APONVIE is now included in the Fifth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

PONV Guidelines

APONVIE^® (aprepitant), the First and Only IV NK1 Antagonist for the Prevention of PONV, Has A1 Level of Evidence for Prevention¹

According to the Fifth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting, aprepitant carries an A1 (highest level) evidence grade for prevention of postoperative nausea and vomiting (PONV) in adults as¹:

A single agent

In combination with select 5-HT3 antagonists

As part of a multimodal regimen (most common is 5-HT3 + dexamethasone + aprepitant)

APONVIE is the only IV NK-1 antagonist approved for prevention of PONV.

NK1: substance P/neurokinin-1.

Aprepitant Demonstrated Proven Efficacy

The consensus guidelines recommend multimodal prophylaxis with ≥3 agents for all high-risk patients (defined as those with 3-4 risk factors) and in all high-risk procedures.¹

As an NK₁ antagonist, aprepitant has shown efficacy in the prevention of postoperative vomiting (POV). In fact, aprepitant monotherapy is more effective compared to 5-HT3 receptor antagonists and is comparable with some combination therapies for prevention of POV.¹

In addition, patients at high risk of Post-Discharge Nausea and Vomiting, an extension of PONV, should be administered prophylactic, long-acting antiemetics before discharge.¹

Explore Multimodal Use

Guidelines Reinforce the Safety Profile of NK₁ Class of Antiemetics

Aprepitant was reported in the consensus guidelines to have relatively few safety concerns, making it an option for high-risk patients (e.g., elderly) or those who may have issues with medication side effects.^1,2

A1 Evidence for APONVIE Supports Improved Healthcare Economics

Enhanced Recovery After Surgery (ERAS) protocols recommend 2+ antiemetics for high-risk patients, potentially reducing PONV incidence and costs of care.³

ERAS protocols include evidence-based practices to improve patient outcomes, including⁴:

Reduced opioid consumption
Decreased PONV
Decreased length of stay

For example, the number needed to treat (NNT), a measure of how many patients must be treated to avoid one instance of PONV, for single and combination therapy with aprepitant highlight its strong clinical impact.¹

NNT = 3.8

for aprepitant + dexamethasone

NNT = 6

for oral aprepitant 80 mg (as the 4th antiemetic)

Learn how an independent Cochrane meta-analysis supports APONVIE as the most efficacious compound for the prevention of post-surgery vomiting.

View Cochrane Meta-Analysis

References: 1. Gan TJ, Jin Z, Ayad S, et al. Fifth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting: Executive Summary. Anesth Analg. 2025 Nov 14. Online ahead of print. doi:10.1213/ANE.0000000000007816. 2. APONVIE [package insert]. San Diego, CA: Heron Therapeutics Inc; 2022. 3. Feldheiser A, Aziz O, Baldini G, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016;60(3):289-334. doi:10.1111/aas.12651. 4. Chiu C, Aleshi P, Esserman LJ, et al. Improved analgesia and reduced post-operative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) pathway for total mastectomy. BMC Anesthesiol. 2018;18(1):41. doi:10.1186/s12871-018-0505-9.

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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.

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.

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 the 2-week period particularly at 7 to 10 days following administration.

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

Use in Specific Populations

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

Adverse Reactions

Most common adverse reactions (incidence ≥3%) are constipation, fatigue, and headache.

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

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

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