title: Compatibility of intravenous fosaprepitant with intravenous 5-HT3 antagonists and corticosteroids.
abstract: OBJECTIVE
  Fosaprepitant dimeglumine for injection is the water-soluble phosphorylated prodrug of the neurokinin-1 receptor antagonist aprepitant. Both agents are approved (in combination with a 5-HT3 antagonist and a corticosteroid) for prevention of chemotherapy-induced nausea and vomiting. Because fosaprepitant is likely to be combined and stored in the same intravenous (IV) bag with 5-HT3 antagonists and corticosteroids, the in vitro compatibility of fosaprepitant with these agents and other IV diluents was assessed.
  
  
  METHODS
  Fosaprepitant (1 mg/mL in 0.9 % sodium chloride injection solution) was combined in binary or tertiary fashion with therapeutic-dose preparations of a 5-HT3 antagonist (ondansetron, granisetron, palonosetron, or tropisetron) and/or a corticosteroid (dexamethasone sodium phosphate or methylprednisolone sodium succinate). For diluent compatibility assessment, fosaprepitant was also prepared 1 mg/mL in 0.9 % sodium chloride injection solution, water for injection, or 5 % dextrose injection solution. After 24-h storage under ambient conditions, samples were assayed for degradation.
  
  
  RESULTS
  Fosaprepitant demonstrated compatibility when combined in the same IV infusion bag with common 5-HT3 antagonists and corticosteroids for storage and IV coadministration, with the exception of palonosetron (incompatible under all experimental conditions) and tropisetron (incompatible unless combined with a corticosteroid). No incompatibility was observed between fosaprepitant and any of the 3 diluents tested.
  
  
  CONCLUSIONS
  Use of fosaprepitant in combination with other antiemetics may provide a flexible option for administration of antiemetics to patients receiving moderately or highly emetogenic chemotherapy.
authors.affiliation: Merck Manufacturing Division, Merck & Co., Inc., Whitehouse Station, NJ, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Sun
authors.forename: Joseph
authors.initials: J
authors.lastname: Schaller
authors.forename: Jiri
authors.initials: J
authors.lastname: Placek
authors.forename: Brett
authors.initials: B
authors.lastname: Duersch
mesh_terms: D000932:Antiemetics / Q000008:administration & dosage / Q000737:chemistry*; D000077608:Aprepitant; D003907:Dexamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000737:chemistry; D004338:Drug Combinations; D004344:Drug Incompatibility; D004355:Drug Stability; D004356:Drug Storage; D005938:Glucocorticoids / Q000008:administration & dosage / Q000737:chemistry*; D005947:Glucose / Q000737:chemistry; D007262:Infusions, Intravenous; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage / Q000737:chemistry; D009025:Morpholines / Q000008:administration & dosage / Q000737:chemistry*; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000008:administration & dosage / Q000737:chemistry*; D012965:Sodium Chloride / Q000737:chemistry
chemical_list: D000932:Antiemetics; D004338:Drug Combinations; D005938:Glucocorticoids; D009025:Morpholines; D058831:Serotonin 5-HT3 Receptor Antagonists; D000077608:Aprepitant; C004180:dexamethasone 21-phosphate; D012965:Sodium Chloride; D008776:Methylprednisolone Hemisuccinate; C579707:fosaprepitant; D003907:Dexamethasone; D005947:Glucose