aprepitant

Generic Name: aprepitant (a PREP i tant)
Brand Name: Emend, Emend 2-Day, Emend 3-Day

What is aprepitant?

Aprepitant blocks the actions of chemicals in the body that trigger nausea and vomiting.

Aprepitant is used together with other medications to prevent nausea and vomiting that may be caused by surgery or cancer chemotherapy.

Aprepitant is given ahead of time and will not treat nausea or vomiting that you already have.

Aprepitant may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about aprepitant?

Do not take aprepitant if you are taking any of the following drugs: cisapride (Propulsid) or pimozide (Orap). These drugs may cause life-threatening interactions when taken together with aprepitant.

If you have liver disease, you may need an aprepitant dose adjustment or special tests.

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Aprepitant can make birth control pills less effective, resulting in pregnancy. This effect can last for up to 28 days after your last dose of this medication. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking aprepitant and for at least 1 month after your treatment ends.

There are many other drugs that can interact with aprepitant. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

What should I discuss with my health care provider before taking aprepitant?

You should not use aprepitant if you are allergic to it.

These other drugs can cause serious or life-threatening medical problems if you take them together with aprepitant:

  • cisapride (Propulsid); or

  • pimozide (Orap).

If you have liver disease, you may need an aprepitant dose adjustment or special tests.

FDA pregnancy category B. Aprepitant is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether aprepitant passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take aprepitant?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Aprepitant can be taken with or without food. If you take aprepitant before surgery, follow your doctor's instructions about any restrictions on food or beverages.

The first dose of aprepitant is usually taken 1 hour before treatment with chemotherapy, or 3 hours before a surgery. You may also need additional doses for a couple days after your chemotherapy treatment. Follow your doctor's instructions.

You may also be given other medicines with aprepitant to further help prevent nausea and vomiting.

Aprepitant is not for long-term use.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Call your doctor for instructions if you forget to take your medicine within the prescribed length of time before your chemotherapy or surgery.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include drowsiness and headache.

What should I avoid while taking aprepitant?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Aprepitant side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • feeling like you might pass out;

  • feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin; or

  • fever, chills, body aches, flu symptoms, sores in your mouth and throat.

Less serious side effects may include:

  • nausea, vomiting, heartburn, stomach pain;

  • diarrhea or constipation;

  • loss of appetite;

  • hiccups;

  • hair loss;

  • headache;

  • dizziness;

  • tired feeling;

  • mild skin rash;

  • ringing in your ears; or

  • sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Aprepitant dosing information

Usual Adult Dose for Nausea/Vomiting -- Chemotherapy Induced:

HIGHLY EMETOGENIC CANCER CHEMOTHERAPY:
Day 1: 125 mg orally 1 hour prior to chemotherapy
Day 2 and 3: 80 mg orally in the morning
Duration of therapy: Three days
Comments:
-Aprepitant is administered in conjunction with a corticosteroid and a 5-HT3 antagonist.
-The recommended dosage of dexamethasone is 12 mg orally on day 1 administered 30 minutes prior to chemotherapy and 8 mg orally in the mornings on days 2 through 4.
-The 5-HT3 antagonist is administered on day 1 only. Consult the package insert for the 5-HT3 antagonist dosing prior to initiation of treatment.
-Aprepitant may be taken with or without food.

Fosaprepitant dimeglumine for Injection (115 mg) may be substituted for oral aprepitant (125 mg), 30 minutes prior to chemotherapy, on Day 1 only of the CINV regimen as an intravenous infusion administered over 15 minutes.

MODERATELY EMETOGENIC CANCER CHEMOTHERAPY:
Day 1: 125 mg orally 1 hour prior to chemotherapy
Day 2 and 3: 80 mg orally in the morning
Duration of therapy: Three days
Comments:
-Aprepitant is administered in conjunction with a corticosteroid and a 5-HT3 antagonist.
-The recommended dosage of dexamethasone is 12 mg orally on day 1 administered 30 minutes prior to chemotherapy.
-The 5-HT3 antagonist is administered on day 1 only. Consult the package insert for the 5-HT3 antagonist dosing prior to initiation of treatment.
-Aprepitant may be taken with or without food.

Usual Adult Dose for Nausea/Vomiting -- Postoperative:

Recommended dose: a single, oral 40 mg dose administered within 3 hours prior to the induction of anesthesia

What other drugs will affect aprepitant?

Aprepitant can make birth control pills less effective, resulting in pregnancy. This effect can last for up to 28 days after your last dose of this medication. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking aprepitant and for at least 1 month after your treatment ends.

Tell your doctor about all other medicines you use, especially:

  • tolbutamide (Orinase);

  • a blood thinner such as warfarin (Coumadin);

  • midazolam (Versed) or similar medicines such as Valium, Xanax, or Tranxene;

  • an antidepressant such as nefazodone (Serzone) or paroxetine (Paxil);

  • an antibiotic such as clarithromycin (Biaxin) or rifampin (Rifater, Rifamate);

  • an antifungal medication such as itraconazole (Sporanox) or ketoconazole (Extina, Ketozole, Nizoral, Xolegal);

  • certain cancer medicines such as ifosfamide (Ifex), vinblastine (Velban), or vincristine (Oncovin, Vincasar);

  • HIV medicines such as nelfinavir (Viracept), lopinavir/ritonavir (Kaletra), or ritonavir (Norvir);

  • seizure medication such as carbamazepine (Tegretol, Carbatrol) or phenytoin (Dilantin); or

  • steroid medicine such as dexamethasone (Decadron, Hexadrol) or methylprednisolone (Medapred, Solu-Medrol).

There are many other drugs that may interact with aprepitant. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about aprepitant.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 3.02. Revision Date: 2010-12-15, 5:01:39 PM.

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