Aprepitant (patient information)

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Why this medication is prescribed

Aprepitant is used with other medications to prevent upset stomach and vomiting caused by cancer chemotherapy treatment. Aprepitant is in a class of medications called antiemetics. It works by blocking the action of neurokinin, a natural substance in the brain that causes upset stomach and vomiting.

How this medication should be used

Aprepitant comes as a capsule to swallow with a drink. Aprepitant is usually taken once daily, with or without food, during the first few days of your cancer chemotherapy treatment. You will probably take aprepitant 1 hour before your first dose of chemotherapy, and then each morning for the next 2 days. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take aprepitant exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Aprepitant capsules come in two different strengths. Your doctor may prescribe both of the strengths for you to take at different times. You should be careful to take the right strength at the right time as directed by your doctor.

Aprepitant only works to prevent upset stomach and vomiting. If you already have these symptoms, do not take aprepitant. Call your doctor instead.

Aprepitant is used only during the first 3 days of cancer chemotherapy treatment cycles. Do not continue taking aprepitant longer than instructed by your doctor.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Special precautions

Before taking aprepitant:

• tell your doctor and pharmacist if you are allergic to aprepitant or any other medications.
• do not take aprepitant if you are taking astemizole (Hismanal), cisapride (Propulsid), pimozide (Orap), or terfenadine (Seldane).
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin); antifungals such as fluconzaole (Diflucan), itraconzaole (Sporanox), and ketoconazole (Nizoral); benzodiazepines such as alprazolam (Xanax), diazepam (Valium), and triazolam (Halcion); buspirone (BuSpar); calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem, Dilacor, Tiazac,), felodipine (Lexxel, Plendil), nifedipine (Adalat, Procardia), nisoldipine (Sular), and verapamil (Calan, Isoptin, Verelan); chlolesterol-lowering medications (statins) such as atorvastatin (Lipitor), fluvastatin (Lescol); lovastatin (Altocor, Mevacor), and simvastin (Zocor); cancer chemotherapy medications such as docetaxel (Taxotere), etoposide (Toposar, VePesid), ifosfamide (Ifex), imatinib (Gleevec), irinotecan (Camptosar), paclitaxel (Taxol), tamoxifen (Nolvadex), vinblastine, vincristine (Vincasar), and vinorelbine (Navelbine); carbamazepine (Tegretol); celecoxib (Celebrex); chlorpheniramine (Chlor-Trimeton, other cough, cold and sinus medications); cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); danazol (Danocrine); delavirdine (Rescriptor); dexamethasone (Decadron); diclofenac (Arthrotec, Voltaren); efavirenz (Sustiva); erythromycin (E.E.S., E-Mycin, Erythrocin); ethosuximide (Zarontin); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); glipizide (Glucotrol); haloperidol (Haldol); HIV protease inhibitors such as indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Fortovase, Invirase); ibuprofen (Advil, Motrin); irbesartan (Avapro, Avalide); isoniazid (INH, Nydriazid); losartan (Cozaar, Hyzaar); methadone (Dolophine, Methadose); methylprednisolone (Medrol); metronidazole (Flagyl); naproxen ( Naprosyn); nefazadone (Serzone); oral contraceptives (birth control pills); phenobarbital (Luminal, Solfoton); phenytoin (Dilantin); piroxicam (Feldene); quinidine (Cardioglute, Quinaglute); quinine; rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); tacrolimus (Prograf); sildenafil (Viagra); sulfamethoxazole (Bactrim, Septra, Sulfatrim); tolbutamide (Orinase); torsemide (Demadex); trazodone; troleandomycin (TAO); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor what herbal products you are taking, especially St. John's Wort.
• tell your doctor if you have or have ever had liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking aprepitant, call your doctor.

Special dietary instructions

Talk to your doctor about drinking grapefruit juice while taking this medicine.

What to do if you forget a dose

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Side Effects

Minor Side Effects

Aprepitant may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• weakness
• extreme tiredness
• dizziness
• diarrhea
• constipation
• stomach pain
• upset stomach
• hiccups
• loss of appetite

Severe Side Effects

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• hives
• skin rash
• difficulty breathing or swallowing
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• hoarseness

Laboratory animals who were given aprepitant developed tumors. It is not known if aprepitant increases the risk of tumors in humans. Talk to your doctor about the risks of taking aprepitant.

Aprepitant may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].

Storage conditions needed for this medication

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

• drowsiness
• headache

Other information

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Brand names

• Emend®