Aprepitant, as a neurokinin-1 receptor antagonist, is mainly used for the prevention of chemotherapy-induced nausea and vomiting. Its side effect profile and management strategies need to be targeted based on the drug's mechanism of action. The following is an explanation from three dimensions: common side effects, serious adverse reactions, and mitigation measures.

1. Common self relieving side effects

(1) Digestive system: About 18% of patients experience mild loss of appetite, which usually recovers on its own within 3-5 days. It is recommended to eat high-energy foods in small amounts and in small portions.

(2) Neurological system: 12% of patients reported drowsiness or fatigue, which is related to blood-brain barrier penetration. Avoiding the simultaneous use of central inhibitors can alleviate symptoms.

(3) Skin reaction: 6% of patients experience flushing or itching, which can be relieved by keeping the skin moist. If it persists for more than 72 hours, medical attention should be sought.

2. Serious reactions requiring medical intervention

(1) Cardiovascular system

The incidence of QT interval prolongation is about 0.7%, and the risk increases threefold when combined with fluoroquinolone antibiotics. Baseline electrocardiogram examination is required before medication.

(2) Allergic reactions

Rapid hypersensitivity reactions manifest as facial edema (0.3%) or bronchospasm (0.1%), requiring immediate cessation of use and rescue with adrenaline.

3. Targeted mitigation measures

(1) Liver function monitoring: CYP3A4 metabolic characteristics require testing ALT every 2 weeks during medication, and stopping medication when the ULN increases by more than 3 times.

(2) Drug interaction management: Avoid using strong CYP3A4 inhibitors (such as ketoconazole) in combination, as it can increase the blood concentration of aripipitan by 5 times.

(3) Fertility protection: Efficient contraceptive measures should be taken from the treatment period to one month after discontinuation of medication. Animal experiments have shown embryotoxicity.

4. Precautions for special populations

(1) Elderly: Patients over 65 years old have a 25% reduction in clearance rate, and it is recommended to use 80% of the standard dose.

(2) Renal insufficiency: No dosage adjustment is required, but patients with end-stage renal disease need to monitor blood pressure fluctuations.