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Aprepitant: Uses, Dosage, Side Effects & Interactions
Summary of Key Points
Aprepitant is a medication used to prevent nausea and vomiting caused by chemotherapy, surgery, or radiation therapy. It works by blocking specific signals in the brain that trigger these symptoms. Aprepitant is often combined with other medications to enhance its effectiveness. Always consult your healthcare provider before starting or adjusting your dose. You can schedule a telemedicine appointment with one of our providers for further guidance.
Names of Medication
US Brand Name: Emend (Aprepitant)
The generic name refers to the active ingredient in the medication, while the brand name is assigned by the manufacturer. In this case, Aprepitant is the generic name, listed in parentheses.
Pharmacologic Category
Substance P/Neurokinin 1 (NK1) Receptor Antagonist
Aprepitant belongs to a class of medications known as NK1 receptor antagonists, which help prevent nausea and vomiting by blocking specific signals in the brain.
Aprepitant Dosage
Aprepitant is used to treat various conditions related to nausea and vomiting. The dosage varies depending on the condition being treated. Always follow your healthcare provider’s instructions and consult them before adjusting your dose. For personalized advice, you can schedule a telemedicine visit with one of our providers.
Chemotherapy-Induced Nausea and Vomiting (CINV)
Prevention: 125 mg orally 1 hour before chemotherapy on Day 1, followed by 80 mg once daily on Days 2 and 3.
Postoperative Nausea and Vomiting (PONV)
Prevention: 40 mg orally within 3 hours before surgery.
Radiation Therapy-Induced Nausea and Vomiting
Prevention: 125 mg orally 1 hour before radiation therapy on Day 1, followed by 80 mg once daily for up to 5 days.
Other Conditions
Motion Sickness: Not typically indicated for this condition. Consult your healthcare provider for alternative treatments.
Migraine-Associated Nausea: Not typically indicated for this condition. Consult your healthcare provider for alternative treatments.
Anxiety-Related Nausea: Not typically indicated for this condition. Consult your healthcare provider for alternative treatments.
Chronic Pain-Associated Nausea: Not typically indicated for this condition. Consult your healthcare provider for alternative treatments.
Hyperemesis Gravidarum (Severe Nausea During Pregnancy): Not typically indicated for this condition. Consult your healthcare provider for alternative treatments.
Dosage Forms and Strengths
Capsules: 40 mg, 80 mg, 125 mg
Oral Suspension: 125 mg/5 mL
Administration Instructions for Aprepitant
Aprepitant is usually taken orally, either as a capsule or oral suspension. It is crucial to take the medication exactly as prescribed by your healthcare provider. If you are taking Aprepitant to prevent nausea and vomiting caused by chemotherapy or surgery, follow the timing instructions carefully to ensure the medication works effectively. If you miss a dose, contact your healthcare provider for guidance.
Contraindications for Aprepitant
A contraindication is a specific condition where a medication should not be used because it may cause harm. Understanding contraindications helps avoid serious side effects or complications. Below are the contraindications for Aprepitant:
Allergy to Aprepitant: If you have had an allergic reaction to Aprepitant or any of its components, you should not take this medication. Allergic reactions can range from mild skin rashes to severe anaphylaxis, which can be life-threatening.
Concurrent use with Pimozide (Orap): Aprepitant can increase Pimozide levels in the blood, potentially leading to serious heart rhythm problems (QT prolongation). This combination is contraindicated due to the risk of life-threatening arrhythmias.
Severe Liver Disease: Aprepitant is metabolized by the liver. If you have severe liver disease, your body may not process the medication effectively, increasing the risk of side effects or toxicity.
Aprepitant Drug Interactions
Aprepitant can interact with other medications, affecting its efficacy or increasing the risk of side effects. Inform your healthcare provider about all medications you are taking, including prescription drugs, over-the-counter medications, and supplements. Below are some key medications that may interact with Aprepitant:
Warfarin (Coumadin): Aprepitant may reduce the effectiveness of Warfarin, a blood thinner, increasing the risk of blood clots. Your doctor may need to monitor your blood clotting levels more frequently.
Rifampin (Rifadin): Rifampin can decrease Aprepitant’s effectiveness by speeding up its breakdown in the liver, reducing its ability to prevent nausea and vomiting.
Ketoconazole (Nizoral): Ketoconazole can increase Aprepitant levels in your blood, raising the risk of side effects like dizziness or fatigue.
Midazolam (Versed): Aprepitant can increase Midazolam levels, leading to excessive drowsiness or slowed breathing.
Dexamethasone (Decadron): Aprepitant may increase Dexamethasone levels, potentially causing side effects such as weight gain, high blood sugar, or mood changes.
Aprepitant in Pregnancy
Is it Safe to Take Aprepitant During Pregnancy?
The safety of Aprepitant during pregnancy has not been fully established. Limited studies in pregnant women, along with animal research, suggest there may be potential risks to the developing fetus. For this reason, Aprepitant should only be used during pregnancy if the potential benefits clearly outweigh the risks. If you are pregnant or planning to become pregnant, it is essential to consult your healthcare provider before taking Aprepitant. They can help you weigh the risks and benefits and explore alternative treatments if necessary.
Aprepitant While Breastfeeding
Is it Safe to Take Aprepitant While Breastfeeding?
It is not yet known whether Aprepitant passes into breast milk. Due to the possibility of serious side effects in a nursing infant, it is generally recommended to either avoid breastfeeding while taking Aprepitant or discuss alternative medications with your healthcare provider. If you are breastfeeding and need to take Aprepitant, your provider can help determine the best course of action for both you and your baby.
Estimated Cost of Aprepitant Medication
The cost of a 30-day supply of Aprepitant without insurance can vary depending on the pharmacy and location. With a GoodRx coupon, the price typically ranges from $200 to $300 for the generic version. To get the most accurate pricing, check with your local pharmacy, and consider using a coupon or discount card to help lower the cost.
Possible Alternatives to Aprepitant
If Aprepitant is not the right option for you, there are other treatments and lifestyle changes that may help manage your symptoms. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss these alternatives:
- Nausea and Vomiting: Over-the-counter medications like Meclizine (Antivert) or natural remedies such as ginger may provide relief. Staying hydrated and eating small, frequent meals can also help reduce nausea.
- Chemotherapy-Induced Nausea and Vomiting: Other anti-nausea medications, such as Ondansetron (Zofran) or Dexamethasone, may be effective. Acupuncture and relaxation techniques may also offer relief.
- Postoperative Nausea and Vomiting: Medications like Scopolamine (Transderm Scop) or Promethazine (Phenergan) may be alternatives. Avoiding heavy meals before surgery and staying hydrated can also help minimize symptoms.
- Radiation Therapy-Induced Nausea and Vomiting: Ondansetron (Zofran) or Metoclopramide (Reglan) may be used. Eating small, frequent meals and avoiding spicy or greasy foods can also help manage symptoms.
- Motion Sickness: Over-the-counter medications like Dimenhydrinate (Dramamine) or natural remedies like ginger may be helpful. Sitting in the front seat of a vehicle and focusing on the horizon can also reduce symptoms.
- Migraine: Medications such as Sumatriptan (Imitrex) or anti-nausea drugs like Metoclopramide (Reglan) may provide relief. Lifestyle changes, including managing stress, staying hydrated, and avoiding migraine triggers, can also be beneficial.
- Anxiety: Anti-anxiety medications like Lorazepam (Ativan) or natural remedies such as deep breathing exercises may help. Cognitive-behavioral therapy (CBT) and mindfulness practices can also reduce anxiety symptoms.
- Chronic Pain: Medications like Gabapentin (Neurontin) or non-drug therapies such as physical therapy and acupuncture may help. Lifestyle changes, including regular exercise and stress management, can also improve chronic pain.
- Hyperemesis Gravidarum: Anti-nausea medications like Ondansetron (Zofran) or Promethazine (Phenergan) may be used. Eating small, frequent meals and staying hydrated can also help manage symptoms.
Recent Updates on Aprepitant Research
Recent studies are exploring the use of Aprepitant beyond chemotherapy-induced nausea and vomiting. Researchers are investigating its potential benefits in treating nausea and vomiting associated with other conditions, such as migraines and anxiety. Additionally, ongoing studies are examining the long-term safety of Aprepitant, particularly for patients with chronic conditions who may require extended use. While these findings are promising, further research is needed to confirm them. If you are interested in learning more, consult your healthcare provider or schedule a telemedicine visit to discuss how this research might impact your treatment plan.
