This combination product contains 2 medications: netupitant and palonosetron. Netupitant belongs to the family of medications known as neurokinin 1 (NK1) receptor antagonists. It works by blocking neurokinin, a substance in the brain that causes nausea and vomiting.

Palonosetron belongs to the class of medications called 5-HT3 receptor antagonists. It works by reducing the effects of a naturally occurring chemical in the body called serotonin, which causes nausea and vomiting.

Netupitant - palonosetron is used in combination with another medication, dexamethasone, to prevent nausea and vomiting caused by certain types of cancer chemotherapy.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The usual dose of netupitant - palonosetron is one capsule taken by mouth approximately one hour before the start of chemotherapy. Only one dose of netupitant - palonosetron is taken for each cycle of chemotherapy. This medication may be taken with food or on an empty stomach.

Swallow the capsules whole. Do not crush, open, or chew the capsules.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Each hard gelatin capsule with a white body and caramel cap, with "HE1" printed on the body, contains 300 mg of netupitant and 0.56 mg of palonosetron hydrochloride (equivalent to 0.50 mg palonosetron). Nonmedicinal ingredients: glycerol monocaprylocaprate, microcrystalline cellulose, sucrose lauric acid esters, povidone K- 30, croscarmellose sodium, colloidal hydrated silica, sodium stearyl fumarate, magnesium stearate, glycerin, polyglyceryl dioleate, purified water, butylated hydroxyanisole (BHA), gelatin, sorbitol, 1,4 sorbitan, titanium dioxide, shellac glaze (partially esterified), yellow, red and black iron oxide, propylene glycol. May contain traces of lecithin derived from soya, medium-chain triglycerides, and denatured ethanol.

Do not take this medication if you:

• are allergic to netupitant, palonosetron, or any ingredients of the medication
• are pregnant
• are taking certain other medications, including, but not limited to:
• pimozide
• cisapride

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• constipation
• dizziness
• fatigue
• headache
• nausea

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abdominal pain

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• symptoms of serotonin syndrome (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abnormal heart rhythms: This medication can cause abnormal heart rhythms. Certain medications (e.g., sotalol, thioridazine, chlorpromazine, pimozide, moxifloxacin, mefloquine, pentamidine, arsenic trioxide, dolasetron mesylate, tacrolimus) can increase the risk of a type of abnormal heart rhythm called QT prolongation, and should not be used in combination with netupitant - palonosetron. You are more at risk for this type of abnormal heart rhythm and its complications if you:

• are female
• are older than 65 years of age
• have a family history of sudden cardiac death
• have a history of heart disease or abnormal heart rhythms
• have a slow heart rate
• have congenital prolongation of the QT interval
• have diabetes
• have had a stroke
• have low potassium, magnesium, or calcium levels
• have nutritional deficiencies

If you have heart disease and abnormal heart rhythms, or are taking certain medications (e.g., verapamil, atazanavir), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Allergy: Some people who are allergic to ondansetron or granisetron may also experience allergic reactions to netupitant - palonosetron. Before you take this medication, inform your doctor about any previous adverse reactions you have had to medications.

It is possible to experience a severe allergic reaction to this medication without having had a reaction to other similar medications. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing or swelling of the face and throat.

Constipation: This medication can slow down the speed that material moves through the large bowel, causing constipation. If you have a history of bowel problems, such as blockage in the bowel or severe constipation, talk to your doctor.

Drowsiness/reduced alertness: Netupitant - palonosetron may cause drowsiness or dizziness, affecting your ability to drive or operate machinery. Avoid driving, operating machinery, or performing other potentially hazardous tasks until you know how this medication affects you.

Galactose intolerance/glucose malabsorption: Netupitant - palonosetron is prepared with sucrose and sorbitol. People with certain hereditary problems, such as fructose intolerance, glucose-galactose malabsorption or sucrose-isomaltase insufficiency, should not take this medication.

Kidney problems: The safety and effectiveness of using this medication have not been established for people with end-stage kidney disease. If you have kidney problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause netupitant to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin syndrome: Severe reactions are possible when palonosetron is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors, medications used to treat depression. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.

If you are taking antidepressants, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Soya: This medication may contain traces of lecithin derived from soya. If you have a known allergy to peanut or soya, you should be monitored closely for an allergic reaction.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if netupitant - palonosetron passes into breast milk. If you are breast-feeding and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

There may be an interaction between netupitant - palonosetron and any of the following:

• alpha blockers (e.g., alfuzosin, silodosin, tamsulosin)
• amiodarone
• antiarrhythmics (e.g., amiodarone, disopyramide, dronedarone, lidocaine)
• anti-cancer medications (e.g., cabazitaxel, docetaxel, doxorubicin, etoposide, ifosfamide, irinotecan, paclitaxel, venetoclax, vincristine)
• anti-psychotics (e.g., cariprazine, clozapine, olanzapine, quetiapine, risperidone)
• apalutamide
• apixaban
• apomorphine
• aprepitant
• "azole" antifungals (e.g., itraconazole)
• certain benzodiazepines (e.g., alprazolam, diazepam, midazolam)
• birth control pills
• bosentan
• bromocriptine
• buprenorphine
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• cannabis
• CF transmembrane regulators (e.g., elexacaftor, ivacaftor, lumacaftor, tezacaftor)
• clindamycin
• colchicine
• conivaptan
• corticosteroids (e.g., budesonide, dexamethasone, fluticasone, methylprednisolone)
• cyclosporine
• darifenacin
• domperidone
• elbasvir and grazoprevir
• eletriptan
• eliglustat
• enzalutamide
• eplerenone
• ergot alkaloids (e.g., dihydroergotamine, ergonovine, ergotamine)
• everolimus
• finerenone
• flibanserin
• guanfacine
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, lopinavir, ritonavir)
• ivabradine
• itraconazole
• linezolid
• lithium
• lemborexant
• lomitapide
• macitentan
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• maraviroc
• mifepristone
• mirtazapine
• modafinil
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, tranylcypromine)
• morphine
• naloxegol
• narcotics (e.g., fentanyl, hydrocodone, methadone, morphine, oxycodone)
• phenobarbital
• phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• pimecrolimus
• praziquantel
• protein kinase inhibitors (e.g., bosutinib, dabrafenib, dasatinib, imatinib)
• ranolazine
• rifabutin
• rifampin
• rivaroxaban
• roflumilast
• St. John's wort
• salmeterol
• saxagliptin
• seizure medications (e.g., carbamazepine, phenytoin)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline, vortioxetine)
• serotonin norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
• sirolimus
• solifenacin
• St. John's wort
• "statin" anti-cholesterol medications (e.g., atorvastatin, lovastatin, simvastatin)
• tacrolimus
• temsirolimus
• ticagrelor
• tofacitinib
• tolterodine
• tolvaptan
• trabectedin
• trazodone
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• tryptophan
• vilazodone
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.