Rolapitant is an antiemetic used in combination with other antiemetic medications in adults for preventing nausea (feeling of vomiting) and vomiting associated late with cancer chemotherapy.
Rolapitant is prescribed to treat nausea and vomiting that occurs after several days in adult patients who undergo cancer chemotherapy.
It is used in combination with other antiemetic agents in patients who are prescribed an initial or repeat course of cancer medications that can cause severe nausea and vomiting.
Rolapitant works by blocking the action of certain substances (neurokinin and Substance P) in the brain and thereby reduces the stimulation for nausea and vomiting.
Rolapitant should not be used in patients -
Who have Allergy Children below 18 years of age
Women undergoing treatment for infertility
Severe liver damage
The dose of rolapitant is selected based on the medication and its severity of inducing nausea and vomiting.
Rolapitant should not be given within 2- week intervals.
Dexamethasone and other medications that control vomiting can also be added to the treatment schedule.
1. Cisplatin or highly emetogenic (emetogenic means vomiting) chemotherapy:
The recommended dose of Rolapitant is 180 mg (if taken as a tablet) or 166.5 mg if given as an injection and this should be given on day one of cancer chemotherapy.
The dose of dexamethasone is 20 mg on the first day of chemotherapy followed by 8 mg on day 2, 3, and 4 respectively.
The dose of agents to control vomiting can be given according to the drugs chosen to prescribe along with the treatment schedule.
2.Anthracycline and cyclophosphamide combination or moderately emetogenic chemotherapy:
The dosage schedule of Rolapitant is the same as prescribed for cisplatin or highly emetogenic chemotherapy but to be given only on the first day.
Medicine to control vomiting can be given on day 2, 3, and 4 of cancer chemotherapy.
No dexamethasone administrations are necessary on day 2, 3, and 4.
Rolapitant is available in tablet and injection form which should be given 2 hours before starting chemotherapy.
Rolapitant tablets are taken orally as a single dose on day 1 with or without food.
Rolapitant injection should be given intravenously or deep into the vein slowly over 30 minutes.
Dexamethasone should be given exactly half an hour before initiating chemotherapy. On day 2, 3, and 4 dexamethasone is given twice daily.
Discard the solution if any particulate matter, discoloration or contamination is present.
This injectable solution should not be diluted. Once the vial stopper of rolapitant injection is punctured it must be used immediately.
This injection can be given with the other fluids like Sodium Chloride 0.9%, Dextrose 5% or Lactated Ringer’s solution.
•Caution is required when treating pregnant or breastfeeding women with rolapitant.
•No dose adjustment needed in mild or moderate liver disease but avoid rolapitant in severe liver disease.
•Patients with end-stage kidney disease should be closely monitored when treated with rolapitant.
•It may impair fertility status in the female. So, caution is required while treating women in the reproductive age group.
• Low white cell count: The most common side effects are low neutrophil count (neutropenia) and hiccups
• Gastrointestinal: Anorexia or decreased appetite, dyspepsia (indigestion), stomach pain, painful and swelling sores of the mouth
• Nervous system: Dizziness
• Urogenital: Urinary tract infections
•Lab abnormalities: Low red and white blood cell count
The dose should be taken as prescribed. A high dose can be dangerous. No specific antidote is available in case of poisoning with rolapitant. Consult your doctor immediately for symptomatic treatment.
• Rifampicin • Methotrexate, • Topotecan • Irinotecan • Warfarin • Thioridazine • Pimozide
Rolapitant should not be given with medicines like rifampicin which significantly reduces the effect of rolapitant.
Rolapitant can increase the blood levels of certain chemotherapy drugs such as methotrexate, topotecan, or irinotecan which can result in toxicity.
Monitor for bleeding by tests like INR and prothrombin time when rolapitant is prescribed along with warfarin.
Avoid rolapitant in patients taking certain medicines (thioridazine and pimozide) with a narrow therapeutic index that may cause severe side effects or toxicity with a slight dose difference. When given with these medicines, it can cause abnormal heart rhythm.
If these medications cannot be avoided use another antiemetic drug or stop taking thioridazine and pimozide, whichever is possible.
Store rolapitant tablets and injections at room temperature between 20ºC and 25ºC.
Keep away from direct sunlight.
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