Broadening Antiemetics Research by Comparing the Effectiveness of Fosaprepitant and Metoclopramide

Phase

2/3

Condition

Vomiting

Colic

Stomach Discomfort

Treatment

Metoclopramide

Fosaprepitant

Clinical Study ID

NCT06740812

2024-16422

Ages > 18
All Genders

Study Summary

The study team proposes a double-blind, comparative effectiveness, randomized controlled trial (RCT) to address the following goal: to determine the relative efficacy and adverse event profile of fosaprepitant compared to the standard of care antiemetic metoclopramide. Fosaprepitant and its active metabolite aprepitant are a relatively new class of antiemetic that exclusively acts in the central nervous system by blocking neurokinin (NK-1) which is a key signaling molecule in the centrally mediated aspects of the vomiting reflex. Currently, fosaprepitant and aprepitant both have only two United Stated Food and Drug Administration (USFDA) approved indications for nausea and vomiting: chemotherapy-induced and postoperative. Neurokinin inhibitors are highly effective and generally well-tolerated. Therefore, this class of medication may be a more appropriate medication for the millions of patients with nausea and vomiting that seek care in emergency departments (EDs). Intravenous fosaprepitant is converted to the active metabolite aprepitant on the order of minutes and is significantly cheaper to procure at this time.

Eligibility Criteria

Inclusion

Inclusion Criteria:

Adults at least 18 years old
Present to ED for treatment of Nausea and/or vomiting as defined by theInternational Classification of Diseases (ICD-10) or identified by treatingclinician

Exclusion

Exclusion Criteria:

Pregnancy, desiring pregnancy, or lactating
Antiemetic use or intravenous fluids prior to presenting to ED for evaluation andmanagement
Bradycardia (< 60 bpm heart rate)
Prolonged QTc (greater than 490ms)
Not conversant in English or Spanish
Altered mental status
Dementia
Lack of phone for follow-up communication

Study Design

Metoclopramide

2/3

June 01, 2025

March 31, 2026

Study Description

Nausea and vomiting (NV) are common and interrelated conditions. Approximately 50% of adults experience nausea in a given year while 30% of adults experience vomiting over the same period. Of this population of symptomatic individuals with NV, 25% of patients seek care in any healthcare delivery setting. Health Care Utilization Project (HCUP) data indicates that nearly 9.0 million patients seek care for NV in EDs each year in the United States.

Antiemetics are used to treat NV. Antiemetics currently utilized in the emergency department setting for NV do not always work on the first dose and have a plethora of side effects because of their peripheral mechanism of action outside of the vomiting reflex pathway in the central nervous system. These medications include ondansetron, promethazine, metoclopramide, olanzapine, haloperidol. Chief among these side effects is alteration of an aspect cardiac electrical signaling called the QT segment which represents the duration of ventricular contraction and relaxation. The QT segment is prolonged with commonly used antiemetics which can often be a prelude to cardiac dysrhythmias that are associated with mortality. As a result, patients with NV often have long length-of-stay (LOS) involving supportive care with intravenous fluids or empiric treatment with medications that can potentiate development of cardiac dysrhythmias. This is a problem in busy emergency departments (EDs) struggling to accelerate patient throughput in order to appropriately keep up with patient volume in an under-supplied hospital bed environment nationally.

Connect with a study center

Montefiore Medical Center
Bronx, New York 10467
United States
Site Not Available

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