Gastroparesis-associated refractory nausea treated with aprepitant.

Area of Science:

• Gastroenterology
• Pharmacology

Background:

• Idiopathic gastroparesis presents a significant challenge in managing refractory nausea and vomiting.
• Standard antiemetic therapies often fail to provide adequate relief for these patients.

Observation:

• A 41-year-old female with idiopathic gastroparesis experienced severe, intractable nausea and vomiting, leading to frequent hospitalizations.
• Previous treatments including metoclopramide, ondansetron, and promethazine were ineffective.
• Aprepitant, a neurokinin-1 receptor antagonist, was administered at 40 mg daily as a last resort before considering gastric pacing.

Findings:

• The patient reported a dramatic decrease in nausea within 48 hours of starting aprepitant.
• Symptomatic improvement included tolerance of oral feeding and reduced need for intravenous hydration.
• Despite discontinuation due to cost, symptoms did not return to baseline severity, and the patient gained weight.

Implications:

• Aprepitant demonstrates potential utility in managing refractory nausea associated with gastroparesis, even in off-label use.
• While expensive, aprepitant may reduce hospital admissions and healthcare costs in select patients.
• Further controlled trials are warranted to validate the efficacy and cost-effectiveness of aprepitant for gastroparesis-induced nausea.