Clinical Pharmacology: Advances and Applications (Nov 2019)
Perioperative Administration of Emend® (Aprepitant) at a Tertiary Care Children’s Hospital: A 12-Month Survey
Abstract
Anuradha Kanaparthi,1 Sarah Kukura,2 Natalie Slenkovich,2 Faris AlGhamdi,2 Shabana Z Shafy,2 Mohammed Hakim,2 Joseph D Tobias2,3 1College of Medicine, Northeast Ohio Medical University (NEOMED), Rootstown, Ohio, USA; 2Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA; 3Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USACorrespondence: Anuradha KanaparthiDepartment of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, Ohio 43205 Tel +1614 722-4200Fax +1614 722-4203Email [email protected]: Aprepitant (Emend®) is a novel antiemetic agent that works through antagonism of neurokinin-1 (NK-1) receptors. To date, there are limited data regarding its use to prevent postoperative nausea and vomiting (PONV) in children. We retrospectively reviewed our initial 12-months experience with aprepitant after it was made available for perioperative use.Methods: The anesthetic records of patients who received aprepitant were retrospectively reviewed and demographic, surgical, and medication data retrieved.Results: The study cohort included 31 patients (15 male and 16 female) ranging in age from 4 to 27 years (15.7 ± 7.4 years) and in weight from 14.4 to 175.7 kilograms (59.3 ± 30.2 kgs). Most of the patients (30 of 31) received the capsule form and 1 received the liquid. The average dose of aprepitant administered was 0.9 ± 0.6 mg/kg; however, only one patient received dosing expressed as mg/kg, and the majority received a 40 mg capsule. All of the patients in the cohort had either a previous history of PONV or risk factors for PONV. PONV occurred in the PACU in 1 patient and during the first 24 postoperative hours in 3 additional patients. No adverse effects related to aprepitant use were noted.Conclusion: Aprepitant was easily added to the preoperative regimen for pediatric patients who may require it. Our approach limited overuse and subsequent cost concerns. Future studies with a comparator group and a greater sample size are needed to demonstrate its efficacy, especially in comparison to time-honored agents such as ondansetron. No adverse effects were noted in our limited study cohort.Keywords: aprepitant, postoperative nausea and vomiting, pediatric
