Emend / Aprepitant info????

[caroladybelle, BSN, RN]

For any of you that have connections with a pharmaceutical rep:

I have had several patients prescribed Emend/Aprepitant for persistant nausea. What is the cost of the regimen (very prohibitively expensive even for PO) and is that cost per pill or for the chemo regimen (a 125mg capsule followed at twenty four hour intervals by an 80 mg and then another 80 mg). How many days worth is typical use? And does the regimen price include the Zofran/Kytril/Anzemet, and the Decadron required per the drug info?

Thanks for any and all assistance.

[caroladybelle, BSN, RN]

Bump - any info anyone?????

[P_RN, ADN, RN]

http://www.heritage-info.com/mocaidrx/files/drug_monographs/06-03/emendmon.doc

don't open this as it is a doc file and not a web page.

it does list the costs of the protocol.

emend® is a substrate, a moderate inhibitor, and an inducer of cyp3a4 and is also an inducer of cyp2c9. because of this the following drugs may interact, therefore caution should be exercised when prescribing the following: warfarin, tolbutamide, phenytoin, dexamethasone, methylprednisolone, oral contraceptives, midazolam, alprazolam, triazolam, ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir, diltiazem, rifampin, carbamazepine and paroxetine. emend© should not be used concurrently with pimozide, terfenadine, astemizole, or cisapride.

dosage and administration 1

day 1

day 2

day 3

day 4

emend® 125mg orally 1 hour prior to chemotherapy

emend® 80mg orally once daily in the morning

emend® 80mg orally once daily in the morning

ondansetron 32mg iv and dexamethasone 12mg orally 30 minutes prior to chemotherapy

dexamethasone 8mg orally

dexamethasone 8mg orally

dexamethasone 8 mg orally

cost comparison 10 (at commonly used dosages)

cost per course $310

80mg capsules $100

125mg capsules $110

conclusion

aprepitant is a selective antagonist of human substance p/neurokinin receptors that has demonstrated efficacy in the treatment of chemotherapy-induced nausea and vomiting when used in combination with other antiemetic agents. it is the first agent approved for the prevention of both acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy. aprepitant appears to augment the antiemetic activity of 5-ht3-receptor antagonists and the corticosteroid dexamethasone and may provide a useful combination therapy option for patients receiving highly emetogenic cancer chemotherapy.

approval criteria

● diagnosis of cancer

● maximum quantity equals three tablets

denial criteria

● inappropriate diagnosis

● therapy exceeding 3 days

recommendation(s)

it is recommended that clinical edits be in place for emendò.

references

emend® (aprepitant). product labeling. merck & co., inc.: whitehouse station, nj. march 2003

bleiberg h: a new class of antiemetics: the nk-1 receptor antagonists. curr op oncol 2000; 12:284-288.

campos d, pereira jr, reinhardt rr et al: prevention of cisplatin-induced emesis by the oral neurokinin-1 antagonist, mk-869, in combination with granisetron and dexamethasone or with dexamethasone alone. j clin oncol 2001; 19:1759-1767.

sorbera la, castaner j & bayes m et al: aprepitant and l-758298. drugs future 2002; 27(3):211-222.

diemunsch p & grelot l: potential of substance p antagonists as antiemetics. drugs 2000; (60):533-546.

devane cl: substance p: a new era, a new role. pharmacotherapy 2001; 21(9):1061-1069.

van belle s, lichninitser mr, navari rm et al: prevention of cisplatin-induced acute and delayed emesis by the selective neurokinin-1 antagonists l-758,298 and mk-869. cancer 2002; 94(11):3032-3041.

anon: mk 869. drugs 2002; 3(3):200-203.

tattersall fd, rycroft w, cumberbatch m et al: the novel nk1 receptor antagonist mk-0869 (l-754,030) and its water soluble phosphoryl prodrug, l-758,298, inhibit acute and delayed cisplatin-induced emesis in ferrets. neuropharmacology 2000; 39:652-663.

amerisource-bergen online catalog average wholesale price (awp)

prepared by: mark m. roaseau, bs pharmacy, md

date: may 7, 2003

info for reimbursement for non insured patients.

http://www.emend.com/aprepitant/emend/consumer/patient_assistance/who_is_qualified.jsp

[caroladybelle, BSN, RN]

Thank You kindly!