Emend

Emend is an anti-emetic drug which is generally used in combination with other medicines (e.g., ondansetron, dexamethasone) to prevent nausea and vomiting caused by certain types of cancer medicines (chemotherapy).

This medicine is also used to prevent nausea and vomiting that may occur after surgery. Aprepitant is well absorbed orally and works in the nervous system to block the action of a chemical that causes vomiting.

This medicine is available only with your doctor's prescription. This product is available in the following dosage forms:

• Capsule
• Powder for Suspension

Before using Emend, you must know all about the risks and complications associated with it. The suitable drug therapy is usually chosen by a doctor with the active participation of the patient.

There are some important factors such as drug interactions, the presence of any metabolic impairment, history of hypersensitivity reaction, pregnancy, lactation etc. which may alter the desired therapeutic effects of a medicine.

Sometimes the presence of other health disorders affects the beneficial effects of this medicine and even may cause serious toxic effects. If you have had any allergic reactions to any medicine then you must tell your doctor about that.

The use of aprepitant is contraindicated in those who are hypersensitive to this drug or any of the ingredients of the formulation. Further, make sure you inform your doctor if you have any other medical problems.

Because of drug-drug interactions, certain medicines should not be used along with this medicine. It is always recommended to consult with your doctor if you are in need of some other medications or even any over-the-counter medicine for another health problem in order to avoid unwanted toxic effects.

Here, concurrent administration of astemizole, cisapride, pimozide, or terfenadine is contraindicated because plasma levels of this drug may be increased which can lead to life-threatening torsade de points arrhythmias.

The following drug interactions should be kept in mind:

• Concurrent use with CYP3A4 inhibitors (e.g., clarithromycin, troleandomycin, diltiazem, verapamil, itraconazole, ketoconazole, nefazodone, ritonavir, nelfinavir) may lead to increased plasma levels of aprepitant.
• Concurrent use with CYP3A4 inducers (e.g., carbamazepine, phenytoin, rifampicin, primidone, phenobarbital) may lead to reduced efficacy of aprepitant.
• Also, this drug may increase plasma levels of dexamethasone, methylprednisolone, colchicine, benzodiazepine (e.g., midazolam, diazepam, alprazolam), ergot derivatives, astemizole, cisapride, pimozide, and terfenadine.

Animal reproduction studies have not shown any adverse effect on the fetus and there are no adequate and well-controlled studies in humans. But animal reproduction studies are not always predictive of human response.

Thus, this drug should be used during pregnancy only if clearly needed. Besides, caution should be exercised when used in lactating women because there are no adequate studies in women for determining infant risk when using this medication during breastfeeding.

To use Emend properly, you must follow all instructions given by your doctor. The dosage schedule and the duration of drug therapy should be individualized and determined based on the physician’s advice.

The therapeutic dose may also vary with the patient’s condition or requirement and the strength of the medicine as well. This medicine comes with patient information.

You should read and follow the instructions carefully before using this medicine; however, the treatment schedule of different dosage forms for different indications are listed below:

For oral dosage form (capsules):

• For prevention of nausea and vomiting caused by chemotherapy:
  • Adults and children of ≥12 years—125 milligrams (mg) 1 hour before chemotherapy (Day 1). Then, 80 mg once in the morning on Days 2 and 3.
  • Children of < 12 years of age, weighing at least 30 kilograms (kg), and can swallow a capsule—125 mg 1 hour before chemotherapy (Day 1). Then, 80 mg once in the morning on Days 2 and 3.
  • Children of < 12 years of age weighing < 30 kg—Use and dose must be determined by your doctor.
• For prevention of nausea and vomiting after surgery:
• Adults—40 mg within 3 hours before surgery.
• Children—Use and dose must be determined by your doctor.

For oral dosage form (powder for suspension):

• For prevention of nausea and vomiting caused by chemotherapy:
  • Adults and children of 6 months to 11 years of age and cannot swallow the capsule—Dose is based on body weight and must be determined by your doctor. The dose is usually 3 milligrams (mg) per kilogram (kg) of body weight up to a maximum dose of 125 mg taken 1 hour before chemotherapy (Day 1). Then, 2 mg per kg of body weight up to a maximum dose of 80 mg taken once in the morning on Days 2 and 3.
  • Children of < 6 months of age—Use and dose must be determined by your doctor.

You should use this medicine following the directions were given by your doctor. If you miss a dose of this medicine, take it as soon as possible. But, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Do not use this drug in larger amounts, more often, or for a longer time than your doctor ordered. Further, it is advised to store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children. However, outdated medicines should be disposed of by an appropriate way.

Before using Emend, there are some precautions you must take. Firstly, regular visits to your doctor are recommended to check that this medicine is working properly or not.

Additionally, the following guidelines should be followed to prevent unwanted complications as well as for the better prognosis of the patients:

• Aprepitant may cause a serious type of allergic reaction called anaphylaxis that can be life-threatening and requires immediate medical attention. Check with your doctor right away if you have itching, hives, rash, trouble breathing, dysphagia, or any swelling of your hands, face, or mouth while you are using this drug.
• This medicine could make hormonal contraceptives (birth control pills) less effective at preventing pregnancy. To keep from getting pregnant, you should use an extra back-up method of contraception (e.g., condoms) both during treatment with the medicine and for 2 months after your last dose.

You should not use any prescription or nonprescription medicine, herbal preparation, or dietary supplement without checking with your doctor while you are using this drug.

Make sure you meet with your doctor in using Emend to avoid unwanted potential side effects. Along with the beneficial effects, this medicine may cause some unwanted effects that may not need any medical attention.

These side effects usually go away during the treatment episode as your body adjusts to the medicine. Your healthcare professional may advise you about the ways how to prevent or reduce those unwanted side effects.

Sometimes you may need to consult with the doctor if you notice any of the following toxic effects:

More common:

• Abdominal pain or discomfort
• Acid or sour stomach
• Belching
• Confusion
• Decreased urination
• Dizziness
• Dry mouth
• Fainting
• Heartburn
• Hiccups
• Increase in heart rate
• Indigestion
• Lack or loss of strength
• Lightheadedness
• Loss of appetite
• Nausea
• Rapid breathing
• Sunken eyes
• Swelling or inflammation of the mouth
• Weight loss
• Wrinkled skin

Less common:

• Black or tarry stools
• Burning feeling in the chest or stomach
• Chills
• Cough
• Fever
• Hot flashes
• Indigestion
• Lower back or side pain
• Painful passage of urine
• Pale skin
• Shortness of breath
• Sore throat
• Ulcers, sores, or white spots in the mouth
• Unusual bleeding or bruising
• Unusual tiredness or weakness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.