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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.

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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.

Side Effects

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

Side effect videos Side Effect Videos
Fatigue Fatigue DiarrheaDiarrheaPainPain

Monitoring

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.

ChemoExperts Tips

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:

  • Aprepitant (Emend®)

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.

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Created: April 1, 2020 Updated: April 19, 2020

What is Nausea and Vomiting?

Nausea is the sensation that there is a need to vomit. Nausea can be acute and short-lived, or it can be prolonged. When prolonged, it is a debilitating symptom. Nausea (and vomiting) can be psychological or physical in origin.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium