Prescribing InformationImportant Safety InformationUS healthcare professionals only
Aponvie logo

APONVIE is now included in the Fifth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

See Recommendations

Managing Postoperative Nausea and Vomiting (PONV)

The Prevalence of PONV

80% icon

Postoperative nausea and vomiting are 2 of the most common adverse events following surgery, with an estimated incidence of 30% in the general surgical population and up to 80% in high-risk patients.1

30% icon

Ondansetron, one of the most commonly used antiemetics, has a relatively short half-life (3 to 6 hours).2 Even when treated with ondansetron or other antiemetics, more than 30% of patients still experience PONV within the first 48 hours after surgery.3 Post‑discharge nausea and vomiting (PDNV) is increasingly recognized as a major contributor to the overall burden of PONV, with significant rates reported in the first 24–72 hours after surgery, well after many outpatient surgery patients have been discharged and no longer have access to fast-onset IV antiemetics or direct care.1,4

Risk Factors for PONV1

Patients at Medium-to-High Risk of PONV Have the Following Risk Factors:

  • Females
  • Nonsmokers
  • A history of PONV or motion sickness
  • Use of postoperative opioids
  • Younger age
  • Surgery type
Apfel Score graphic
Apfel Score graphic

Risk Level Per # of Factors:

0 to 1 Low Risk

2 Medium Risk

3+ High Risk

PONV Is a Significant Burden to Patients and Facilities

PONV Is a major cause of patient dissatisfaction after surgery, with patients ranking vomiting as the most undesirable outcome when asked about postsurgical complications5

Poorly managed PONV affects overall length of hospital stay and may require unanticipated hospital readmission, which can lead to increased cost to the patient and to the healthcare system6-8

Consensus guidelines recommend patients at high risk of PONV should be given prophylactic, long-acting antiemetics before discharge

Clinical complications of persistent retching or vomiting can include8,9:

  • Aspiration
  • Tension on suture lines
  • Development of hematomas beneath surgical flaps
  • Electrolyte abnormalities
  • Dehydration

Enhanced Recovery After Surgery (ERAS) protocols include evidence-based practices to improve patient outcomes, including10:

  • Reduced opioid consumption
  • Decreased PONV
  • Decreased length of stay
Learn how APONVIE can prevent PONV in your moderate-to-high risk patients »

References: 1. Gan TJ, Jin Z, Ayad S, et al. Fifth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting: Executive Summary. Anesth Analg. Published online November 14, 2025. 2020;131(2):411-448. doi:10.1213/ANE.0000000000007816. 2. Zofran [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2017. 3. Diemunsch P, Gan TJ, Philip BK, et al. Single-dose aprepitant vs ondansetron for the prevention of postoperative nausea and vomiting: a randomized, double-blind Phase III trial in patients undergoing open abdominal surgery. Brit J Anaesth. 2007;99(2):202-211. doi:10.1093/bja/aem133. 4. Apfel CC, Philip BK, Cakmakkaya OS, et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology. 2012;117(3):475-486. doi:10.1097/ALN.0b013e318267ef31. 5. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89(3):652-658. doi:10.1097/00000539-199909000-00022. 6. Habib AS, Chen Y-T, Taguchi A, Hu XH, Gan TJ. Postoperative nausea and vomiting following inpatient surgeries in a teaching hospital: a retrospective database analysis. Curr Med Res Opin. 2006;22(6):1093-1099. doi:10.1185/030079906X104830. 7. Hill RP, Lubarsky DA, Phillips-Bute B, et al. Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol or placebo. Anesthesiology. 2000;92(4):958-967. doi.10.1097/00000542-200004000-00012. 8. Golembiewski J, Chernin E, Chopra T. Prevention and treatment of postoperative nausea and vomiting. Am J Health Syst Pharm. 2005;62(12):1247-1260. doi:10.1093/ajhp/62.12.1247. 9. Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment, and prevention. Anesthesiology. 1992;77(1):162-184. doi:10.1097/00000542-199207000-00023. 10. Chiu C, Aleshi P, Esserman LJ, et al. Improved analgesia and reduced post-operative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) pathway for total mastectomy. BMC Anesthesiol. 2018;18(1):41. doi:10.1186/s12871-018-0505-9.

[+] Expand

Important Safety Information

Contraindications

APONVIE is contraindicated in patients with a history of hypersensitivity to aprepitant or any component of the product, and in patients taking pimozide. Increased pimozide levels may cause serious or life-threatening reactions, such as QT prolongation.

Warnings and Precautions

Hypersensitivity Reactions: Serious hypersensitivity reactions, including anaphylaxis, during or soon after administration of aprepitant have occurred. Symptoms including dyspnea, eye swelling, flushing, pruritus, and wheezing have been reported. Monitor patients during and after administration.

Clinically Significant CYP3A4 Drug Interactions: Aprepitant is a substrate, weak-to-moderate (dose-dependent) inhibitor, and an inducer of CYP3A4. Use of pimozide, a CYP3A4 substrate, with APONVIE is contraindicated.

Decrease in INR with Concomitant Warfarin: Use of aprepitant with warfarin, a CYP2C9 substrate, may result in a clinically significant decrease in the International Normalized Ratio (INR) of prothrombin time. Monitor the INR in the 2-week period particularly at 7 to 10 days following administration.

Risk of Reduced Efficacy of Hormonal Contraceptives: The efficacy of hormonal contraceptives may be reduced for 28 days following administration. Advise patients to use effective alternative or back-up methods for 1 month.

Use in Specific Populations

Avoid use of APONVIE in pregnant women as alcohol is an inactive ingredient. There is no safe level of alcohol exposure in pregnancy.

Adverse Reactions

Most common adverse reactions (incidence ≥3%) are constipation, fatigue, and headache.

Report side effects to Heron at 1-844-437-6611 or to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Indication

APONVIE is a substance P/neurokinin-1 (NK1) receptor antagonist, indicated for the prevention of postoperative nausea and vomiting (PONV) in adults.

Limitations of Use: APONVIE has not been studied for treatment of established nausea and vomiting.

Please see full Prescribing Information.

Full Prescribing Information

Connect With Heron

How could you incorporate APONVIE as the foundation of your institution's PONV management strategy? Connect with us to find out.

Fields marked with an asterisk (*) are required.

I would like to*:

To report an adverse event or product complaint:

844-HERON11 (844-437-6611)
heronmc@eversana.com

For general information:

844-HERON11 (844-437-6611)

Investors and Media:

IR@HeronTx.com

For all other inquiries, please visit the Heron Therapeutics corporate website.

Go to Heron Website