The combination of netupitant and palonosetron is used to prevent nausea and vomiting caused by cancer chemotherapy. Netupitant is in a class of medications called neurokinin (NK1) antagonists. It works by blocking neurokinin, a natural substance in the brain that causes nausea and vomiting. Palonosetron is in a class of medications called 5-HT₃ receptor antagonists. It works by blocking serotonin, a natural substance in the body that causes nausea and vomiting.

The combination of netupitant and palonosetron comes as a capsule to take by mouth. It is usually taken about 1 hour before the start of chemotherapy with or without food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take netupitant and palonosetron exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

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

Before taking netupitant and palonosetron,

• tell your doctor and pharmacist if you are allergic to netupitant and palonosetron, alosetron (Lotronex), dolasetron (Anzemet), granisetron (Sancuso), ondansetron (Zofran, Zuplenz), any other medications, or any of the ingredients in netupitant and palonosetron capsules. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: benzodiazepines including alprazolam (Xanax), midazolam, and triazolam (Halcion); certain chemotherapy medications such as cyclophosphamide (Cytoxan), docetaxel (Docefrez, Taxotere), etoposide, ifosfamide (Ifex), imatinib (Gleevec), irinotecan (Camptosar), paclitaxel (Taxol), vinblastine, vincristine, and vinorelbine (Navelbine); dexamethasone; erythromycin (E.E.S., Ery-tab, others); fentanyl (Abstral, Actiq, Duragesic, Fentora, Lazanda, Onsolis, Subsys); ketoconazole (Nizoral); lithium (Lithobid); medications to treat migraines such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig); methylene blue; mirtazapine (Remeron); monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), linezolid (Zyvox), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate); phenobarbital; rifampin (Rifadin, Rimactane, in Rifater, in Rifamate); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); and tramadol (Conzip, Ultram, in Ultracet). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had liver or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking netupitant and palonosetron, call your doctor.

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

Netupitant and palonosetron should only be taken before chemotherapy as instructed by your doctor. It should not be taken on a regularly scheduled basis.

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

• headache
• stomach pain
• heartburn
• constipation
• weakness
• redness of the skin

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or seek emergency medical treatment:

• hives
• rash
• itching
• difficulty breathing or swallowing
• shortness of breath
• dizziness, lightheadedness, and fainting
• fast, slow or irregular heartbeat
• agitation
• hallucinations (seeing things or hearing voices that do not exist)
• fever
• flushing
• excessive sweating
• confusion
• nausea, vomiting, and diarrhea
• loss of coordination
• stiff or twitching muscles
• seizures
• coma (loss of consciousness)

Netupitant and palonosetron 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 (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

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 light, 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.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Keep all appointments with your doctor.

Do not let anyone else take your medication.

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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