Netupitant and Palonosetron (Oral)

Cancer patients undergoing chemotherapy are often given this combination medication to combat the effects of severe nausea and/or vomiting.


Netupitant and palonosetron are two medicines generally administered in tandem to patients who have to undergo chemotherapy treatments for cancer. Together, the drugs work to block the signals sent to the brain which induce nausea and vomiting, so the patient can experience at least some level of relief. This medication is marketed commercially under the brand name of Akynzeo and comes in the form of a capsule which is orally ingested.

Both of these medications work in the body by blocking signals between receptors which would ordinarily trigger a response of nausea and/or vomiting, and they are much more effective when working together than either drug would be alone.

While palonosetron is easily absorbed into the body and begins working almost immediately, netupitant can take as long as three full hours to be fully absorbed by the body, depending on a number of specific factors with each individual patient. Generally speaking, the peak effectiveness period for the combination medication would be about five hours after initial ingestion.

Condition treated

  • Nausea and vomiting due to chemotherapy treatment

Type Of Medicine

  • Antiemetic

Side Effects

Although it can provide some very welcome relief from the symptoms attendant upon chemotherapy treatments, this combination medication can also induce some unwanted side effects on some patients, in varying degrees. While some patients may experience very few side effects which are relatively mild, others can be subject to severe side effects that occur frequently, and may even require medical attention.

Although it is very uncommon, some patients do experience an allergic reaction to this medication, and this is a situation where it may be necessary to seek emergency medical assistance because symptoms can become extremely severe, and possibly even life-threatening. The side effects which you should look for if you suspect that you are having an allergic reaction include the following:

  • Extreme itchiness on the skin surfaces of the body
  • Hives and or rashes which appear at various locations
  • Dizziness or lightheadedness, with the sensation that you might faint
  • Tightness of the chest, often accompanied by problems with breathing
  • Noticeable swelling or puffiness in the area of around the face, especially in the eyelids, tongue, lips, and throat.

There are a number of other side effects which range in frequency from patient to patient and are listed below. If you should experience any of the side effects listed here, and they become uncomfortable to the point where you feel medical attention is necessary, you should contact your doctor immediately, and explain what kind of side effects you are observing.

  • Persistent headaches
  • Unusual fatigue or weakness, even without any significant exertion
  • Constipation
  • Agitation or nervousness
  • Confusion or disorientation
  • Fevers and/or chills
  • Trembling and shaking
  • Profuse sweating
  • Uncontrollable shivering
  • Stomach discomfort or pain
  • Indigestion
  • Heartburn
  • Flushing on the skin
  • Sudden loss of coordination
  • Twitching of the muscles
  • Seeing or hearing things which are not really there, and can't be sensed by anyone else.


You should only take this combination medication as recommended by your family doctor, and that means taking no more of it or less of it than is specifically prescribed, or for any longer period of time than your doctor has recommended.

It will generally come with an information guide that provides useful data on the medication itself and how it is to be administered. If you have any questions about this guide, you should contact your doctor and review the information, so that you have a good understanding of how it is to be taken. The dosage of netupitant and palonosetron will vary from one patient to another, based on several factors including your specific medical condition, your body's tolerance to the medication, the actual dosage you take at any given time, the frequency of dosing and the duration of your treatment program. While the dosages listed below can be accepted as typical or standard dosages, they are not meant to be considered as a recommendation for your personal circumstances.

For the oral dosage in capsule form, intended for the treatment of vomiting and/or nausea caused by chemotherapy sessions:

  • Children of any age would need to have usage and dosage specifically tailored to their situations by a pediatric doctor
  • Adults should ingest one full capsule of the medication an hour prior to the beginning of a scheduled chemotherapy treatment.

If you forget to take this medication at your regularly scheduled time, it is allowable to take it as soon as you do remember it. However, if you don't think of it until close to the time of your next regularly scheduled dosage, it's better to skip the missed dosage entirely, and just wait for the next scheduled dosage. It's never a good idea to double up on dosages, either because you're trying to get back on schedule, or because your symptoms are particularly uncomfortable, and you feel you need additional medication.


As with most drugs, there is a potential for netupitant and palonosetron to interact with other medications which you might be taking. These interactions can take several forms, the first of which could be adverse side effects which are imparted to you as the patient. The other kind of interaction which is possible is a decrease in the effectiveness of either this medication or the one interacting with it. Neither of these kinds of interaction are desirable and are to be avoided if at all possible.

That being so, it is strongly recommended that you prepare a full list of all medications which you are currently taking, including all over-the-counter drugs, vitamins, herbal supplements and other prescription medications, as well as the dosages of each. Your doctor can review this list to make a determination whether any of your current medications should be discontinued temporarily, or reduced in dosage temporarily, while you are concurrently taking netupitant and palonosetron.

You can also provide this list to any doctor at an emergency room or another healthcare clinic you have to visit, where your primary care doctor is not in residence. By reviewing the list, a doctor can safely prescribe treatment for your condition without interfering with any other drug you might be taking.

Some of the drugs most commonly checked by doctors for potential interaction with netupitant and palonosetron are all the following listed below:

  • Amitriptylinoxide
  • Amoxapine
  • Clomipramine
  • Cocaine
  • Cyclobenzaprine
  • Rifampin
  • Rifapentine
  • Rizatriptan
  • Desipramine
  • Desvenlafaxine
  • Doxepin
  • Duloxetine
  • Efavirenz
  • Buspirone
  • Carbamazepine
  • Chlorpheniramine
  • Pentazocine
  • Phenelzine
  • Phenytoin
  • Brompheniramine
  • Buprenorphine
  • Citalopram
  • Cilostazol
  • Fentanyl
  • Fluoxetine
  • Fluvoxamine
  • Hydroxytryptophan
  • Imipramine
  • Iproniazid
  • Isocarboxazid
  • Levomilnacipran
  • Linezolid
  • Eletriptan
  • Enzalutamide
  • Escitalopram
  • Lithium
  • Meperidine
  • Mitotane
  • Nefazodone
  • Nialamide
  • Nortriptyline
  • Lofepramine
  • Lorcaserin
  • Melitracen
  • Olaparib
  • Opipramol
  • Oxcarbazepine
  • Almotriptan
  • Amineptine
  • Tramadol
  • Tranylcypromine
  • Dextromethorphan
  • Dibenzepin
  • Fosphenytoin
  • Frovatriptan
  • Furazolidone
  • Domperidone
  • Trazodone
  • Vilazodone
  • Amitriptyline
  • Oxycodone
  • Paroxetine
  • Moclobemide
  • Naloxegol
  • Naratriptan
  • Methadone
  • Methylene Blue
  • Trimipramine
  • Tryptophan
  • Venlafaxine
  • Rasagiline
  • Rifabutin
  • Selegiline
  • Sertraline
  • Milnacipran
  • Mirtazapine
  • Piperaquine
  • Sibutramine
  • Simeprevir
  • St John's Wort
  • Sumatriptan
  • Tapentadol
  • Tianeptine
  • Vortioxetine
  • Zolmitriptan
  • Primidone
  • Procarbazine
  • Protriptyline


There are some precautions and warnings which you should be aware of when taking netupitant and palonosetron, and by being aware of these, you can avoid worsening any medical condition you may already have, or possibly triggering a new condition.

If you already know that you are allergic to either of the two medications in this combination medicine, make sure to alert your doctor to that fact before taking this drug. It is possible that some of the active or inactive ingredients in this combination medicine can trigger other allergic reactions you may have, for instance to pets, foods, preservatives, or fabrics, so make a point of discussing with your doctor any allergic reactions that you have to other substances.

After you have left a treatment center where you underwent chemotherapy sessions, you may still experience nausea and vomiting, even though you have taken this medication. Be sure to alert your doctor to this fact, especially if you experience severe symptoms of this type, because it may be necessary to consider an alternative form of treatment.

Be sure to discuss with your doctor if you are pregnant or thinking of becoming pregnant while taking netupitant and palonosetron. Studies conducted on various animal populations have been inconclusive, with some research indicating no adverse effects that all, while others did show some negative impact on fetuses. Studies conducted on rabbit populations did show an increased occurrence of fetal abnormalities, as well as low fetal weight and maternal toxicity. Since the dosages used in these rabbit population studies were fairly close to what would be prescribed for humans, there is a very real danger that there could be a negative impact on a human fetus.

It is also known that this medication is passed through breastmilk to a nursing infant, and that makes it inadvisable to be breastfeeding while you are also undergoing a program of treatment with netupitant and palonosetron. Both these conditions, i.e. pregnancy and breastfeeding, should be thoroughly reviewed with your doctor beforehand, and if you should become pregnant while taking the medication, the same kind of thorough consultation should be engaged in with your doctor.


Netupitant and palonosetron should be stored in the package or container that the medication came in, well out of the reach of pets or any curious younger children in the household. It should also be stored at room temperature, out of direct lighting, and in a location which is not subject to extremes of temperature or humidity, for instance, the bathroom.

Any medication which has expired or is no longer needed should be discarded using proper disposal methods, not thrown in the trash or flushed down the toilet. Your doctor or pharmacist can apprise you of proper disposal methods, lacking this information, you can also consult the FDA website for the safe disposal of medicines.

Make sure that this medication is not stored in a weekly pill reminder, because these containers seldom have locking mechanisms which can prevent unwanted access.


Netupitant and palonosetron is a combination medication which is primarily used to treat nausea and vomiting that a chemotherapy patient might commonly experience. By blocking signals to the brain which trigger nausea, this medication can relieve the symptoms which would otherwise prevail after chemotherapy treatment. It is normally administered about an hour prior to a chemo treatment, and it will be effective for several hours afterward.

There is a large number of other drugs which have the potential for interacting with this medication, so it's important to review your current medications with a doctor before taking netupitant and palonosetron. Side effects tend to be generally mild and do not affect the majority of patients who take this drug.