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Drug Information: Aprepitant

Why is this medication prescribed?

Aprepitant is used with other medications to prevent nausea and vomiting caused by cancer chemotherapy treatment.Aprepitant is also used alone to prevent nausea and vomiting caused by surgery. Aprepitant is not used to treat nausea and vomiting that you already have. 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 nausea and vomiting.

How should this medicine be used?

Aprepitant comes as a capsule to take by mouth. To prevent nausea and vomiting caused by cancer chemotherapy, 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. To prevent nausea and vomiting caused by surgery, aprepitant is usually taken as one dose within 3 hours before the start of surgery. 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 nausea and vomiting. Call your doctor if you already have these symptoms and do not begin to take aprepitant. .

When used to prevent nausea and vomiting caused by cancer chemotherapy, aprepitant is usually used only during the first 3 days of the chemotherapy treatment cycles. Do not continue taking aprepitant longer than instructed by your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Other uses for this medicine

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

What special precautions should I follow?

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, not available in the U.S.), cisapride (Propulsid, not available in the U.S.) , pimozide (Orap), or terfenadine (Seldane, not available in the U.S.).
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin);antifungals such as itraconzaole (Sporanox), ketoconazole (Nizoral), and lansoprazole; benzodiazepines such as alprazolam (Xanax), diazepam (Valium), midazolam (Versed), and triazolam (Halcion);diltiazem (Cardizem, Dilacor, Tiazac), 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); clarithromycin (Biaxin); diltiazem (Cardizem, Dilacor, Tiazac);HIV protease inhibitors such as nelfinavir (Viracept) and ritonavir (Norvir); hormonal contraceptives (birth control pills, patches, rings, and injections); nefazadone (Serzone); oral steroids such as dexamethasone (Decadron, Dexone); and methylprednisolone (Medrol); paroxetine (Paxil, Pexeva); phenytoin (Dilantin); rifampin (Rifadin, Rimactane); tolbutamide (Orinase);and troleandomycin (TAO). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with aprepitant, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
• tell your doctor if you have or have ever had liver disease.
• tell your doctor if you are pregnant or plan to become pregnant. If you are taking birth control medications during treatment with aprepitant you should also use an additional method of birth control to avoid pregnancy during treatment with aprepitant and for one month after treatment. Talk to your doctor about birth control methods while you are taking aprepitant and after treatment. If you become pregnant while taking aprepitant, call your doctor.
• tell your doctor if you are breast-feeding. Do not breastfeed while you are taking aprepitant.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I 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.

What side effects can this medication cause?

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

• weakness
• tiredness
• dizziness
• diarrhea
• constipation
• gas
• stomach pain
• heartburn
• nausea
• hiccups
• loss of appetite
• headache
• fever
• itching
• hair loss

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• hives
• rash

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/index.html] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?

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

What other information should I know?

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.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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