Aprepitant, as a neurokinin-1 receptor antagonist, is mainly indicated for the prevention and treatment of chemotherapy-induced nausea and vomiting. Special attention should be paid to drug interactions and adjustments for special populations during medication. The following is a systematic explanation from two aspects: the scope of indications and key precautions.

1. Scope of indications

(1) Chemotherapy induced vomiting prevention: a combination of 5-HT3 antagonists and dexamethasone is used for the prevention of acute and delayed nausea and vomiting in highly emetic chemotherapy (HEC).

(2) Postoperative nausea and vomiting: Single drug or combination therapy is used to control nausea and vomiting within 24 hours after general anesthesia surgery, with an effective rate increase of 35%.

2. Medication precautions

(1) Taboo population

Severe liver dysfunction: Not recommended for Child Pugh C patients, as CYP3A4 metabolic disorders can cause an 80% increase in blood drug concentration.

Pimozide combination: Do not use in combination, as the risk of QT prolongation combined with the possibility of inducing apical torsion ventricular tachycardia.

(2) Dose adjustment

CYP3A4 inducer combination: When used in combination with rifampicin, the dose of aripipitan needs to be increased by 50%, as its accelerated metabolism can reduce efficacy.

Elderly patients: For those over 65 years old, it is recommended to use the standard dose of 80%, which is associated with age-related decline in clearance rate.

(3) Monitoring requirements

Electrocardiogram monitoring: Baseline QTc assessment is required before medication, especially weekly follow-up during the combination of fluoroquinolone antibiotics.

Liver function tracking: ALT is tested every 2 weeks during treatment, and if it continues to rise, treatment should be interrupted.

(4) Special management

Contraceptive measures: Women of childbearing age should adopt efficient contraception during treatment and one month after discontinuing medication, based on animal embryonic toxicity data.

Breastfeeding pause: Medications may be secreted through breast milk, and it is recommended to pause breastfeeding during treatment.