In the U.S.—

• Antiemetic

Aprepitant ( ap-RE-pi-tant) is used in combination with other antiemetics to prevent acute and delayed nausea and vomiting associated with cancer chemotherapy.

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

Oral
• Capsules (U.S.)

In deciding to use a medicine, the risks of taking aprepitant must be weighed against the good it will do. This is a decision you and your doctor will make. For aprepitant, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to aprepitant. Also tell your doctor and pharmacist if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Aprepitant has not been studied in pregnant women. However, aprepitant has not been shown to cause birth defects or other problems in animal studies. Before taking this medicine, make sure your doctor knows if you are pregnant or plan to become pregnant.

Breast-feeding—It is not known whether aprepitant passes into breast milk. However, aprepitant is not recommended during breast feeding because it may cause unwanted effects in nursing babies.

Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of aprepitant in children with use in other age groups.

Older adults—This medicine has been studied in the elderly and has not been shown to cause different side effects or problems in older people than it does in younger adults. However, elderly people may be more sensitive to the adverse effects of aprepitant which may require caution.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine. When you are taking aprepitant, it is especially important that your doctor and pharmacist know if you are taking any of the following:

• Astemizole (e.g., Hismanal) or
• Cisapride (e.g., Propulsid) or
• Pimozide (e.g., Orap) or
• Terfenadine (e.g., Seldane)—These medicines may increase the chance of serious side effects and should not be taken with aprepitant.

• Benzodiazepines, such as
• Alprazolam (e.g., Xanax), or
• Midazolam (e.g., Versed), or
• Triazolam (e.g., Halcion)—These medicines may increase the risk of side effects when taken with aprepitant.

• Dexamethasone (e.g., Decadron) or
• Methylprednisolone (e.g., Medrol)—The dose of these medicines may need to be decreased if you take them with aprepitant.

• Chemotherapy agents (medicine for cancer), such as
• Docetaxel (e.g., Taxotere) or
• Etoposide (e.g., Vepesid) or
• Ifosfamide (e.g., Ifex) or
• Imatinib (e.g., Gleevec) or
• Irinotecan (e.g., Camptosar) or
• Paclitaxel (e.g., Taxol) or
• Vinblastine or
• Vincristine (e.g., Vincasar PFS) or
• Vinorelbine (e.g., Navelbine)—Careful monitoring and caution is recommended when giving with aprepitant.

• Oral contraceptives (birth control pills)—Aprepitant may decrease the effectiveness of these medicines; additional birth control measures may be needed to decrease the risk of pregnancy.

• Warfarin (e.g., Coumadin)—Anticoagulant effectiveness may be decreased.

• Severe liver problems—Aprepitant has not been studied in patients with severe liver problems.

Read the patient information provided with your medicine before starting therapy with aprepitant and each time you refill your aprepitant prescription.

Do not start taking aprepitant if you already have nausea and vomiting. Contact your doctor about what to do.

Dosing—

The dose of aprepitant will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of aprepitant. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking aprepitant.

You may take aprepitant with or without food.

• For oral dosage form (capsules):
  • For chemotherapy induced nausea and vomiting:
    • Adults—125 milligrams (mg) one hour before chemotherapy treatment (Day 1) and 80 mg once a day in the morning on Days 2 and 3.
    • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

Oral contraceptives (birth control pills) may not work properly if you take them while you are taking aprepitant. Unplanned pregnancies may occur. You should use a different or additional means os birth control while you are taking aprepitant. If you have any questions about this, check with your health care professional.

If your symptoms do not improve or if they become worse, check with your doctor.

Do not take other medicines unless they have been discussed with your doctor.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

• Less common
  • Black or tarry stools;  chills;  cough;  fever;  lower back or side pain;  painful or difficult urination ;  pale skin;  shortness of breath;  sore throat;  ulcers, sores, or white spots in mouth;  unusual bleeding or bruising;  unusual tiredness or weakness 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome.

• Incidence unknown
  • Blistering, peeling, loosening of skin;  diarrhea;  itching;  joint or muscle pain;  large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, sex organs;  red irritated eyes;  redness of skin ;  red skin lesions, often with a purple center;  skin rash;  slow or irregular heartbeat  
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome.

• More Common
  • Confusion;  decreased urination;  dizziness;  dry mouth;  fainting;  heartburn;  hiccups ;  increase in heart rate;  lack or loss of strength;  lightheadedness;  loss of appetite;  nausea;  rapid breathing;  sunken eyes;  thirst;  weight loss;  wrinkled skin 
  
  

• Less common
  • Burning feeling in chest or stomach;  indigestion;  pain or discomfort in chest, upper stomach, or throat;  tenderness in stomach area 
  
  

• Incidence unknown
  • Confusion about identity, place, and time 
  
  

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