gefapixant citrate: clinical use

Prescribing considerations

• Confirm refractory or unexplained chronic cough in an adult.
• Assess renal function; evidence is insufficient in end-stage renal disease requiring dialysis.
• Address moderate or severe obstructive sleep apnoea appropriately before initiation.
• Reassess treatment if an acute lower respiratory tract infection develops.
• Discuss the high likelihood of taste disturbance and its effect on treatment acceptability.

Contraindications and cautions

• Hypersensitivity to gefapixant or any excipient.
• Use cautiously with known sulphonamide hypersensitivity because cross-hypersensitivity cannot be excluded.

Monitoring

• Renal function where impairment is present or may develop.
• Taste disturbance, appetite and treatment acceptability.
• Symptoms suggesting urinary stones.
• Clinical status if lower respiratory infection develops or obstructive sleep apnoea is present.

Clinical pharmacology

Gefapixant selectively antagonises ATP-gated P2X3 receptors and also acts at P2X2/3 receptors. Food does not meaningfully affect absorption, hepatic metabolism is minor, renal excretion is the main elimination route and central nervous system penetration is low.

Formulation and product differences

• The product is a pink, round, convex 45 mg film-coated tablet marked “777” and must be swallowed whole.
• The formulation is essentially sodium-free and requires no special storage conditions.

Tablet

Route: Oral

Strengths: 45 mg