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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Focinvez
Generic Name
Fosaprepitant Dimeglumine
Active Ingredient
Fosaprepitant DimeglumineCategory
Other
Variants
2
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 150 mg/50mL | INJECTION | INTRAVENOUS | 82449-231 |
| 150 mg/50mL | INJECTION | INTRAVENOUS | 70121-2631 |
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Focinvez, you must consult a qualified healthcare professional.
Detailed information about Focinvez
Fosaprepitant dimeglumine is a high-potency intravenous prodrug of aprepitant, classified as a neurokinin-1 (NK1) receptor antagonist, primarily used to prevent chemotherapy-induced nausea and vomiting (CINV).
For adults undergoing chemotherapy, the standard recommended dose of fosaprepitant dimeglumine is 150 mg. This is administered as a single intravenous infusion on Day 1 of the chemotherapy cycle. The infusion should be completed approximately 30 minutes prior to the start of the chemotherapy treatment.
In clinical practice, this 150 mg dose is designed to replace the three-day oral aprepitant dosing schedule. When used with highly emetogenic chemotherapy (HEC), it is typically combined with:
Fosaprepitant is approved for pediatric patients from 6 months to 17 years of age. The dosing is weight-based and depends on the emetogenicity of the chemotherapy:
For children, the infusion time is typically longer (up to 60 minutes for younger infants) to ensure safety and monitoring for infusion-site reactions.
No dosage adjustment is necessary for patients with renal impairment, including those with end-stage renal disease (ESRD) undergoing hemodialysis. The drug is not significantly cleared by dialysis.
In clinical trials, no overall differences in safety or effectiveness were observed between patients over 65 and younger patients. Dosage adjustments are generally not required based solely on age, though individual health status should always be considered.
Fosaprepitant is administered only by healthcare professionals in a clinical setting (hospital or infusion center).
Because fosaprepitant is administered by a healthcare provider immediately before chemotherapy, a missed dose is unlikely. However, if your chemotherapy session is delayed or rescheduled, the timing of the fosaprepitant infusion must be adjusted accordingly to ensure it is given 30 minutes before the chemotherapy starts. If you believe you missed the dose, notify your oncology team immediately.
In the event of an overdose, there is no specific antidote. Symptoms may include extreme drowsiness or a worsening of side effects like headache. Treatment consists of supportive care and monitoring of vital signs. Because the drug is highly protein-bound, it cannot be removed from the body through dialysis.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance. Always inform your nurse if you feel any pain or burning at the injection site during the infusion.
Side effects of fosaprepitant dimeglumine are often difficult to distinguish from the side effects of the chemotherapy itself. However, the following are frequently reported:
Fosaprepitant dimeglumine is a potent medication that requires careful clinical oversight. The most critical safety consideration is its potential to interact with other drugs. Because it is a 'moderate' inhibitor of the CYP3A4 enzyme, it can raise the levels of other drugs in your blood, potentially leading to dangerous toxicity. Conversely, other drugs can lower the effectiveness of fosaprepitant.
No FDA black box warnings for Fosaprepitant Dimeglumine.
Fosaprepitant must NEVER be used with the following medications due to the risk of life-threatening heart rhythm problems:
There are specific scenarios where fosaprepitant dimeglumine must never be used:
These are conditions where the doctor must weigh the benefits against significant risks:
Fosaprepitant is classified under a framework where human data is limited. Animal studies using doses much higher than the human equivalent did not show clear evidence of birth defects. However, because Substance P and NK1 receptors play roles in neurological development, use during pregnancy should be limited to cases where the clinical need is certain. There is no data regarding its use in fertility treatments; however, since it interferes with hormonal contraceptives, it is clear the drug interacts with hormonal pathways.
It is not known whether fosaprepitant or its active metabolite, aprepitant, is excreted in human milk. In animal studies (rats), aprepitant was present in milk. Because of the potential for serious adverse reactions in a nursing infant, a decision should be made whether to discontinue nursing or to avoid the drug, taking into account the importance of the drug to the mother.
Fosaprepitant is approved for use in pediatric patients as young as 6 months of age. Clinical trials have shown that the safety profile in children is generally similar to that in adults, with infusion site reactions being slightly more common in the younger cohorts. It is not approved for use in infants under 6 months old due to immature metabolic pathways.
Fosaprepitant dimeglumine is an intravenous prodrug that is rapidly converted via hydrolysis by non-specific esterases to aprepitant. Aprepitant is a selective high-affinity antagonist of human substance P/neurokinin-1 (NK1) receptors. It has little to no affinity for serotonin (5-HT3), dopamine, or corticosteroid receptors. By blocking the NK1 receptor in the CNS, it inhibits the emetic reflex, particularly the delayed phase associated with chemotherapy.
Aprepitant penetrates the blood-brain barrier and occupies NK1 receptors in the brain. Positron Emission Tomography (PET) studies in humans have shown that a 150 mg IV dose of fosaprepitant results in >90% receptor occupancy in the striatum of the brain, which is maintained for at least 48 hours. This explains why a single dose is effective at preventing nausea for several days.
| Parameter | Value |
|---|---|
Common questions about Focinvez
Fosaprepitant dimeglumine is an intravenous medication used to prevent nausea and vomiting caused by chemotherapy. It is specifically designed to target both the immediate (acute) and late-onset (delayed) nausea that often follows cancer treatments. This drug is typically given to patients receiving 'highly emetogenic' or 'moderately emetogenic' chemotherapy, which are treatments known to cause significant stomach upset. It is important to understand that this is a preventive medicine, meaning it is given before you feel sick to stop the symptoms from starting. It is not used to treat nausea that you already have. Your doctor will usually give it as a single injection about 30 minutes before your chemotherapy session begins.
The most frequently reported side effects include infusion site reactions, such as pain, redness, or swelling where the IV was placed. Many patients also experience significant fatigue or a general feeling of weakness for a few days after the infusion. Digestive issues like diarrhea, constipation, and indigestion are also quite common. Some patients report a persistent case of hiccups, which is a known side effect of this specific class of drugs. While most side effects are mild, you should always report them to your oncology nurse. They can often provide simple remedies to help manage these symptoms during your recovery.
There is no known direct chemical interaction between alcohol and fosaprepitant dimeglumine. However, medical professionals generally advise against drinking alcohol in the days surrounding chemotherapy. Alcohol can irritate the lining of the stomach and esophagus, which may worsen the nausea that the drug is trying to prevent. Furthermore, alcohol can contribute to dehydration and fatigue, both of which are common side effects of cancer treatment. If you do choose to have a drink, it is vital to discuss it with your doctor first. They can provide guidance based on your specific chemotherapy regimen and overall health status.
The safety of fosaprepitant during pregnancy has not been fully established in humans. While animal studies did not show a high risk of birth defects, there is not enough data from pregnant women to guarantee it is safe for a developing fetus. Because the drug can cross the placenta, it is only used during pregnancy if the potential benefit to the mother justifies the potential risk to the baby. Additionally, this drug makes hormonal birth control (like the pill) less effective for up to 28 days. If you are of childbearing age, you must use a backup, non-hormonal method of contraception like condoms. Always inform your doctor if you are pregnant or planning to become pregnant before receiving this treatment.
Fosaprepitant begins working almost immediately after it is infused into your vein. Because it is given intravenously, it reaches its peak concentration in the blood by the time the 20-to-30-minute infusion is finished. Once in the body, it quickly converts to its active form, aprepitant, and travels to the brain to block the receptors that trigger vomiting. It is specifically timed to be in your system 30 minutes before your chemotherapy starts so that the 'vomiting centers' in your brain are already protected. The effects of a single dose are long-lasting, providing protection for up to 48 to 72 hours. This long duration is why it is so effective at preventing the 'delayed' nausea that occurs days after treatment.
Fosaprepitant is not a daily medication, so there is no risk of 'withdrawal' or traditional addiction. It is administered as a single dose at the beginning of each chemotherapy cycle. If you decide you do not want to receive it for your next cycle, you can stop, but you must discuss this with your oncologist first. Stopping the medication will significantly increase your risk of severe nausea and vomiting during and after your chemotherapy. Most doctors recommend completing the anti-emetic protocol for every cycle to ensure you can stay hydrated and maintain your strength. There is no need to 'taper' the dose since it is not used continuously.
Because this medication is administered by a healthcare professional in a clinic or hospital, it is very difficult to 'miss' a dose. It is part of a strictly timed pre-chemotherapy protocol. However, if your chemotherapy appointment is rescheduled or if you realize the infusion was skipped, you should notify your doctor or nurse immediately. The drug must be given before the chemotherapy to be effective; it cannot be given after you have already started vomiting. If a dose is missed, your doctor may need to prescribe alternative oral medications to help manage your symptoms. Always double-check your pre-medication list with your nurse before the chemotherapy begins.
Weight gain is not a recognized side effect of fosaprepitant dimeglumine. In fact, many patients undergoing chemotherapy struggle with weight loss due to a decreased appetite or the metabolic demands of the illness. While some other medications given with fosaprepitant, such as the steroid dexamethasone, can cause fluid retention or increased appetite leading to weight gain, fosaprepitant itself does not have this effect. If you notice sudden swelling or rapid weight gain, it is more likely related to other medications or a underlying medical condition. You should report any significant changes in your weight to your oncology team. They can help determine the cause and adjust your supportive care plan accordingly.
Fosaprepitant has several significant drug interactions that your doctor must manage. It is a 'moderate inhibitor' of the CYP3A4 enzyme, which means it can slow down how your body processes other drugs, leading to higher levels in your blood. For example, it often requires a dose reduction of steroids like dexamethasone. It can also interfere with the blood thinner warfarin and hormonal birth control. You must provide your doctor with a complete list of all prescriptions, over-the-counter drugs, and herbal supplements you are taking. Your doctor will check this list to ensure there are no dangerous combinations. Most medications can be continued, but some may require dose adjustments or extra monitoring.
Yes, generic versions of fosaprepitant dimeglumine have been approved by the FDA and are available in the United States. The brand name version is known as Emend for Injection. Generic versions are required by law to have the same active ingredient, strength, dosage form, and route of administration as the brand-name drug. They must also prove 'bioequivalence,' meaning they work in the body the same way. The availability of a generic version often makes the treatment more affordable for hospitals and patients. Whether you receive the brand or the generic, the efficacy in preventing chemotherapy-induced nausea remains the same.
Other drugs with the same active ingredient (Fosaprepitant Dimeglumine)
While rare, some side effects require emergency medical care.
> Warning: Stop taking Fosaprepitant Dimeglumine and call your doctor immediately if you experience any of these:
Because fosaprepitant is typically used as a single dose per chemotherapy cycle (once every 2-4 weeks), long-term cumulative side effects are rare. However, repeated infusions into the same vein can lead to permanent vein hardening or scarring. There is no evidence that fosaprepitant causes long-term organ damage when used as directed for CINV prevention.
No FDA black box warnings currently exist for fosaprepitant dimeglumine. However, the FDA has issued safety communications regarding the risk of severe infusion site reactions and the potential for significant drug interactions that could lead to toxicity of other medications.
Report any unusual symptoms to your healthcare provider. It is helpful to keep a 'nausea diary' to track when symptoms occur and which side effects are most bothersome, as this helps your oncology team refine your supportive care plan.
Your healthcare provider will perform several checks while you are on this medication:
Fosaprepitant can cause dizziness and fatigue. While these effects are often due to the chemotherapy itself, patients should avoid driving or operating heavy machinery until they know how the medication affects them. It is highly recommended to have someone else drive you home after your infusion.
There is no direct chemical interaction between alcohol and fosaprepitant. However, alcohol can irritate the stomach lining and worsen nausea or dehydration caused by chemotherapy. It is generally advised to avoid alcohol during the days surrounding your chemotherapy treatment.
Fosaprepitant is not a chronic medication; it is given as a single dose per cycle. Therefore, there is no 'withdrawal syndrome' or need for tapering. If you decide to stop receiving fosaprepitant for future cycles, discuss this with your oncologist, as your risk of severe vomiting will significantly increase.
> Important: Discuss all your medical conditions with your healthcare provider before starting Fosaprepitant Dimeglumine. Ensure they have a complete list of every medication you take, including 'as needed' drugs and herbals.
Because fosaprepitant is administered intravenously, traditional food interactions affecting absorption are not a concern. However:
Fosaprepitant does not generally interfere with common laboratory tests, though it may cause transient elevations in liver enzymes (ALT/AST) and blood urea nitrogen (BUN) which could be misinterpreted as organ dysfunction if the timing of the drug administration is not considered.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking. Even 'natural' products can change how your body processes this drug.
Patients who have had a skin rash, hives, or breathing trouble after taking oral Aprepitant (Emend capsules) are highly likely to have the same reaction to Fosaprepitant. Furthermore, because the IV formulation contains Polysorbate 80, patients who have reacted poorly to other IV drugs containing this stabilizer (such as certain formulations of docetaxel or amiodarone) should be screened carefully for cross-sensitivity.
> Important: Your healthcare provider will evaluate your complete medical history before prescribing Fosaprepitant Dimeglumine. Always disclose any previous 'bad reactions' to medications, even if they seemed minor at the time.
Clinical studies did not identify significant differences in the safety or efficacy of fosaprepitant between patients 65 years and older and younger patients. However, elderly patients are more likely to have decreased hepatic or renal function and are often on multiple other medications (polypharmacy), which increases the risk of drug-interactions. No specific dose adjustment is recommended for the elderly.
No dosage adjustment is necessary for patients with any degree of renal impairment. The drug is not cleared by the kidneys in its active form, and studies in patients with end-stage renal disease (ESRD) showed that the pharmacokinetics were not significantly altered.
> Important: Special populations require individualized medical assessment. Pediatric and elderly patients should be monitored more frequently during the infusion for signs of distress or site irritation.
| Protein Binding | >95% (Albumin) |
| Half-life | 9 to 13 hours (Aprepitant) |
| Tmax | End of 20-30 min infusion |
| Metabolism | Rapid conversion to aprepitant; then CYP3A4 |
| Excretion | Fecal 45%, Renal 40% (as metabolites) |
Fosaprepitant is a Neurokinin-1 (NK1) Receptor Antagonist. It is often grouped with other 'prepitants' like oral aprepitant, rolapitant, and netupitant. It is a cornerstone of 'Triple Therapy' (NK1 antagonist + 5-HT3 antagonist + Corticosteroid) for emesis prevention.