renally). **Half-life:** 9–13 hrs.

#####    ​LIFESPAN CONSIDERATIONS

**Pregnancy/Lactation:** Unknown if drug crosses placenta or is distributed in breast milk. **Pregnancy Category B. Children:** Safety and efficacy not established. **Elderly:** No age-related precautions noted.

#####  INTERACTIONS

**DRUG:** **Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin)** may increase concentration. **Strong CYP3A4 inducers (e.g., carbamazepine, rifampin)** may decrease concentration. May decrease effectiveness of **hormonal contraceptives, warfarin. HERBAL:** **St. John's wort** may decrease plasma concentration. **FOOD:** **Grapefruit products** may increase plasma concentration. **LAB VALUES:** May increase serum BUN, creatinine, glucose, alkaline phosphatase, ALT, AST. May produce proteinuria.

#####  AVAILABILITY (Rx)

**Capsules (Emend):** 40 mg, 80 mg, 125 mg. **Emend (Combination):** 80 mg (2), 125 mg (1). **Injection, Powder for Reconstitution (Fosaprepitant):** 150 mg.

#####  ADMINISTRATION/HANDLING

PO

• Give without regard to food.

  IV

**Reconstitution** • Reconstitute eachincrease alkaline phosphatase, GGT. May decrease serum uric acid.

#####  AVAILABILITY (Rx)

**Tablets:** 50 mg, 150 mg, 200 mg, 250 mg.

#####  ADMINISTRATION/HANDLING

PO

• May give without regard to food.

#####  INDICATIONS/ROUTES/DOSAGE

Narcolepsy, Obstructive Sleep Apnea–Hypopnea Syndrome

**PO:** **ADULTS, ELDERLY:** 150 or 250 mg/day given as a single dose in the morning.

Shift-Work Sleep Disorder

**PO:** **ADULTS, ELDERLY:** 150 mg given daily approximately 1 hr prior to the start of work shift.

Dosage in Renal/Hepatic Impairment

No dose adjustment. **Severe Hepatic Impairment:** May decrease dose.

#####  SIDE EFFECTS

**Frequent (17%–7%):** Headache, nausea. **Occasional (5%–4%):** Dizziness, insomnia, dry mouth, diarrhea, anxiety. **Rare (2%):** Depression, fatigue, palpitations, dyspepsia, rash, upper abdominal pain.

#####  ADVERSE EFFECTS/TOXIC REACTIONS

Small risk of serious rash, including Stevens-Johnson syndrome.

#####  NURSING CONSIDERATIONS

BASELINE ASSESSMENT

Obtain baseline evidence of narcolepsy or other sleep disorders, including pattern, environmental situations,