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USE OF APREPITANT AS AN ANTIEMETIC IN CYSTIC FIBROSIS PATIENTS
  1. A Jamali1,
  2. M Harrison2,
  3. D Bilton2,
  4. N Simmonds2 and
  5. J Ross1
  1. 1Royal Marsden and Royal Brompton Palliative Care Service, Royal Brompton Hospital, London, UK
  2. 2Adult Cystic Fibrosis Service, Royal Brompton Hospital, London, UK

Abstract

Introduction Aprepitant is a NK1 receptor antagonist licensed for treatment of nausea and vomiting (n&v) associated with emetogenic chemotherapy. There are case reports of use for n&v post-operatively or secondary to diabetic gastroparesis. There is no published evidence in patients with cystic fibrosis (CF).

Tigecycline is used in treatment of Non-Tuberulosis Mycobacteria in CF. However uncontrolled n&v can result in dose reduction, interruption or discontinuation, and treatment failure.

Aims To evaluate the efficiacy and side-effects of aprepitant (added to domperidone and ondansetron) in CF patients requiring tigecycline treatment.

Methods Retrospective and prospective audits (studies) were conducted with case note review of consecutive CF patients receiving IV tigecycline, using a standardised proforma. Consecutive admissions for IV tigecycline therapy were consented and commenced on aprepitant 80mg OD for the first five days of tigecycline therapy. They completed daily n&v and side-effect diaries.

Results 16 case notes were evaluated retrospectively and 10 patients prospectively audited.

Aprepitant was likely to have contributed to reduction in n&v in 17/26 (65%) cases. 9/10 (90%) patients in prospective audit completed the full course/dose of tigecycline.

8/26 (31%) cases reported mild side-effects (headache (3), hiccups, dyspepsia (2), abdominal pain, atrial tachycardia); all resolved on continuing aprepitant or persisted despite stopping aprepitant.

Conclusion(s) Aprepitant was well tolerated and appeared to be effective for a number of CF patients. Ongoing work will further evaluate the benefit of aprepitant in this population and inform clinical guidelines for management of n&v in CF patients.

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