Aprepitant for the Prevention of Acute Chemotherapy-Induced Nausea and Vomiting in Children: Overcoming Barriers

Aprepitant is an effective antiemetic for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) in children. This thesis presents an updated clinical practice guideline for the prevention of acute CINV that recommends children receiving highly emetogenic chemotherapy be given an antiemetic regimen that includes aprepitant. However, aprepitant-antineoplastic drug interactions and lack of a commercially available aprepitant oral liquid formulation limit its utility. A systematic review of aprepitant-drug interactions was undertaken to identify clinically significant interactions. Significant pharmacokinetic interactions were found between aprepitant and the following antineoplastic agents: bosutinib, cabazitaxel and cyclophosphamide. A crossover study was conducted in healthy adult volunteers to establish the relative bioavailability of an extemporaneous aprepitant oral suspension compared to the commercially available capsule. Relative bioavailability of the oral suspension was found to be 82.3%, demonstrating sufficient absorption of aprepitant to have an antiemetic effect. Overall, these projects have addressed barriers to aprepitant use in children.M.Sc.2019-11-15 00:00:0