Aprepitant for Chronic Nausea: APRON Results

The American Gastroenterological Association’s¹ 2025 guidance conditionally advises against aprepitant as a first-line treatment for gastroparesis. That wording leaves room for an individual treatment discussion; it does not recommend starting it for unexplained nausea.¹

Who was studied?

APRON randomized 126 adults with nausea of presumed gastric origin lasting ≥6 months to 125 mg aprepitant daily or placebo for four weeks. 57% had delayed stomach emptying.²

Did nausea improve?

Response required a treatment-period mean ≥25 mm below the baseline mean, or a treatment-period mean <25 mm, using daily 0–100-mm nausea ratings. 29/63 versus 25/63 responded: relative risk 1.2 (95% confidence interval 0.8–1.7; P = .43). Superiority was not demonstrated. Four aprepitant participants without any follow-up ratings counted as nonresponders.²

Why secondary results?

Secondary 0–5 nausea scores improved more, but the protocol specified no adjustment for multiple comparisons. Adverse events affected 22/63 versus 11/63, aprepitant versus placebo.²³

NIH/Merck funded it; authors reported no manuscript-related conflicts.²

Before prescribing?

The current US oral aprepitant capsule label covers prevention of chemotherapy-related nausea and vomiting and, in adults, postoperative nausea and vomiting. Chronic nausea treatment is off-label. The label does not recommend continuous chronic administration, citing lack of study and possible changes in the interaction profile. The trial regimen is not a routine dosing recommendation.⁴

A pharmacist should review the full medicine list. Pimozide is contraindicated; aprepitant can alter exposure to several medicines through liver-enzyme interactions. Warfarin may require additional clotting tests. Hormonal contraception can become less effective; the label advises effective alternative or backup contraception during treatment and for one month after the last dose. Tell the prescriber about pregnancy or plans for pregnancy; human safety data are insufficient.⁴

“Time It: Your Belly Clock” in Bloated by Dinner records meals, symptoms and medicines with their times. Bring that record to the review, including medicines taken only occasionally. Keep nausea, vomiting and fullness on separate lines so the conversation identifies which symptom a proposed treatment aims to change.