Resource CenterFrequently Asked QuestionsImportant Safety InformationPrescribing Information
Aponvie logo

US healthcare professionals only.

Connect with Heron
Guidelines Plastic Surgery TKA and THA Craniotomy Laparoscopic Cholecystectomy Facial Plastic Surgery TKA

APONVIE as the Foundation of a Multimodal Regimen for Patients at Moderate-to-High Risk of PONV

Guidelines for Multimodal Treatment

According to the newest version of the Society for Ambulatory Anesthesiology’s consensus guidelines on the management of PONV, multimodal prophylaxis should be considered for patients with one or more risk factors.1

As an NK1 antagonist (a guideline-recommended class of PONV medications), APONVIE has little or no affinity for serotonin (5-HT3), dopamine, and corticosteroid receptors, the targets of other therapies for PONV, which makes it a good option for use as a first-line therapy in a multimodal approach for patients at moderate-to-high risk.1,2

Vallejo et al: Prospective Study Shows Aprepitant as Part of a Multimodal Approach Is Highly Effective for Moderate-to-High-Risk Plastic Surgery Patients3

This prospective, double-blinded, randomized 2-arm study evaluated the occurrence of vomiting and the severity of nausea in the 48 hours following surgery in 150 ambulatory plastic surgery patients undergoing general anesthesia with 2 or more risk factors for PONV. Patients received either aprepitant plus IV ondansetron or IV ondansetron and placebo.

Primary Endpoint

% patients with no vomiting, 0-48 hours

Vallejo Bar Graph

When aprepitant was added to IV ondansetron, 20% more patients experienced no vomiting in the first 48 hours following surgery (P = .003). In both treatment groups, all episodes of vomiting occurred in the first 12 hours.

Secondary Endpoint

Mean nausea verbal rating score, 0-48 hours

Vallejo Line graph

In a summary analysis of the first 48 hours following surgery,a patients receiving aprepitant in addition to IV ondansetron had significantly lower-severity nausea (P = .024b ).

Note: Nausea was rated on a verbal rating scale of 0 to 10, with a score of 0 meaning no nausea and a score of 10 meaning the worst nausea ever.

aMean differences in VRS scores over 48 hours tested simultaneously with a multivariate analysis of variance.

bUnadjusted P value.

View study

Dilorio et al: Retrospective Chart Review Showed that Total Knee Arthroplasty and Total Hip Arthroplasty Patients Receiving Aprepitant Experienced Reduced Severity of PONV4

Fifty patients undergoing total hip arthroplasty or total knee arthroplasty who received a preoperative dose of oral aprepitant were matched to 50 patients who received no PONV prophylactic. Patients in both groups were treated postoperatively with IV ondansetron 4 mg only as rescue medication if PONV occurred. Patients' charts were retrospectively reviewed. Instances of PONV were noted for the entire length of hospital stay.

Severity of PONV

Number of patients

Dilorio Bar Chart

Key Metrics of PONV Reduced

Table of Dilorio Key Metrics

On average, patients receiving oral aprepitant had approximately 40% fewer episodes of PONV, required less than half the amount of rescue medication, and were ready for discharge a day sooner.

View study

Habib et al: Prospective Study Showed That Aprepitant Reduced the Incidence of Vomiting in Craniotomy Patients5

In this prospective, double-blind, randomized study of 104 patients undergoing craniotomy under general anesthesia, patients received dexamethasone as well as either oral aprepitant or IV ondansetron. Though the complete response was similar between treatment groups, using aprepitant in addition to dexamethasone significantly reduced the incidence of vomiting compared to IV ondansetron at multiple timepoints.

Incidence of Vomiting

Habib Bar Graph

Aprepitant significantly reduced the incidence of vomiting compared to IV ondansetron at multiple timepoints.

View study

Kaur et al: Prospective Study Showed Aprepitant Demonstrated a Longer-Acting Effect than IV ondansetron in Laparoscopic Cholecystectomy6

In a randomized, double-blind, prospective trial, 90 patients undergoing laparoscopic cholecystectomy were treated with either oral aprepitant 40 mg, IV ondansetron 4 mg, or placebo. Though nausea scores across both treatment groups were similar, and the difference in the number of episodes of vomiting was not statistically significant in the first 24 hours, fewer episodes of vomiting were reported in the 24- to 48-hour time period in patients treated with aprepitant than in those treated with IV ondansetron.

Episodes of Vomiting

Kaur Bar Graph

There was no statistically significant difference in early episodes of vomiting between the aprepitant and IV ondansetron groups; however, aprepitant demonstrated a longer acting effect than IV ondansetron and better prevented delayed vomiting.

View study

Trimas et al: Retrospective Analysis Shows Aprepitant Reduced Postoperative Nausea in Facial Plastic Surgery7

In a retrospective analysis of 172 consecutive patients undergoing facial plastic surgery with general anesthesia, patients were treated with IV ondansetron and dexamethasone. In addition, 56 patients also received aprepitant. The addition of aprepitant reduced the likelihood of postoperative nausea compared to IV ondansetron and dexamethasone.

98% icon

98% of patients receiving aprepitant in addition to IV ondansetron and dexamethasone experienced no PONV

84% icon

84% of patients receiving only IV ondansetron and dexamethasone experienced no PONV

View study

Hartrick et al: Open-Label Study Showed Aprepitant Outperformed Multimodal PONV Therapies in TKA8

In a sequential, open-label, matched case control study, 24 patients underwent total knee arthroplasty with extended-release epidural morphine. One group of patients received ondansetron and dexamethasone, combined with either metoclopramide, diphenhydramine, or prochlorperazine, while the other received only oral aprepitant preoperatively. Incidence of PONV was then compared between the two groups. In this study, patients were considered positive for PONV if they reported any incidence of nausea or vomiting. Aprepitant used as a single agent significantly reduced the incidence of PONV compared to a multimodal antiemetic regimen (P = .039 ).

75% icon

75% of patients who received aprepitant experienced no PONV

25% icon

25% of patients who received the multimodal therapy experienced no PONV

View studyUnderstand the value of APONVIE »

Resources

PONV Guidelines: Gan, et al.

Fourth consensus guidelines for the managemen...
Fourth consensus guidelines for the management of postoperative nausea and vomiting. Published in Anesthesia and Analgesia.

Vallejo, et al.

Aprepitant plus ondansetron compared with ond...
Aprepitant plus ondansetron compared with ondansetron alone in reducing postoperative nausea and vomiting in ambulatory patients undergoing plastic surgery. Published in Plastic and Reconstructive Surgery.

Dilorio, et al.

Antiemesis after total joint arthroplasty: do...
Antiemesis after total joint arthroplasty: does a single preoperative dose of aprepitant reduce nausea and vomiting? Published in Clinical Orthopaedics and Related Research.

Habib, et al.

A comparison of the combination of aprepitant...
A comparison of the combination of aprepitant and dexamethasone versus the combination of ondansetron and dexamethasone for the prevention of postoperative nausea and vomiting in patients undergoing craniotomy. Published in Anesthesia and Analgesia.

Kaur, et al.

A comparison of aprepitant and ondansetron in...
A comparison of aprepitant and ondansetron in prophylaxis of postoperative nausea and vomiting in laparoscopic cholecystectomy. Published in Scholars Journal of Applied Medical Sciences.

Trimas, et al.

Use of aprepitant and factors associated with...
Use of aprepitant and factors associated with incidence of postoperative nausea and vomiting in patients undergoing facial plastic surgery. Published in Facial Plastic Surgery and Aesthetic Medicine.

Hartrick, et al.

Aprepitant versus multimodal prophylaxis in t...
Aprepitant versus multimodal prophylaxis in the prevention of nausea and vomiting following extended-release epidural morphine. Published in Pain Practice.

References: 1. Gan TJ, Belani KG, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020;131(2):411-448. doi:10.1213/ane.0000000000004833. 2. APONVIE [package insert]. San Diego, CA: Heron Therapeutics Inc; 2022. 3. Vallejo MC, Phelps AL, Ibinson JW, et al. Aprepitant plus ondansetron compared with ondansetron alone in reducing postoperative nausea and vomiting in ambulatory patients undergoing plastic surgery. Plast Reconstr Surg. 2012;129(2):519-526. doi:10.1097/PRS.0b013e31822b6932. 4. Dilorio TM, Sharkey PF, Hewitt AM, Parvizi J. Antiemesis after total joint arthroplasty: does a single preoperative dose of aprepitant reduce nausea and vomiting? Clin Orthop Relat Res. 2010;468(9):2405-2409. doi:10.1007/s11999-010-1357-x. 5. Habib AS, Keifer JC, Borel CO, White WD, Gan TJ. A comparison of the combination of aprepitant and dexamethasone versus the combination of ondansetron and dexamethasone for the prevention of postoperative nausea and vomiting in patients undergoing craniotomy. Anesth Analg. 2011;112(4):813-818. doi:10.1213/ANE.0b013e3181ff47e2. 6. Kaur U, Sharma VK, Sidhu JS. A comparison of aprepitant and ondansetron in prophylaxis of postoperative nausea and vomiting in laparoscopic cholecystectomy. Sch J App Med Sci. 2014;2(3B):1020-1027. 7. Trimas SJ, Trimas MD. Use of aprepitant and factors associated with incidence of postoperative nausea and vomiting in patients undergoing facial plastic surgery. JAMA Facial Plast Surg. 2015;17(4):251-255. doi:10.1001/jamafacial.2015.0307. 8. Hartrick CT, Tang YS, Hunstad D, et al. Aprepitant vs. multimodal prophylaxis in the prevention of nausea and vomiting following extended-release epidural morphine. Pain Pract. 2010;10(3):245-248. doi:10.1111/j.1533-2500.2010.00364.x.

[+] Expand@!

Important Safety Information!

Contraindications

APONVIE is contraindicated in patients with a history of hypersensitivity to aprepitant or any component of the product, and in patients taking pimozide. Increased pimozide levels may cause serious or life-threatening reactions, such as QT prolongation.

Warnings and Precautions

Hypersensitivity Reactions: Serious hypersensitivity reactions, including anaphylaxis, during or soon after administration of aprepitant have occurred. Symptoms including dyspnea, eye swelling, flushing, pruritus, and wheezing have been reported. Monitor patients during and after administration. If hypersensitivity reactions occur, administer appropriate medical therapy. Do not administer APONVIE in patients who experienced these symptoms with previous use of aprepitant.

Clinically Significant CYP3A4 Drug Interactions: Aprepitant is a substrate, weak-to-moderate (dose-dependent) inhibitor, and an inducer of CYP3A4. Use of pimozide, a CYP3A4 substrate, with APONVIE is contraindicated. Use of APONVIE with strong CYP3A4 inhibitors (eg, ketoconazole) may increase plasma concentrations of aprepitant and result in an increased risk of adverse reactions related to APONVIE. Use of APONVIE with strong CYP3A4 inducers (eg, rifampin) may result in a reduction in aprepitant plasma concentrations and decreased efficacy of APONVIE.

Decrease in INR with Concomitant Warfarin: Use of aprepitant with warfarin, a CYP2C9 substrate, may result in a clinically significant decrease in the International Normalized Ratio (INR) of prothrombin time. Monitor the INR in patients on chronic warfarin therapy in the 2-week period particularly at 7 to 10 days, following administration of APONVIE.

Risk of Reduced Efficacy of Hormonal Contraceptives: The efficacy of hormonal contraceptives may be reduced for 28 days following administration of APONVIE. Advise patients to use effective alternative or back-up methods of non-hormonal contraception for 1 month following administration of APONVIE.

Use in Specific Populations

Avoid use of APONVIE in pregnant women as alcohol is an inactive ingredient in APONVIE. There is no safe level of alcohol exposure in pregnancy.

Adverse Reactions

Most common adverse reactions (incidence ≥3%) for APONVIE are constipation, fatigue, and headache and for oral aprepitant are constipation and hypotension.

Report side effects to Heron at 1-844-437-6611 or to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Indication

APONVIE is a substance P/neurokinin-1 (NK1) receptor antagonist, indicated for the prevention of postoperative nausea and vomiting (PONV) in adults.

Limitations of Use: APONVIE has not been studied for treatment of established nausea and vomiting.

Please see full Prescribing Information.

Full Prescribing Information

Connect with Heron!

How could you incorporate APONVIE as the foundation of your institution's PONV management strategy? Connect with us to find out.

Fields marked with an asterisk (*) are required.

I would like to*:

To report an adverse event or product complaint:

844-HERON11 (844-437-6611)
MedInfo@HeronTx.com

For general information:

844-HERON11 (844-437-6611)

Investors and Media:

IR@HeronTx.com

For all other inquiries, please visit the Heron Therapeutics corporate website.

Go to Heron Website