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3. Duplicative Therapy

Cinvanti (aprepitant) intravenous emulsion is indicated for use on day 1 of the chemotherapy cycle, and oral aprepitant is indicated on days two and three for moderate emetic risk chemotherapy regimens [8]. Fosaprepitant, the injectable aprepitant formulation, may be used in three-day chemotherapy regimens, and oral capsules or the oral suspension may be used as an alternative to the injectable formulation on days two and three in patients 6 months to 17 years of age [9]. Concurrent administration of selective human substance P/NK1 receptor antagonists is not supported in the literature and may result in enhance adverse pharmacologic effects. Additionally, combined use of oral rolapitant or netupitant/palonosetron is not indicated and may result in increased adverse effects. Combined use of substance P/NK1 receptor antagonists or adjunctive use of oral and parenteral substance P/NK1 receptor antagonist formulations is not recommended and will be reviewed.