Aprepitant: A New Modality for the Prevention of Postoperative Nausea and Vomiting: An Evidence-Based Review

Purpose Postoperative nausea and vomiting (PONV) affects as many as 30% of surgical patients. Aprepitant, an antagonist of the neurokinin-1 receptor with a 40% half-life, may be effective for prophylaxis for PONV. This review describes the evidence of adding aprepitant to antiemetic therapy for PONV prophylaxis. Methods A literature search was conducted to answer the population-intervention-comparison-outcome-time (PICOT) question: In adult patients undergoing general anesthesia (P), does aprepitant (I) decrease PONV (O) postoperatively (T) as compared to patients receiving other antiemetic therapy or a placebo (C)? Results Eight randomized controlled trials, one prognostic study, and one post hoc analysis were appraised. Perioperatively, aprepitant decreased the severity and number of episodes of PONV. Discussion Aprepitant appears to be more effective in decreasing the incidence of PONV postoperatively as compared with ondansetron. It is recommended that aprepitant is used to treat patients at risk for PONV and for whom PONV could lead to catastrophic adverse outcomes.