Realize the operational advantages of IV Push


CINVANTI 2-minute IV Push
(aprepitant) injectable emulsion*1-3
Emend® IV infusion
(fosaprepitant) for injection2-4
Akynzeo® IV infusion
(fosnetupitant/palonosetron) for injection2,3,5
Reduces need for materials such as tubing and bags Yes NO NO
Requires no dilution Yes NO NO
Requires no reconstitution Yes NO NO
Under 5-minute administration time for patients Yes NO NO
60-day room temperature stability in the vial Yes NO NO
  Emend IV and Akynzeo IV are included for illustrative purposes only; products should not be compared directly.

2-minute IV Push provides operational advantages over longer IV infusions by:

REDUCING preparation and administration time1,6,7
– Decreases pharmacy workload, requires fewer preparation steps, and allows for storage in automated dispensing devices

REDUCING patient time required for treatment7,8
– Gives patients time back in their day

REDUCING use of infusion supplies1-3
– Eliminates the need for materials such as administration sets, tubing, and bags of parenteral solution

IV Push administration requires fewer supplies and materials vs IV infusion2,3,9,10,11

IV Push administration materials2,9 IV infusion administration materials2,3,10,11
  • 1 Pair of gloves
  • 1 Needle
  • 1 Syringe
  • 2 Alcohol swabs
  • 2 Saline syringes and an alcohol disinfectant cap to flush the line
  • 2 Pairs of gloves and other protective equipment
  • 1 Needle
  • 1 Syringe
  • 3 Alcohol swabs
  • 1 Infusion bag
  • 1 Infusion pump
  • 1 Seal
  • Primary and secondary tubing
  • 1 Administration set
  • 1 IV pole
  • 1 Compounding hood

Indication

CINVANTI is a substance P/neurokinin-1 (NK1) receptor antagonist, indicated in adults, in combination with other antiemetic agents, for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy (HEC) including high-dose cisplatin and nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy (MEC).

Limitations of Use: CINVANTI has not been studied for treatment of established nausea and vomiting.

Important Safety Information

Contraindications

CINVANTI is contraindicated in patients with hypersensitivity to any of the components of CINVANTI.

Concurrent use of pimozide with CINVANTI is contraindicated.

Warnings and Precautions

Clinically Significant CYP3A4 Drug Interactions

Aprepitant is a substrate, weak-to-moderate (dose-dependent) inhibitor, and an inducer of CYP3A4.

  • Use with other drugs that are CYP3A4 substrates may result in increased plasma concentration of the concomitant drug.
    • Use of pimozide with CINVANTI is contraindicated due to the risk of significantly increased plasma concentrations of pimozide, potentially resulting in prolongation of the QT interval, a known adverse reaction of pimozide.
  • Use of CINVANTI with strong or moderate CYP3A4 inhibitors (e.g., ketoconazole, diltiazem) may increase plasma concentrations of aprepitant and result in an increased risk of adverse reactions related to CINVANTI.
  • Use of CINVANTI with strong CYP3A4 inducers (e.g., rifampin) may result in a reduction in aprepitant plasma concentrations and decreased efficacy of aprepitant.

Hypersensitivity Reactions

Serious hypersensitivity reactions, including anaphylaxis during or soon after administration of CINVANTI have occurred. Symptoms including dyspnea, eye swelling, flushing, pruritus, and wheezing have been reported. If hypersensitivity reactions occur, discontinue CINVANTI. Do not reinstate CINVANTI in patients who experience these symptoms with previous use.

Decrease in INR with Concomitant Warfarin

Co-administration of CINVANTI with warfarin, a CYP2C9 substrate, may result in a clinically significant decrease in the International Normalized Ratio (INR) of prothrombin time. Monitor the INR in patients on chronic warfarin therapy in the 2-week period, particularly at 7 to 10 days, following initiation of CINVANTI with each chemotherapy cycle.

Risk of Reduced Efficacy of Hormonal Contraceptives

The efficacy of hormonal contraceptives may be reduced during administration of and for 28 days following the last dose of CINVANTI. Advise patients to use effective alternative or back-up methods of non-hormonal contraception during treatment with CINVANTI and for 1 month following administration of CINVANTI or oral aprepitant, whichever is administered last.

Use in Specific Populations

Avoid use of CINVANTI in pregnant women as alcohol is an inactive ingredient for CINVANTI. There is no safe level of alcohol exposure in pregnancy.

Adverse Reactions

The most common adverse reactions with the 3-day oral aprepitant regimen in conjunction with MEC (≥1% and greater than standard therapy) were fatigue and eructation.

The most common adverse reactions with the single-dose intravenous fosaprepitant regimen in conjunction with HEC were generally similar to that seen in prior HEC studies with oral aprepitant. In addition, infusion site reactions (3%) occurred.

The most common adverse reactions with single-dose CINVANTI (≥2%) were headache and fatigue. The safety profile of CINVANTI in healthy subjects who received a single 2-minute injection was similar to that seen with a 30-minute infusion.

Report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. Report side effects to Heron at 1-844-437-6611.

For more information about CINVANTI, please see full Prescribing Information.

References:
  1. CINVANTI [prescribing information]. Heron Therapeutics, Inc., San Diego, CA; February 2019.
  2. Intermountain Healthcare. Fact sheet for patients and families. https://intermountainhealthcare.org/ext/Dcmnt?ncid=520977298. Accessed February 8, 2019.
  3. DeBernardo, Christina. Medication administration via intravenous piggyback (IVPB). KLA education services. https://www.ivyleaguenurse.com/courses/IVPB.pdf. Accessed February 9, 2019.
  4. Emend IV [prescribing information]. Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ; September 2018.
  5. Akynzeo [prescribing information]. Helsinn Healthcare SA., Lugano, Switzerland: April 2018.
  6. Grissinger M. Some IV medications are diluted unnecessarily in patient-care areas, creating undue risk. P&T. 2017;42(8):490-508.
  7. Tsao NW, Lo C, Babich M, Shah K, Bansback NJ. Decentralized automated dispensing devices: systematic review of clinical and economic impacts in hospitals. Can J Hosp Pharm. 2014;67(2):138-148.
  8. Raajasekar AKA, Barola S, Tehrani L, Chandra AB. To push or not to push: the benefit of administering anti-emetics by intravenous push. Blood. 2015;126(23):3314.
  9. Doyle GR, McCutcheon JA. Parental Medication Administration: parental medications and preparing medications from ampules and vials. Clinical procedures for safer patient care. British Columbia Institute of Technology. https://opentextbc.ca/clinicalskills/chapter/safe-injection-administration-and-preparing-medication-from-ampules-and-vials/. Accessed February 11, 2019.
  10. ASHP Media. Practice basics—Chapter 16: Aseptic technique, sterile compounding, and IV admixture programs. http://www.ashpmedia.org/bookstore/P2074/Chpt-16.ppt. Accessed February 8, 2019.
  11. Study.com. Pharmaceutical compounding: equipment & supplies. https://study.com/academy/lesson/pharmaceutical-compounding-equipment-supplies.html. Accessed February 8, 2019.