fosaprepitant

Generic Name: fosaprepitant (FOS a PREP i tan t)
Brand Names: Emend for Injection

What is fosaprepitant?

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

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

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

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

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

You should not receive fosaprepitant if you are taking cisapride (Propulsid) or pimozide (Orap). These drugs may cause life-threatening interactions when taken together with fosaprepitant. Before you receive fosaprepitant, tell your doctor if you have liver disease. You may need a dose adjustment or special tests to safely use this medication. Fosaprepitant 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. Talk to your doctor about the use of a non-hormonal back-up form of birth control (such as condoms, a diaphragm, or spermicides) during treatment with fosaprepitant, and for 1 month afterward.

There are many other medicines that can interact with fosaprepitant. 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. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

What should I discuss with my health care provider before I receive fosaprepitant?

You should not use this medication if you are allergic to fosaprepitant, aprepitant (oral Emend).

The following drugs should not be used while you are receiving fosaprepitant:

• cisapride (Propulsid); or

• pimozide (Orap).

To make sure you can safely take fosaprepitant, tell your doctor if you have liver disease. FDA pregnancy category B. Fosaprepitant is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while you are being treated with fosaprepitant. Fosaprepitant 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. Talk to your doctor about the use of a non-hormonal back-up form of birth control (such as condoms, a diaphragm, or spermicides) during treatment with fosaprepitant and for at least 1 month after your treatment ends. It is not known whether fosaprepitant passes into breast milk or if it could harm a nursing baby. Before you receive this medication, tell your doctor if you are breast-feeding a baby.

How is fosaprepitant given?

Fosaprepitant is injected into a vein through an IV. You will receive this injection in a clinic or hospital setting. Fosaprepitant must be given slowly, and the IV infusion can take at least 15 minutes to complete.

The first dose of fosaprepitant is usually given 30 minutes before your chemotherapy treatment begins.

You may also be given other medicines, including oral Emend (aprepitant capsules), for 3 or 4 days to further help prevent nausea and vomiting.

Fosaprepitant is not for long-term use.

What happens if I miss a dose?

Since fosaprepitant injection is given only once on the first day of your chemotherapy treatment, you are not likely to be on a dosing schedule.

What happens if I overdose?

An overdose of this medication is not likely to occur since it is given by a healthcare professional. However, overdose symptoms may include drowsiness and headache.

What should I avoid while receiving fosaprepitant?

Follow your doctor's instructions about any restrictions on food, beverages, or activity while you are being treated with fosaprepitant.

Fosaprepitant 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. Tell your caregivers at once if you have any of these serious side effects:

• feeling light-headed, fainting;

• slow heart rate;

• pale skin, easy bruising or bleeding; or

• pain or burning when you urinate.

Less serious side effects may include:

• nausea, vomiting, heartburn, stomach pain;

• diarrhea or constipation;

• loss of appetite;

• hiccups;

• increased thirst or hot, dry skin;

• weakness, dizziness, tired feeling;

• headache;

• ringing in your ears;

• fever, chills, body aches, flu symptoms;

• sleep problems (insomnia); or

• pain or a hard lump where the medicine was injected.

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: fosaprepitant side effects (in more detail)

Fosaprepitant Dosing Information

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

Prevention of Nausea and Vomiting Associated with Highly Emetogenic Chemotherapy (HEC):

One day fosaprepitant regimen:

Fosaprepitant 150 mg on Day 1 only as an IV infusion over 20 to 30 minutes approximately 30 minutes prior to chemotherapy (in combination with a 5-HT3 antagonist on day 1 and dexamethasone on days 1 to 4).

Day 1: Fosaprepitant for injection: 150 mg IV; Dexamethasone: 12 mg orally; Ondansetron: 32 mg IV

Day 2: Fosaprepitant for injection: none; Dexamethasone: 8 mg orally; Ondansetron: none

Day 3: Fosaprepitant for injection: none; Dexamethasone: 8 mg orally twice daily; Ondansetron: none

Day 4: Fosaprepitant for injection: none; Dexamethasone: 8 mg orally twice daily; Ondansetron: none

Dexamethasone should be administered 30 minutes prior to chemotherapy treatment on Day 1 and in the morning on Days 2 through 4. The dose of dexamethasone accounts for drug interactions. Ondansetron should be administered 30 minutes prior to chemotherapy treatment on Day 1.

Three day fosaprepitant regimen:

Fosaprepitant 115 mg on Day 1 only as an IV infusion over 15 minutes approximately 30 minutes prior to chemotherapy (in combination with a 5-HT3 antagonist on day 1 and dexamethasone on days 1 to 4). Capsules of aprepitant 80 mg should be administered on Days 2 and 3.

Day 1: Fosaprepitant for injection: 115 mg IV; Dexamethasone: 12 mg orally; Ondansetron: 32 mg IV

Day 2: Aprepitant: 80 mg orally; Dexamethasone: 8 mg orally; Ondansetron: none

Day 3: Aprepitant: 80 mg orally; Dexamethasone: 8 mg orally; Ondansetron: none

Day 4: Aprepitant: none; Dexamethasone: 8 mg orally; Ondansetron: none

Dexamethasone should be administered 30 minutes prior to chemotherapy treatment on Day 1 and in the morning on Days 2 through 4. The dose of dexamethasone accounts for drug interactions. Ondansetron should be administered 30 minutes prior to chemotherapy treatment on Day 1.

Prevention of Nausea and Vomiting Associated with Moderately Emetogenic Chemotherapy (MEC):

Fosaprepitant 115 mg on Day 1 only as an IV infusion over 15 minutes approximately 30 minutes prior to chemotherapy (in combination with a 5-HT3 antagonist on day 1 and dexamethasone on days 1 to 4). Capsules of aprepitant 80 mg should be administered on Days 2 and 3.

Day 1: Fosaprepitant for injection: 115 mg IV; Dexamethasone: 12 mg orally; Ondansetron: 8 mg orally twice daily

Day 2: Aprepitant: 80 mg orally; Dexamethasone: none; Ondansetron: none

Day 3: Aprepitant: 80 mg orally; Dexamethasone: none; Ondansetron: none

Dexamethasone should be administered 30 minutes prior to chemotherapy treatment on Day 1. The dose of dexamethasone accounts for drug interactions. Ondansetron 8 mg capsule should be administered 30 to 60 minutes prior to chemotherapy treatment and one 8 mg capsule should be administered 8 hours after the first dose on Day 1.

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

No dosage adjustment is necessary for the elderly.

What other drugs will affect fosaprepitant?

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

• diltiazem (Cardizem, Cartia, Tiazac);

• tolbutamide (Orinase);

• a blood thinner such as warfarin (Coumadin, Jantoven);

• 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 (Nizoral);

• certain cancer medicines such as etoposide (VePesid), irinotecan (Camptosar), ifosfamide (Ifex), imatinib (Gleevec), paclitaxel (Onxol, Taxol), 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).

This list is not complete and other drugs may interact with fosaprepitant. 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.

Where can I get more information?

• Your doctor or pharmacist can provide more information about fosaprepitant.