Full Prescribing Information Important Safety Information

CINVANTI—the only synthetic–surfactant-free NK1 RA approved for 2-minute IV Push1,2

CINVANTI IV (aprepitant) injectable emulsion1,4-9 Fosaprepitant for injection*2 Akynzeo® IV (fosnetupitant/ palonosetron) for injection and injection3
Approved for prevention of acute and delayed CINV due to both HEC and MEC Yes NO NO
Delivers the trusted efficacy of aprepitant Yes Yes NO
Provides operational advantages of 2-minute IV Push Yes NO NO
Clinical flexibility of single-agent NK1 RA Yes Yes NO
Synthetic–surfactant-free formulation
(ie, no polysorbate 80)
Yes NO Yes
Emulsion formulation requires no reconstitution Yes NO NO
Vials can be stored at room temperature for up to 60 days Yes NO NO

*Includes generic fosaprepitant and Emend® IV (fosaprepitant) for injection.
Akynzeo for injection requires reconstitution, while Akynzeo injection does not.
Akynzeo for injection requires refrigeration, while Akynzeo injection does not.

NCCN Category 1 recommended option

Aprepitant injectable emulsion (CINVANTI) is a Category 1 recommended option in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Antiemesis for the prevention of acute and delayed emesis due to HEC and MEC.10‡§II¶

National Comprehensive Cancer Network® (NCCN®).
§ Category 1: Based upon high-level evidence, there is uniform National Comprehensive Cancer Network® (NCCN®) consensus that the intervention is appropriate.
II When used in recommended prophylactic antiemetic combination regimens.
Aprepitant injectable emulsion is a unique formulation of aprepitant and is NOT interchangeable with the intravenous formulation of fosaprepitant.

CINV=chemotherapy-induced nausea and vomiting; HEC=highly emetogenic chemotherapy; IV=intravenous; MEC=moderately emetogenic chemotherapy; NK1 RA=neurokinin-1 receptor antagonist.


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 as a single-dose regimen; delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy (MEC) as a single-dose regimen; and nausea and vomiting associated with initial and repeat courses of MEC as a 3-day regimen.

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

Important Safety Information


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 of CINVANTI 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 CINVANTI.

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 reinitiate 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 are:

  • Single-dose fosaprepitant with MEC (≥2%): fatigue, diarrhea, neutropenia, asthenia, anemia, peripheral neuropathy, leukopenia, dyspepsia, urinary tract infection, pain in extremity.
  • 3-day oral aprepitant with MEC (≥1% and greater than standard therapy): fatigue and eructation.
  • Single-dose fosaprepitant with HEC: generally similar to 3-day oral aprepitant. In addition, infusion site reactions (3%) occurred.
  • Single-dose CINVANTI (≥2%): 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.

  1. CINVANTI [prescribing information]. Heron Therapeutics, Inc., San Diego, CA; March 2022.
  2. Emend IV [prescribing information]. Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ; April 2020.
  3. Akynzeo [prescribing information]. Helsinn Healthcare SA., Lugano, Switzerland: May 2020.
  4. Data on file [Clinical Summary]. Heron Therapeutics, Inc., San Diego, CA.
  5. Grissinger M. Some IV medications are diluted unnecessarily in patient-care areas, creating undue risk. PT. 2017;42(8):490-508.
  6. 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.
  7. 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.
  8. Intermountain Healthcare. Fact sheet for patients and families. Accessed October 2, 2019. https://intermountainhealthcare.org/ext/Dcmnt?ncid=520977298.
  9. DeBernardo, Christina. Medication administration via intravenous piggyback (IVPB). KLA Education Services. Accessed October 2, 2019. https://www.ivyleaguenurse.com/courses/IVPB.pdf.
  10. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Antiemesis V.2.2022. © National Comprehensive Cancer Network, Inc. 2022 All rights reserved. Accessed April 11, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.