Emend®

Class: Supportive care

Generic Name: Aprepitant (uh-PREP-I-tent)
Trade Name: Emend®

For which conditions is this drug approved? Aprepitant is FDA approved for the use with other antiemetic (anti-nausea) agents for the prevention of acute or delayed nausea and vomiting caused by chemotherapy that is highly or moderately associated with nausea and vomiting, including high doses of the chemotherapy agent Platinol® (cisplatin). It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Aprepitant belongs to a class of drugs called antiemetics. Antiemetics help prevent nausea and vomiting caused by chemotherapy. Aprepitant produces its anti-nausea effects by binding to a specific receptor in cells in the brain called P/neurokinin 1 (NK1). This binding blocks a pathway that normally triggers nausea or vomiting.

How is aprepitant typically given (administered)? Aprepitant is administered orally and the dose depends on several factors, including the condition being treated, the particular regimen being used and the overall health of the patient. The regimen of aprepitant includes an additional antiemetic (5-HT3 antagonist) and a corticosteroid, such as ondansetron and dexamethasone. Aprepitant is taken for three days, typically an hour before chemotherapy, and for the two days following chemotherapy.
How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with aprepitant. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Since aprepitant has drug interactions with several agents, patients who are receiving agents that interact with aprepitant may be closely monitored in ways specific to their individual situation.

Side effects of treatment with aprepitant are uncommon, and include the following:

• Fatigue, weakness
• Hiccups
• Dizziness
• Diarrhea
• Constipation
• Loss of appetite
• Abdominal discomfort
• Heartburn
• Changes in liver or kidney function laboratory tests

This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.

Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
Are there any special precautions patients should be aware of before starting treatment?

• Treatment with aprepitant may reduce the effectiveness of oral contraceptives and back-up methods of contraception should be considered.
• Treatment with aprepitant may interact with the drug warfarin.
• Aprepitant does interact with some other drugs. Patients who are receiving drugs that interact with aprepitant may be closely monitored.
• Avoid grapefruit juice.
• If an oral dose is missed, do not double up on doses. Patients should contact their physician in this event.
• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

When should patients notify their physician?

• Difficulty breathing
• Chest pain
• Fever
• Prolonged diarrhea
• Extreme or prolonged fatigue
• Severe heartburn
• Yellowing skin or eyes

What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

The information provided above on the drug you have selected is provided for your information only and is not a substitute for consultation with an appropriate medical doctor. We are providing this information solely as a courtesy and, as such, it is in no way a recommendation as to the safety, efficacy or appropriateness of any particular drug, regimen, dosing schedule for any particular cancer, condition or patient nor is it in any way to be considered medical advice. Patients should discuss the appropriateness of a particular drug or chemotherapy regimen with their physician.

As with any printed reference, the use of particular drugs, regimens and drug dosages may become out-of-date over time, since new information may have been published and become generally accepted after the latest update to this printed information. Please keep in mind that health care professionals are fully responsible for practicing within current standards, avoiding use of outdated regimens, employing good clinical judgment in selecting drugs and/or regimens, in calculating doses for individual patients, and verifying all dosage calculations.

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