Parenteral fosaprepitant (Emend) has the potential to cause venous irritation. What are best practices to reduce venous irritation and delayed irritation? Is the drug an irritant or vesicant? If the drug infiltrates, what is the management? —Name withheld on request

Fosaprepitant is a prodrug of aprepitant (Emend), a neurokinin (NK1) antagonist used for the prevention of chemotherapy-induced nausea and vomiting, that may be administered intravenously. Once in the body, fosaprepitant is rapidly converted to aprepitant. Injection site reactions (including phlebitis) have been reported in approximately 3% of patients receiving fosaprepitant. Injection site reactions may include infusion site erythema, pruritis, pain, induration and thrombophlebitis. Patients experiencing venous irritation should be counseled regarding care for the site as appropriate per the patient’s symptoms. In patients experiencing irritation, it may be helpful to administer a more dilute form of the drug for future doses. For instance, fosaprepitant may be diluted to a final volume of 250 mL, or may be administered through a Y-site with additional saline.

If fosaprepitant infiltrates, the infusion should be stopped immediately. The infiltration should be managed per your organization’s standard procedure for managing infiltration of a nonvesicant, nonirritant drug, based on patient symptoms and the estimated volume that may have infiltrated.