, each milliliter of the final solution contains 1 mg of fosaprepitant (1 mg/mL).
Other Ingredients (Excipients)
- Disodium edetate (E386): Used as a chelating agent to improve stability
- Polysorbate 80 (E433): Used as a solubilizing agent – individuals with known allergy to polysorbate 80 should inform their healthcare provider
- Anhydrous lactose: Used as a bulking agent – note: the amount of lactose present is very small and is unlikely to cause issues for lactose-intolerant individuals
- Sodium hydroxide (E524): Used for pH adjustment
- Dilute hydrochloric acid (E507): Used for pH adjustment
Appearance and Packaging
Fosaprepitant Accord is a white to off-white powder for solution for infusion. The powder is supplied in a clear glass vial sealed with a rubber stopper and an aluminum crimp cap with an orange flip-off cap. Each carton contains one vial with 150 mg of fosaprepitant. Not all pack sizes may be marketed in every country.
Fosaprepitant Accord is manufactured by Accord Healthcare, a global pharmaceutical company headquartered in the Netherlands (Accord Healthcare B.V., Winthontlaan 200, 3526 KV Utrecht, Netherlands). The product is a generic equivalent of the originator product IVEMEND (manufactured by Merck Sharp & Dohme), containing the same active substance in the same strength and pharmaceutical form.
Frequently Asked Questions About Fosaprepitant Accord
Fosaprepitant is a prodrug – an inactive precursor – of aprepitant. Fosaprepitant itself is not pharmacologically active but is designed to be rapidly converted to aprepitant in the body by phosphatase enzymes. The key difference is the route of administration: fosaprepitant is given intravenously (as an IV infusion), while aprepitant is available as oral capsules. The IV route is particularly useful for patients who cannot tolerate oral medications, for example due to nausea, vomiting, mucositis, or difficulty swallowing. Once converted, the aprepitant derived from fosaprepitant works identically to oral aprepitant, blocking NK1 receptors in the brain to prevent nausea and vomiting.
Fosaprepitant Accord is specifically approved for the prevention of nausea and vomiting associated with cancer chemotherapy (CINV). It is not approved for other types of nausea, such as post-operative nausea and vomiting (PONV), motion sickness, or nausea during pregnancy. While the oral form (aprepitant, marketed as EMEND) has been studied and approved in some regions for the prevention of PONV, the intravenous fosaprepitant formulation is indicated only for chemotherapy-related use. If you are experiencing nausea from a cause other than chemotherapy, speak with your healthcare provider about appropriate treatment options.
Clinical trials have demonstrated that the triple antiemetic regimen including an NK1 receptor antagonist (fosaprepitant/aprepitant), a 5-HT3 receptor antagonist (such as ondansetron), and dexamethasone provides significantly better protection against CINV than the two-drug combination without an NK1 antagonist. In pivotal trials with highly emetogenic chemotherapy (e.g., cisplatin), complete response rates (no vomiting and no need for rescue antiemetics) were approximately 70–90% during the acute phase (first 24 hours) and 60–80% during the delayed phase (days 2–5). The addition of the NK1 antagonist is particularly beneficial for the delayed phase, where it provides the most substantial improvement over standard therapy.
If you experience pain, burning, redness, swelling, or any discomfort at or around the infusion site during or after the infusion, inform your nurse or doctor immediately. Mild infusion-site reactions are relatively common and usually resolve on their own. However, more serious reactions have been reported, particularly when fosaprepitant is administered alongside vesicant chemotherapy drugs (agents that can cause tissue damage if they leak from the vein). In rare cases, tissue necrosis (death of surrounding tissue) has occurred. Your healthcare team will monitor the infusion site carefully and take appropriate action if a reaction develops, which may include slowing or stopping the infusion.
Yes, Fosaprepitant Accord is approved for use in children and adolescents aged 6 months and older (weighing at least 6 kg) for the prevention of chemotherapy-induced nausea and vomiting. The dose is calculated based on the child’s age and body weight, and the infusion is given over a longer period (60–90 minutes) compared to adults (30 minutes). Depending on the chemotherapy schedule, fosaprepitant may be given on Day 1 only, or on Days 1, 2, and 3, with oral aprepitant as an alternative for Days 2 and 3. It should not be used in children under 6 months of age or those weighing less than 6 kg, as safety and efficacy have not been established in this population.
Fosaprepitant Accord (via its active metabolite aprepitant) can interact with certain chemotherapy drugs that are metabolized by the CYP3A4 enzyme system. These include irinotecan, etoposide, vinorelbine, and ifosfamide. However, fosaprepitant has been extensively studied in combination with many common chemotherapy regimens, and the clinical significance of these interactions is generally manageable. Your oncologist is aware of these interactions and will adjust chemotherapy doses or monitoring as needed. The benefit of preventing CINV with a triple antiemetic regimen generally outweighs the risks of these interactions. Always inform your oncology team about all medications you are taking.
References
- European Medicines Agency (EMA). Fosaprepitant Accord – Summary of Product Characteristics. Last updated 2024. Available at: www.ema.europa.eu
- U.S. Food and Drug Administration (FDA). IVEMEND (fosaprepitant dimeglumine) – Prescribing Information. Merck Sharp & Dohme. Available at: www.accessdata.fda.gov
- Roila F, Molassiotis A, Herrstedt J, et al. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Annals of Oncology. 2016;27(suppl 5):v119–v133. doi:10.1093/annonc/mdw270
- Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: ASCO Guideline Update. Journal of Clinical Oncology. 2020;38(24):2782–2797. doi:10.1200/JCO.20.01296
- National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Antiemesis. Version 1.2025. Available at: www.nccn.org
- Grunberg SM, Warr D, Gralla RJ, et al. Evaluation of new antiemetic agents and definition of antineoplastic agent emetogenicity – state of the art. Supportive Care in Cancer. 2011;19(Suppl 1):S43–S47. doi:10.1007/s00520-010-1003-x
- Lasseter KC, Gambale J, Jin B, et al. Tolerability of fosaprepitant and bioequivalence to aprepitant in healthy subjects. Journal of Clinical Pharmacology. 2007;47(7):834–840. doi:10.1177/0091270007301800
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List, 2023. Available at: www.who.int
- Navari RM, Aapro M. Antiemetic Prophylaxis for Chemotherapy-Induced Nausea and Vomiting. New England Journal of Medicine. 2016;374(14):1356–1367. doi:10.1056/NEJMra1515442
- British National Formulary (BNF). Fosaprepitant – Drug Monograph. Available at: bnf.nice.org.uk
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