How does it work?
The active ingredients in Akynzeo are responsible for blocking two mechanisms involved in inducing nausea and vomiting, initiated during chemotherapy.
Netupitant blocks neurokinin-1 receptors found broadly in the central and peripheral nervous systems. These receptors are responsible for the delayed phase of nausea and vomiting, usually occurring after the first 24 hours after receiving chemotherapy.
Palonosetron blocks 5HT3 receptors acting as an antagonist. These receptors can be found in the gut and are responsible for the immediate phase of nausea, happening within the first 24 hours of receiving chemotherapy, and are highly dependent on serotonin and 5HT3 receptors. Chemotherapy induces vomiting and sickness by stimulating the production of serotonin in the small intestine. Serotonin activates 5HT3 receptors in the vagal afferents and starts the vomiting reflex. Combining these drugs helps control both phases of nausea and vomiting induced by chemotherapy.
Akynzeo comes in capsule form with 300mg of netupitant and 0.5mg of palonosetron.
How to take Akynzeo?
Take Akynzeo precisely as prescribed.
Those undergoing highly emetogenic chemotherapy, usually cisplatin-based, are recommended to have a capsule 1 hour before the administration of chemotherapy. This is generally accompanied by the administration of dexamethasone 30 minutes before the administration of chemotherapy. Dexamethasone can also be given for a few days after the chemotherapy has been administered.
For moderately emetogenic chemotherapy, one capsule of Akynzeo is recommended an hour before the start of chemotherapy and accompanied by dexamethasone 30 minutes before. Usually, in these cases, follow-up dexamethasone doses are not required.
You can take Akynzeo either with or without food. However, the capsule should not be opened and should be swallowed whole.
Akynzeo is given in advance to prevent nausea and vomiting.
How to store Akynzeo?
Store the capsules in their original container, away from moisture or heat. Keep at room temperature and away from children and pets. Avoid storing it in the bathroom.
Acute symptoms of overdose with Akynzeo are:
- Anxiety and palpitations
- Leg pain
Because of the antiemetic properties of this medication, drug-induced emesis may not be successful.
If you suspect overdosing on Akynzeo, discontinue taking it and seek immediate medical attention. Seek immediate medical attention by contacting the poison control center or calling 911 if you feel like passing out or have difficulty breathing.
Contact your healthcare professional if you notice any of the following symptoms.
Common side effects of this medication include:
- Tiredness and weakness
- Upset stomach
- Serotonin syndrome. Signs of this condition include agitation, fever, sweating, hallucinations, increased heart rate, muscle stiffness, twitching, diarrhea, loss of coordination, dilated pupils, confusion, headache, unconsciousness, and shivering. When Akynzeo is used concomitantly with serotonergic drugs like SSRIs, SNRIs, mirtazapine, fentanyl, lithium, tramadol, and monoamine oxidase inhibitors, serotonin levels can accumulate in the body. Seratonin syndrome can be fatal if left untreated. If you start experiencing any of these symptoms, you are to discontinue Akynzeo and seek immediate medical attention. Mild serotonin syndrome can go away within a couple of days once you seize to take the medications that have caused it. You may be given medication that blocks serotonin to counteract serotonin syndrome.
You may experience signs of anaphylaxis after taking Akynzeo. Signs and symptoms include hives, itchiness, hypotension, throat swelling and tightness, chest pain, difficulty breathing, and loss of consciousness.
Do not take Akynzeo if you are allergic or have a hypersensitivity to its active ingredients or excipients.
All women should do a pregnancy test before starting this medication, including premenopausal women. Women of childbearing potential should not become pregnant while on this medication. Instead, effective contraceptive methods should be used.
It is not known whether Akynzeo passes through breast milk. Akynzeo should not be used while breastfeeding. It should be discontinued during the treatment, and no breastfeeding should be done for one month after treatment is stopped.
Since Aknyzeo can cause dizziness and fatigue, it may moderately affect driving or operating machinery. Therefore, driving or operating machinery should be done with caution.
Palonosetron can increase bowel transit time; therefore, patients with a history of constipation should be monitored closely following the administration of Akynzeo.
Akynzeo should not be given to children under the age of 18 years.
Inform your doctor if you have severe hepatic or renal impairment or end-stage renal disease. You may need to be prescribed a slightly adjusted dose of Akynzeo or given a different treatment if this is the case.
If you are allergic to dolasetron, ondansetron, or other medication used for nausea and vomiting, let your doctor know before they prescribe Aknyzeo.
Inform your doctor if you take medication for depression, Parkinson’s disease, migraine, or headaches. This medication can be a stimulant or opioid medication. Any medication can interact with Akynzeo and cause a condition called Serotonin Syndrome.
Illicit drugs and Akynzeo may cause serotonin syndrome; therefore, be sure to inform your doctor if you use such substances and have been prescribed Akynzeo.
If you take any other over-the-counter medication, prescription, or herbal remedy, be sure to inform your doctor.
The following are drugs that can interact with Aknyzeo:
- Ivabradine- Used to treat chronic heart failure
- SNRIs such as duloxetine, atomoxetine, and venlafaxine- Used to treat depression
- SSRIs such as citalopram, escitalopram, fluoxetine, sertraline, and paroxetine- Used to treat depression
- Sumatriptan- Used to treat migraines and cluster headaches
- Oxycodone- Used to treat moderate to severe pain
- Olanzapine- Used to treat schizophrenia, mania, and bipolar disorder
- Hydromorphone- Used to treat moderate to severe chronic pain
- Teriparatide- Used to strengthen bones and reduce their risk of breaking
- Famotidine- Used to prevent and treat heartburn, stomach ulcers, esophagitis, and GERD
- St John’s Wort- Used to treat depression
- Rifampin- Used to treat Tuberculosis
- Ketoconazole- Used to treat skin infections caused by fungi
- Granisetron, ondansetron- Used to treat nausea and vomiting
Patients who are already on tacrolimus, imatinib, anastrozole, or paclitaxel can have increased plasma concentration of these medications when taken with Aknyzeo.
Akynzeo with rifampin, carbamazepine, phenobarbital, or pioglitazone should be avoided.
Inform your doctor of any prescription, over-the-counter or herbal medicines you take before starting on Akynzeo.
Akynzeo is contraindicated in:
- Patients with an allergy or hypersensitivity to its active ingredients or any of its excipients
- Pregnant women