Treatment Name: Aprepitant (Emend®)
Aprepitant (Emend®) is a Supportive Care Therapy for Nausea and Vomiting
How does oral aprepitant (Emend®) work?
Aprepitant is designed to block receptors in your brain called substance P/neurokinin 1 (NK1) receptors which, when activated, can trigger nausea and vomiting.
Depending upon the type of chemotherapy, certain types may contribute to substance P being released. Substance P then binds to the NK1 receptors, which tells the body to vomit. Aprepitant (Emend®) binds to NK1 receptors instead of substance P, and thereby stops the reflex to vomit.
Goals of oral aprepitant (Emend®) therapy:
Aprepitant capsules are given to prevent both early and delayed nausea and vomiting (also known as “emesis”) from chemotherapy and is commonly given on a scheduled basis. Aprepitant is not typically used to treat nausea and vomiting. When a medicine is given to prevent nausea and vomiting, it is known as prophylaxis, or prophylactic anti-emetic therapy.
How is aprepitant (Emend®) given to prevent nausea and vomiting?
- Usual aprepitant (Emend®) starting dose:
- Aprepitant 125 mg oral capsule by mouth once daily on Day 1 of each chemotherapy cycle
- Aprepitant 80 mg oral capsule by mouth once daily on Days 2 and 3 of each chemotherapy cycle
- Aprepitant is also available as an oral suspension (liquid) if you have trouble swallowing
- Aprepitant can be taken with or without food
On days when chemotherapy is given and a dose of aprepitant is to be taken, aprepitant is usually brought from home and taken at the infusion center, approximately one hour prior to treatment. On days when a dose of aprepitant is to be taken but no chemotherapy is given, aprepitant is usually taken at home in the morning.
Aprepitant is typically taken, along with other anti-nausea medications, for chemotherapy regimens that have a high or moderate risk of causing acute and delayed nausea and vomiting. These are sometimes referred to as highly emetogenic or moderately emetogenic chemotherapy regimens. Duration of aprepitant therapy depends upon response, tolerability, and number of cycles chemotherapy prescribed.
Aprepitant may be given by the infusion center as an intravenous medicationprior to chemotherapy and is known as IV Emend. If IV Emend is used, oral aprepitant is not needed.
What are the most common side effects of oral aprepitant (Emend®) therapy?
In the prescribing label information (aprepitant package insert), the most commonly reported side effects from aprepitant (Emend®) are shown here:
- Fatigue (13%)
- Diarrhea (9%)
- Weakness (7%)
- Heartburn (7%)
- Stomach pain (6%)
- Hiccups (5%)
- Decreased white blood cells [neutropenia] (4%)
- Dehydration (3%)
Note: The exact percentages of patients that will experience aprepitant side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials
Aprepitant should be used in pregnant women only if the potential benefits to the mother outweigh the potential risks to the unborn baby.
Watch videos on common oral aprepitant therapy side effects below
How often is monitoring needed with oral aprepitant (Emend®) therapy?
Labs (blood tests) typically do not need to be monitored for aprepitant, but may be checked before each chemotherapy treatment. Aprepitant has been associated with an increase in liver function tests, as measured through the use of a comprehensive metabolic panel (CMP).
How often is imaging needed with oral aprepitant (Emend®) therapy?
Imaging is not usually necessary to start or continue aprepitant therapy.
How might blood test results/imaging affect treatment with oral aprepitant (Emend®)?
Depending upon the results, your doctor may advise to continue aprepitant as planned or switch to an alternative therapy.
What are the most important things to know about oral aprepitant (Emend®) when receiving treatment?
- Remember to bring your aprepitant capsules with you to the infusion center to take before treatment!
- Aprepitant is commonly dispensed as a “Tri-Pack” that contains one 125 mg capsule labeled as “Day 1” and two 80 mg capsules, one of which is labeled “Day 2” and the other as “Day 3”. Be sure you are taking the correct dosage on the correct day
- If you are receiving warfarin, aprepitant may cause a decrease in your INR and your dose of warfarin may need to be adjusted to prevent unwanted blood clots
- Aprepitant may decrease efficacy of oral contraceptives. Use an alternative, yet effective method of contraception during aprepitant (Emend®) treatment and for one month following the last dose of aprepitant
- May interact with certain antifungal and seizure medications. Ask your doctor or pharmacist to review your medications for any possible interactions
- Avoid therapy with St. Johns Wort as it will decrease blood levels of aprepitant. This could decrease the effectiveness of aprepitant
- Store at room temperature (68°-77°F)
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Aprepitant (Emend®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Aprepitant (Emend®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Aprepitant (Emend®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.