Fosnetupitant and Palonosetron

• Akynzeo
• Fosnetupitant/Palonosetron
• IV NEPA
• Palonosetron and Fosnetupitant
• Palonosetron/Pronetupitant
• Pronetupitant and Palonosetron
• Pronetupitant/Palonosetron

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intravenous:

Akynzeo: 235-0.25 MG (1 ea) [contains edetate disodium]

Fosnetupitant is a prodrug of netupitant. For netupitant, the Cmax was 35% higher in females than in males while the AUC was similar between males and females. For palonosetron, the mean AUC was 35% higher and the mean Cmax was 26% higher in females than in males.

Chemotherapy-induced nausea and vomiting: Prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic chemotherapy (in combination with dexamethasone).

Limitations of use: Has not been studied for the prevention of nausea and vomiting associated with anthracycline plus cyclophosphamide (AC) chemotherapy.

There are no contraindications listed in the manufacturer's labeling.

Refer to adult dosing.

Reconstitute by slowly adding 20 mL of D5W or NS to the vial, directing solution toward the wall of the vial to avoid foaming. Swirl the vial gently. Prepare an infusion vial or bag filled with 30 mL of D5W or NS. Add entire volume of the fosnetupitant/palonosetron reconstituted solution to the infusion vial or bag containing 30 mL of D5W or NS to a total vial/bag volume of 50 mL. Gently invert the vial or bag to mix completely.

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience constipation, headache, redness, loss of strength and energy, or nausea. Have patient report immediately to prescriber signs of serotonin syndrome (dizziness, severe headache, agitation, hallucinations, tachycardia, abnormal heartbeat, flushing, tremors, sweating a lot, change in balance, severe nausea, or severe diarrhea) (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.