Neurokinin-1 receptor antagonist therapy for post- stroke vomiting: A case report

Abstract

Post-stroke vomiting is a common but often challenging complication of cerebellar and brainstem strokes, which may be refractory to standard antiemetic therapy. We present a case of a 61-year- old male with recurrent ischemic strokes who suffered bilateral cerebellar infarcts and subsequently developed persistent vomiting during his inpatient rehabilitation stay. Despite empirical treatment with multiple classes of antiemetics, his symptoms remained unresolved. An off-label trial of aprepitant, a neurokinin-1 (NK-1) receptor antagonist typically used for chemotherapy-induced nausea and vomiting and post-operative nausea and vomiting, was initiated. The 3 day course of oral aprepitant, with a starting dose of 125mg once daily, followed by 80mg once daily for another 2 days, successfully resolved his vomiting. This case highlights the potential utility of NK-1 receptor antagonists in the management of refractory post-stroke vomiting. Cautious patient selection is paramount given their potential interactions with liver cytochrome enzymes, affecting the metabolism of anticoagulants such vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). Further studies are warranted to ascertain the efficacy and adverse effects of this novel class of antiemetics in the post stroke population.