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1. Dosage

Current therapies for chemotherapy-induced nausea/vomiting (CINV) and post-operative nausea and vomiting (PONV) target corticosteroid, dopamine, and serotonin (5-HT3) receptors. In the central nervous system, tachykinins and neurokinins play a role in some autonomic reflexes and behaviors. Substance P and NK1 receptors control the emetic reflex, and substance P increases contractions of smooth gastrointestinal muscles leading to vasodilation [1].  Aprepitant is a selective human substance P/neurokinin 1 (NK1) antagonist with a high affinity for NK1 receptors and little, if any, attraction for corticosteroid, dopamine, or 5-HT3 receptors.1-3 Rolapitant (Varubi) is a selective, competitive antagonist of substance P/NK1 receptors, and it has little to no affinity for NK2 or NK3 receptors [1,4]. Combination therapy including netupitant, a substance P/NK1 antagonist and palonosetron, a selective 5-HT3 receptor antagonist (Akynzeo), is also available. Palonosetron targets CINV in the acute phase while netupitant prevents CINV in both the acute and delayed phases [1,5].