Adding aprepitant to prevent nausea and vomiting after outpatient surgery

Adding Aprepitant to a Multimodal Strategy for the Prevention of Postoperative Nausea and Vomiting in High-risk Outpatient Surgical Patients

This trial will test whether a single 40 mg dose of aprepitant, added to standard anti-nausea care, reduces nausea and vomiting in adults at high risk after outpatient surgery.

Quick facts

• Phase: PHASE3
• Study type: Interventional
• Enrollment: 260 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Centre hospitalier de l'Université de Montréal (CHUM) (other)
• Locations: 1 site (Montreal, Quebec)
• Trial ID: NCT07248280 on ClinicalTrials.gov

What this trial studies

This randomized, placebo-controlled Phase 3 trial at CHUM enrolls adults having ambulatory surgery who are at high risk for postoperative nausea and vomiting (Apfel score ≥3). Participants receive either 40 mg aprepitant or matching placebo in addition to the recommended multimodal antiemetic strategy. The primary outcome is complete response — no nausea, no vomiting, and no need for rescue medication within 48 hours after surgery — with symptoms tracked in the immediate postoperative period and at home. The trial focuses on real-world outpatient recovery where PONV is often under-measured and burdensome to patients.

Who should consider this trial

Good fit: Adults (18+) scheduled for ambulatory surgery who are at high risk for PONV (≥3 Apfel risk factors) and can give informed consent are the intended participants.

Not a fit: Patients with a known allergy to aprepitant, those taking strong CYP3A4-interacting medications, those unable to consent, or patients at low risk for PONV are unlikely to benefit from this intervention.

Why it matters

Potential benefit: If successful, adding aprepitant could lower rates of PONV at home, speed recovery, and improve patient comfort and satisfaction after outpatient surgery.

How similar studies have performed: Previous trials of aprepitant for PONV have shown benefit in some settings, particularly for delayed symptoms, but results have been mixed and outpatient-specific evidence remains limited.

Eligibility criteria

Inclusion Criteria:

* 18 years and over, requiring an ambulatory surgery
* at high risk of post-operative nausea and vomitting defined by at least 3 factors from the Apfel score, calculated just prior to the surgery (female sex; non smoker; previous nausea or vomitting post-op., or motion sickness; expected opioid consumption in postoperative care).

Exclusion Criteria:

* Refusal or unable to consent
* Suspected or documented allergy to aprepitant (emend)
* Concomitant use of medication interacting via the cytochrome CYP3A4 with aprepitant (pimozide, terfenadine, astemizole, comtadin or cisapride).

Where this trial is running

Montreal, Quebec

• Centre hospitalier de l'Université de Montréal (CHUM) — Montreal, Quebec, Canada (RECRUITING)

Study contacts

• Principal investigator: Maxim Roy, MD, FRCPC — Centre hospitalier de l'Université de Montréal (CHUM)
• Study coordinator: Maxim Roy, MD, FRCPC

Conditions: Nausea and Vomiting, Postoperative, Prevention, Ambulatory care, Aprepitant