Limited Use Note(s)

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APREPITANT125mg & 80mg Cap
Reason For Use CodeClinical Criteria
452In combination with a 5HT3 receptor antagonist and dexamethasone for highly emetogenic chemotherapy (HEC) regimens: - Cisplatin-based chemotherapy where a single daily dose is greater than or equal to 70 mg per meter squared - Cisplatin and cyclophosphamide combinations where the single daily dose is greater than or equal to 50mg per meter squared - Cisplatin (any dose) given for 3 to 5 consecutive days - Non-cisplatin based highly emetogenic chemotherapy (such as those containing anthracycline greater than or equal to 60mg per meter squared plus cyclophosphamide) Dosage: Recommend aprepitant 125mg orally on Day 1 of HEC followed by 80mg orally on Days 2 to 3 post-chemotherapy for each cycle.
LU Authorization Period: 1 year
453For patients receiving moderately emetogenic chemotherapy (MEC) regimens AND who have had inadequate symptom control using a 5HT3 antagonist and dexamethasone in a previous cycle. Dosage: Recommend aprepitant 125mg orally on Day 1 of MEC followed by 80mg orally on Days 2 to 3 post-chemotherapy for each cycle.
LU Authorization Period: 1 year