Prophylactic effect of fosaprepitant on postoperative nausea and vomiting: a narrative review of the current clinical literature

Abstract Postoperative nausea and vomiting (PONV) remains a common complication, with persistently high failure rates even in high-risk patients receiving standard combination regimens such as ondansetron and dexamethasone. This finding highlights the limitations of current therapies in terms of the duration of action, particularly for delayed PONV, and receptor coverage. Fosaprepitant, an intravenous neurokinin-1 receptor antagonist, represents a novel strategy to overcome this challenge. Its long duration of action (half-life of 9–13 h) and potent blockade of substance P, a key component of the pathway involved in vomiting, provide a new approach to managing this complication. A systematic search of major databases (PubMed, Web of Science, and Cochrane Library) was conducted to identify clinical studies published between January 2000 and June 30, 2025, investigating intravenous fosaprepitant for the prevention of postoperative nausea and vomiting. Keywords included fosaprepitant, neuropeptide-1 receptor antagonist, postoperative nausea and vomiting, drug interactions, and intravenous administration. The relevant literature was screened based on clinical relevance and the study design. The findings of this review indicate that compared with conventional agents, fosaprepitant demonstrates superior or equivalent efficacy in preventing vomiting, particularly across multiple surgical procedures involving opioid use or high-risk patients, and is suitable as the cornerstone of multimodal protocols. However, its interactions with CYP3A4-metabolized drugs and the associated hypotension risk remain challenges that require careful consideration before its integration into routine perioperative management. Thus, fosaprepitant, with its unique mechanism and pharmacokinetic advantages, represents a significant option for optimizing PONV prevention and advancing personalized therapy. Future research should focus on developing standardized strategies for managing drug interactions to fully realize its clinical potential.