Emend

Posology Adults EMEND is given for 3 days as part of a regimen that includes a corticosteroid and a 5-HT3 antagonist. The recommended dose is 125 mg orally once daily one hour before start of chemotherapy on Day 1 and 80 mg orally once daily on Days 2 and 3 in the morning.

3 The following regimens are recommended in adults for the prevention of nausea and vomiting associated with emetogenic cancer chemotherapy: Highly Emetogenic Chemotherapy Regimen Day 1 Day 2 Day 3 Day 4 EMEND 125 mg orally 80 mg orally 80 mg orally none Dexamethasone 12 mg orally 8 mg orally 8 mg orally 8 mg orally 5-HT3 antagonists Standard dose of 5-HT3 antagonists.

See the product information for the selected 5-HT3 antagonist for appropriate dosing information none none none Dexamethasone should be administered 30 minutes prior to chemotherapy treatment on Day 1 and in the morning on Days 2 to 4.

The dose of dexamethasone accounts for active substance interactions. Moderately Emetogenic Chemotherapy Regimen Day 1 Day 2 Day 3 EMEND 125 mg orally 80 mg orally 80 mg orally Dexamethasone 12 mg orally none none 5-HT3 antagonists Standard dose of 5-HT3 antagonists.

See the product information for the selected 5-HT3 antagonist for appropriate dosing information none none Dexamethasone should be administered 30 minutes prior to chemotherapy treatment on Day 1. The dose of dexamethasone accounts for active substance interactions.

Paediatric population Adolescents (aged 12 through 17 years) EMEND is given for 3 days as part of a regimen that includes a 5-HT3 antagonist. The recommended dose of capsules of EMEND is 125 mg orally on Day 1 and 80 mg orally on Days 2 and 3.

EMEND is administered orally 1 hour prior to chemotherapy on Days 1, 2 and 3. If no chemotherapy is given on Days 2 and 3, EMEND should be administered in the morning. See the Summary of Product Characteristics (SmPC) for the selected 5-HT3 antagonist for appropriate dosing information.

1). The safety and efficacy of the 80 mg and 125 mg capsules have not been demonstrated in children less than 12 years of age. No data are available. Refer to the powder for oral suspension SmPC for appropriate dosing in infants, toddlers and children aged 6 months to less than 12 years.

General Efficacy data in combination with other corticosteroids and 5-HT3 antagonists are limited. 5. Please refer to the SmPC of co-administered 5-HT3 antagonist medicinal products. 2). 2). 2). Hepatic impairment No dose adjustment is necessary for patients with mild hepatic impairment.

Summary of the safety profile The safety profile of aprepitant was evaluated in approximately 6,500 adults in more than 50 studies and 184 children and adolescents in 2 pivotal paediatric clinical trials. 5 %). 9 %). 0 %). Tabulated list of adverse reactions The following adverse reactions were observed in a pooled analysis of the HEC and MEC studies at a greater incidence with aprepitant than with standard therapy in adults or paediatric patients or in post- marketing use.

The frequency categories given in the table are based on the studies in adults; the observed frequencies in the paediatric studies were similar or lower, unless shown in the table. Some less common ADRs in the adult population were not observed in the paediatric studies.

Frequencies are defined as: very common (≥ 1/10); common (≥ 1/100 to < 1/10); uncommon (≥ 1/1,000 to < 1/100); rare (≥ 1/10,000 to < 1/1,000) and very rare (< 1/10,000), not known (cannot be estimated from the available data). System organ class Adverse reaction Frequency Infection and infestations candidiasis, staphylococcal infection rare Blood and lymphatic system disorders febrile neutropenia, anaemia uncommon Immune system disorders hypersensitivity reactions including anaphylactic reactions not known Metabolism and nutrition disorders decreased appetite common polydipsia rare 9 System organ class Adverse reaction Frequency Psychiatric disorders anxiety uncommon disorientation, euphoric mood rare Nervous system disorders headache common dizziness, somnolence uncommon cognitive disorder, lethargy, dysgeusia rare Eye disorders conjunctivitis rare Ear and labyrinth disorders tinnitus rare Cardiac disorders palpitations uncommon bradycardia, cardiovascular disorder rare Vascular disorders hot flush/flushing uncommon Respiratory, thoracic and mediastinal disorders hiccups common oropharyngeal pain, sneezing, cough, postnasal drip, throat irritation rare Gastrointestinal disorders constipation, dyspepsia common eructation, nausea†, vomiting†, gastroesophageal reflux disease, abdominal pain, dry mouth, flatulence uncommon duodenal ulcer perforation, stomatitis, abdominal distension, faeces hard, neutropenic colitis rare Skin and subcutaneous tissue disorders rash, acne uncommon photosensitivity reaction, hyperhidrosis, seborrhoea, skin lesion, rash pruritic, Stevens-Johnson syndrome/toxic epidermal necrolysis rare pruritus, urticaria not known Musculoskeletal and connective tissue disorders muscular weakness, muscle spasms rare Renal and urinary disorders dysuria uncommon pollakiuria rare 10 System organ class Adverse reaction Frequency General disorders and administration site conditions fatigue common asthenia, malaise uncommon oedema, chest discomfort, gait disturbance rare Investigations ALT increased common AST increased, blood alkaline phosphatase increased uncommon red blood cells urine positive, blood sodium decreased, weight decreased, neutrophil count decreased, glucose urine present, urine output increased rare †Nausea and vomiting were efficacy parameters in the first 5 days of post-chemotherapy treatment and were reported as adverse reactions only thereafter.

Patients with moderate to severe hepatic impairment There are limited data in patients with moderate hepatic impairment and no data in patients with severe hepatic impairment. 2). 5). Additionally, concomitant administration with irinotecan should be approached with particular caution as the combination might result in increased toxicity.

5). Co-administration with hormonal contraceptives The efficacy of hormonal contraceptives may be reduced during and for 28 days after administration of EMEND. 5). Excipients EMEND capsules contain sucrose. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine.

Sodium This medicinal product contains less than 1 mmol sodium (23 mg) per capsule, that is to say essentially ‘sodium-free’.

1. 5).