Aprepitant for managing nausea and vomiting alongside headaches

Nausea and vomiting (feeling and being sick) can occur as part of a range of  conditions. Aprepitant is a medication used to stop nausea and vomiting or reduce how often it occurs and its severity. This information sheet from Great Ormond Street Hospital (GOSH) describes aprepitant, how it can be used and some of the possible side effects.Aprepitant is an antiemetic medicine, also known as a neurokinin-1 receptor antagonist. It works by blocking the action of neurokinin, a natural substance in the brain that causes nausea and vomiting.

Aprepitant is not licensed for children and young people to use for all conditions. Medicines are often used ‘off label’ in children for a number of reasons, for example having limited data available for a specific condition. This does not necessarily mean this is a high risk medicine but should be explained and agreed with a consultant before use.

Aprepitant comes as a capsule or oral suspension (powder mixed with water). The aprepitant is taken once a day for three days. Your doctor will tell you the dose to take and when. For further information on giving you child medicines please see our online resource.

People with the following conditions should discuss taking aprepitant with their doctor.

• Hypersensitivity to aprepitant or any of its ingredients
• Intolerance of some sugars – the capsules may need to be used instead of the oral suspension
• Existing liver problems
• Acute Porphyria
• Weighing less than 6kg
• Pregnant, could be pregnant, trying to become pregnant or breastfeeding 
• Taking any of the following medicines: pimozide, terfenadine, astemizole or cisapride

Each person reacts differently to medicines and many will not suffer any side effects at all.

Some children have an allergy to the aprepitant. This reaction may be mild to severe. Signs of a mild allergic reaction include skin rashes and itching, high temperature, shivering, redness of the face, a feeling of dizziness or headache. Signs of a severe allergic reaction include any of the above, as well as shortness of breath. Stop giving the medicine and see a doctor straightaway.

The following side effects have been reported. If your child experiences any of them or you have concerns, please discuss with your doctor, nurse or pharmacist.

• Constipation
• Decreased appetite
• Headache
• Hiccups
• Indigestion
• Lack of energy

Always check with your doctor or pharmacist before giving your child any other medicines, including herbal or complementary medicines.

• Certain migraine medicines containing ergot such as ergotamine
• Certain antibiotics including rifampicin and clarithromycin
• Some sedative medicines including midazolam or phenobarbitol
• Anti-seizure medicines such as phenytoin or carbamazepine
• Anti-fungal medicines called ‘azoles’ such as itraconazole

The effectiveness of hormonal contraceptives may be reduced if taken at the same time as aprepitant. It is advised to use different forms of contraceptives during treatment and for two months after stopping aprepitant.

• Keep medicines in a safe place where children cannot reach them.
• The medicine should be kept in a cool, dry place out of direct sunlight and heat.
• The oral suspension is supplied in a pre-filled oral syringe containing the prescribe dose – keep this in the fridge until you give the medicine to your child.
• If your doctor decides to stop treatment of medicine passes its expiry date, return the unused medicine to the pharmacist. Do not flush them down the toilet or throw them away.