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Treatment Name: Rolapitant (Varubi®)

Rolapitant (Varubi®) is a Supportive Care Therapy to prevent Nausea and Vomiting

How does Rolapitant (Varubi®) work?
Chemotherapy can cause a molecule called Substance P to be released in the body. Vomiting may occur when Substance P binds to Neurokinin 1 (NK1) receptors in your brain. Rolapitant is designed to block NK1 receptors, in place of Substance P, thereby stopping the reflex to vomit.

Goals of therapy:
Rolapitant is taken to prevent delayed nausea and vomiting with chemotherapy (your cancer treatment), and is not used to treat nausea or vomiting that has already occurred. When a medicine is taken to prevent nausea and vomiting, it is known as prophylaxis, or prophylactic therapy.

Schedule

  • Usual starting dose: Take two 90-mg oral tablets (total dose 180mg) by mouth once on Day 1 of each chemotherapy cycle
  • Rolapitant is to be taken approximately 1 to 2 hours before chemotherapy on Day 1 of each chemotherapy cycle. Depending on your schedule and travel distance to chemotherapy, you may take rolapitant at home or bring rolapitant from home to the infusion center to take 1 to 2 hours prior to chemotherapy
  • Consider setting a reminder for yourself so that you do not forget to take rolapitant before chemotherapy.

Rolapitant is usually taken with two other medications used to prevent nausea. These include a corticosteroid such as dexamethasone (Decadron®), and a 5HT3 antagonist such as ondansetron (Zofran®) or palonosetron (Aloxi®). The duration of rolapitant therapy depends upon response, tolerability, and number of chemotherapy cycles prescribed.

Side Effects

In the prescribing label information (rolapitant package insert), the most commonly reported side effects from rolapitant (Varubi®) are shown here. Please note the risk for certain rolapitant side effects have been shown to vary based on the type of chemotherapy that has been prescribed. The exact percentages of patients that will experience rolapitant side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials:

  • Decreased appetite (9%)
  • Decreased white blood cells [Neutropenia] (7 - 9%)
  • Dizziness (6%)
  • Hiccups (5%)
  • Indigestion (4%)
  • Urinary tract infection (4%)
  • Mouth sores (4%)
  • Stomach pain (3%)
  • Decreased red blood cells [Anemia] (3%)

Inform your doctor if you are pregnant or are planning to become pregnant. The risks of rolapitant harming an unborn baby are not known. Rolapitant should be used in pregnant women only if the prescribing doctor determines that the potential benefits to the mother outweigh the potential risks to the unborn baby.

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Monitoring

How often is monitoring needed?
Labs (blood tests) typically are not required prior to starting or during rolapitant treatment, but may be checked before each chemotherapy treatment.

How often is imaging needed?
Imaging is not typically required prior to starting or during rolapitant treatment.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue rolapitant as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.

ChemoExperts Tips

  • Remember to take rolapitant by mouth 1 to 2 hours prior to the start of chemotherapy on Day 1 of each chemotherapy cycle
  • It is not recommended to take repeat doses of rolapitant sooner than every 14 days
  • Rolapitant may interact with your other prescription and over-the-counter medicines, as well as herbal supplements and vitamins. A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Do NOT take rolapitant if you are taking a medicine known as thioridazine. It is also NOT recommended to take rolapitant in combination with pimozide. Inform your doctor immediately if you are taking either of these medicines.
  • Rolapitant is supplied in single-dosage blister packaging. Each blister package contains two 90-mg tablets
  • Store rolapitant at room temperature, 20° to 25°C (68° to 77°F)

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 Rolapitant (Varubi®), 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 Rolapitant (Varubi®). Depending upon your income, they may be able to help cover the cost of:

  • Rolapitant (Varubi®)

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 Rolapitant (Varubi®) 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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References

Prescribing label information. Rolapitant (Varubi®) package insert.

Created: September 1, 2017 Updated: March 27, 2018

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 delayed nausea and vomiting?

Delayed nausea and vomiting (also known as late nausea and vomiting), is nausea or vomiting that occurs more than 24 hours after chemotherapy (cancer treatment) has been given.