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aprepitant aprepitant

 
  Trade/other name(s)
Emend (capsue form), fosaprepitant (intravenous form) 		 
  Pronunciation: a-prep-it-unt  
  Why would this drug be used?
Aprepitant or fosaprepitant is given with two other types of anti-nausea drugs to prevent immediate and delayed nausea and vomiting after highly vomit-inducing chemotherapy. 		 
  How does this drug work?
Aprepitant belongs to the class of drugs called anti-nausea drugs or anti-emetics. It blocks a receptor in the brain called the neurokinin-1 (NK1) receptor. This prevents the stimulation of the vomiting center and chemotherapy receptor trigger zone in the brain.

While aprepitant comes in capsule form, fosaprepitant is an intravenous (IV) form of the drug that is converted into aprepitant once it is in the body.

  
  Before taking this medicine

Tell your doctor: 		 
 
  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you are pregnant or plan to become pregnant. It is not known if this drug can harm the fetus.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.
  
  Interactions with other drugs
Do not take aprepitant/fosaprepitant if you are taking pimozide (Orap). It may raise the pimozide in the blood to dangerous levels.

Aprepitant/fosaprepitant may cause birth control pills not to work. Backup methods of birth control should be used during treatment and for one month after the last dose of this drug.

Aprepitant/fosaprepitant may raise the blood levels of steroid drugs such as methylprednisolone and dexamethasone. If you keep taking dexamethasone after treatment, your dose may need to be reduced.

Aprepitant/fosaprepitant may lower the blood levels of the blood thinner warfarin (Coumadin), the diabetes drug tolbutamide, and the anti-seizure drug phenytoin.

Aprepitant/fosaprepitant may raise blood levels of certain sedatives, anesthetics, or sleeping medicines such as diazepam (Valium), midazolam (Versed), alprazolam (Xanax), triazolam (Halcion). These drugs may need dose adjustment. Be sure to tell any doctor or dentist who is treating you that you have recently taken or are taking aprepitant/fosaprepitant.

The following drugs can raise the blood levels of aprepitant/fosaprepitant:

  • antifungal drugs ketoconazole, itraconazole
  • antidepressant drug nefazodone
  • antibiotics such as clarithromycin and troleandomycin
  • blood pressure medicine diltiazem
  • HIV drugs ritonavir, saquinavir, and nelfinavir

The following drugs may lower the blood levels of aprepitant/fosaprepitant so that it doesn't work as well:

  • TB drugs rifampin and rifabutin
  • anti-seizure drugs carbamazepine and phenytoin
  • dietary supplement St. John's wort
.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

 
  Interactions with foods
Grapefruit or grapefruit juice may raise the level of this drug in your body. This can worsen any bad effects the drug may have on you and may increase its action. Check with your doctor, nurse, or pharmacist about whether other foods may be a problem. 		 
 
Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

  
  How is this drug taken or given?
On the day of chemotherapy treatment, this drug is given in one of 2 ways:
  • as a capsule taken 1 hour before chemotherapy, together with a serotonin receptor antagonist and dexamethasone with food
  • as an intravenous (IV) infusion over 15 minutes, starting about 30 minutes before chemotherapy, together with a serotonin receptor antagonist and dexamethasone

On the 2 days after the chemotherapy treatment, a smaller dose of aprepitant is taken each morning (in capsule form), along with dexamethasone and food. Each day, be sure that you have the right dose. Take this drug exactly as your doctor tells you to. If you do not understand the instructions, your doctor or nurse can explain them to you.

Store the medicine in a tightly closed container away from heat and moisture and away from children and pets.

 
  Precautions

If you are taking warfarin (Coumadin), you may need extra tests and possibly dose adjustments during and after the time you take aprepitant/fosaprepitant. Be sure the doctor who prescribed the warfarin knows you are taking this drug.

Rarely, allergic reactions may occur, with symptoms such as hives (skin welts); itching; swelling of the face, mouth, tongue, or throat; dizziness; trouble breathing or swallowing. Get emergency help right away if you have these symptoms.

 
 
Possible side effects
  
  Common
You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.
  • fatigue and feeling listless
  • constipation
  • diarrhea
  • loss of appetite
  • hiccups
  • heartburn or indigestion (sour stomach)
  • pain at injection site (IV form)
  • itching
  
  Rare
  • dizziness
  • ringing in the ears
  • headache
  • allergic reaction with rash, swelling of throat or mouth, dizziness, trouble breathing or swallowing*

*See "Precautions" section for more detailed information.

  
 
There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.
  
 
 
  FDA approval
Yes - first approved in 2003. 		 
 
 
  Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.  


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