Netupitant and Palonosetron
Netupitant and palonosetron is a combination anti-nausea medicine used with dexamethasone to prevent nausea and vomiting caused by cancer chemotherapy in adults.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 1 clinical label set within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
Akynzeo, on the U.S. market since about 2014, is one capsule pairing palonosetron, which blocks the serotonin signal behind nausea on chemotherapy day, with netupitant, which blocks the substance P signal behind delayed nausea in the following days; taken with dexamethasone, it is a standard specialist choice for preventing nausea and vomiting from cancer chemotherapy in adults. Most people tolerate it well, and what they notice is usually mild headache, tiredness, indigestion or constipation. The thing to watch is interactions, since netupitant raises the levels of many drugs for days afterward, including dexamethasone (hence its lower dose), so make sure your care team sees every medicine you take.
Clinical pearls
- Take the capsule about an hour before chemotherapy starts, with or without food, alongside your dexamethasone plan.
- Your reduced dexamethasone dose is intentional, because netupitant more than doubles its levels in your body.
- On warfarin, expect an INR check (the clotting blood test) around chemotherapy, since netupitant can change how warfarin works.
- Antidepressants like SSRIs, tramadol or fentanyl raise the risk of serotonin overload; report agitation, fever, tremor or muscle stiffness quickly.
Patient information guide A plain-language walkthrough of Netupitant and Palonosetron, written from its FDA label.
What Netupitant and Palonosetron is used for
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Netupitant and palonosetron is used with dexamethasone in adults to prevent chemotherapy-related nausea and vomiting.
- Akynzeo capsules: prevent acute and delayed nausea and vomiting with initial and repeat courses of cancer chemotherapy, including highly emetogenic chemotherapy.
- Akynzeo for injection and Akynzeo injection: prevent acute and delayed nausea and vomiting with initial and repeat courses of highly emetogenic chemotherapy.
- Akynzeo for injection and Akynzeo injection have not been studied with anthracycline plus cyclophosphamide chemotherapy.
How Netupitant and Palonosetron works
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This is a combination of two medicines that block different nausea pathways. Palonosetron blocks 5-HT3 receptors. Chemotherapy triggers serotonin release in the gut, and serotonin acting on these receptors starts the vomiting reflex, especially early on.
Netupitant blocks NK-1 receptors, which substance P activates. This pathway is largely linked to delayed nausea and vomiting.
Netupitant and Palonosetron dosage
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Dosing depends on the product, so follow your prescriber and the label.
- Akynzeo capsules: one capsule by mouth about 1 hour before chemotherapy, with or without food.
- Akynzeo for injection and Akynzeo injection: infused into a vein over 30 minutes, starting 30 minutes before chemotherapy.
- Dexamethasone is taken along with it, at a lower dose than usual.
Dosing details from the FDA-approved label
From the Netupitant and Palonosetron prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.
- Highly Emetogenic Chemotherapy, including Cisplatin-Based Chemotherapy (AKYNZEO capsules)
- 1 capsule of AKYNZEO 1 hour before chemotherapy on Day 1
- Dexamethasone 12 mg 30 minutes before chemotherapy on Day 1
- Dexamethasone 8 mg once a day on Days 2 to 4
- Capsules can be taken with or without food
- Highly Emetogenic Chemotherapy, including Cisplatin-Based Chemotherapy (AKYNZEO for injection and AKYNZEO injection)
- 1 vial of AKYNZEO infused over 30 minutes starting 30 minutes before chemotherapy on Day 1
- Dexamethasone 12 mg 30 minutes before chemotherapy on Day 1
- Dexamethasone 8 mg once a day on Days 2 to 4
- Anthracyclines and Cyclophosphamide-Based Chemotherapy and Chemotherapy Not Considered Highly Emetogenic (AKYNZEO capsules)
- 1 capsule of AKYNZEO 1 hour before chemotherapy on Day 1
- Dexamethasone 12 mg 30 minutes before chemotherapy on Day 1
- None on Days 2 to 4
- Capsules can be taken with or without food
Read the label’s full dosing text
2 DOSAGE AND ADMINISTRATION Recommended Dosage AKYNZEO capsules: The recommended dosage is one AKYNZEO capsule administered 1 hour prior to the start of chemotherapy, with or without food. ( 2.1 ) Preparation and Administration AKYNZEO injection is supplied either as a Ready-to-Use (with hanger) vial or a To-be-Diluted vial. (2.2) AKYNZEO for injection requires dilution prior to administration. ( 2.3 ) See full prescribing information for information on preparation, administration, and incompatibilities for each product. (2.2, 2.3, 2.4 ) 2.1 Recommended Dosage The recommended dosages of AKYNZEO and dexamethasone in adults for the prevention of nausea and vomiting associated with administration of emetogenic chemotherapy are shown in Table 1. AKYNZEO capsules can be taken with or without food. Table 1: Antiemetic Treatment Regimen Treatment Regimen Day 1 Days 2 to 4 Highly Emetogenic Chemotherapy, including Cisplatin-Based Chemotherapy AKYNZEO capsules 1 capsule of AKYNZEO 1 hour before chemotherapy Dexamethasone 8 mg once a day Dexamethasone 12 mg 30 minutes before chemotherapy AKYNZEO for injection and AKYNZEO injection 1 vial of AKYNZEO Infuse over 30 minutes starting 30 minutes before chemotherapy [see Dosage and Administration (2.2)] Dexamethasone 8 mg once a day Dexamethasone 12 mg 30 minutes before chemotherapy Anthracyclines and Cyclophosphamide-Based Chemotherapy and Chemotherapy Not Considered Highly Emetogenic AKYNZEO capsules 1 capsule of AKYNZEO 1 hour before chemotherapy None Dexamethasone 12 mg 30 minutes before chemotherapy 2.2 Preparation and Administration of AKYNZEO Injection (Ready-to-Use and To-be-Diluted) AKYNZEO injection is supplied as either a Ready-to-Use (with hanger) vial or a To-be-Diluted vial. AKYNZEO injection (Ready-to-Use; with hanger) See Table 2 for preparation instructions of AKYNZEO injection (Ready-to-Use) for intravenous infusion. AKYNZEO injection (Ready-to-Use) does not require dilution prior to administration. Table 2: Preparation and Administration of AKYNZEO Injection (Ready-to-Use) for Intravenous Infusion Step 1 Before administration, inspect the solution for particulate matter and discoloration. Discard the vial if particulates and/or discoloration are observed. Step 2 Using aseptic technique, insert a vented intravenous set through the septum of the vial. Once the stopper is punctured, use immediately.
Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →
Netupitant and Palonosetron side effects
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The most common side effects reported with Akynzeo capsules were:
Common side effects
- Headache
- Weakness or lack of energy (asthenia)
- Tiredness (fatigue)
- Indigestion (dyspepsia)
- Constipation
- Skin redness (erythema)
When to get medical help
- Get emergency help for signs of a serious allergic reaction (anaphylaxis), which has been reported with palonosetron.
- Call your doctor right away if you develop agitation, hallucinations, fast heartbeat, fluctuating blood pressure, dizziness, sweating, flushing, high fever, tremor, muscle stiffness or twitching, poor coordination, seizures, or nausea, vomiting or diarrhea together with these. These can be signs of serotonin syndrome.
- Tell your care team if you take other serotonin-affecting medicines and notice any of these symptoms.
Seek help right away for signs of a serious allergic reaction or serotonin syndrome. Side effects with the injection were generally similar to the capsules.
Netupitant and Palonosetron warnings and precautions
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- Serious allergic reactions (anaphylaxis) have been reported with palonosetron.
- Serotonin syndrome has been reported, mostly with other serotonin-affecting medicines. Some cases were fatal. Symptoms can include agitation, hallucinations, fast heartbeat, sweating, fever, tremor, stiffness, seizures, and stomach upset.
- Drug interactions: netupitant affects CYP3A4 and can raise levels of many other medicines.
Netupitant and Palonosetron interactions
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Netupitant is a moderate CYP3A4 inhibitor, so many interactions involve that enzyme.
- CYP3A4-processed drugs: levels may rise for about 6 days.
- Dexamethasone: exposure more than doubles, so a lower dose is used.
- Midazolam, alprazolam, triazolam: levels may rise.
- Chemotherapy such as docetaxel, paclitaxel, etoposide and vincristine: levels may rise, so monitoring is advised.
- Rifampin: lowers netupitant levels and should be avoided.
- Ketoconazole: raises netupitant levels, but no change is needed for a single dose.
- Serotonergic drugs (SSRIs, SNRIs, tramadol, fentanyl, lithium and others): raise serotonin syndrome risk.
- Warfarin: INR monitoring is needed.
- Oral contraceptives with levonorgestrel and ethinyl estradiol: no clinically significant effect.
Interactions listed in the FDA-approved label
From the Netupitant and Palonosetron prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.
- CYP3A4 substrates: Netupitant is a moderate inhibitor of CYP3A4; a single oral dose of netupitant 300 mg significantly inhibits CYP3A4 for 6 days, which can increase plasma concentrations of the concomitant drug. Avoid concomitant use for one week, if feasible; if not avoidable, consider dose reduction of the CYP3A4 substrate.
- Dexamethasone: A single oral dose of netupitant 300 mg or a single fosnetupitant infusion of 235 mg increased the systemic exposure of dexamethasone more than 2-fold on Days 2 and 4. Administer a reduced dose of dexamethasone with AKYNZEO.
- Midazolam and other benzodiazepines metabolized via CYP3A4 (alprazolam, triazolam): When administered with netupitant, the systemic exposure to midazolam was significantly increased. Consider the potential effects of increased plasma concentrations of midazolam or other benzodiazepines when administering with AKYNZEO.
- Chemotherapeutic agents metabolized by CYP3A4 (docetaxel, paclitaxel, etoposide, irinotecan, cyclophosphamide, ifosfamide, imatinib, vinorelbine, vinblastine, vincristine): The systemic exposure of chemotherapy agents metabolized by CYP3A4 can increase when administered with AKYNZEO. Caution and monitoring for chemotherapeutic related adverse reactions are advised.
- Oral contraceptives (levonorgestrel and ethinyl estradiol): There is no clinically significant effect of AKYNZEO on the efficacy of oral contraceptives containing levonorgestrel and ethinyl estradiol.
- Warfarin: Effects of AKYNZEO for injection and capsules on INR and prothrombin time have not been studied, although exposure to S-warfarin was predicted not to increase substantially with intravenous AKYNZEO. Monitor INR and adjust the warfarin dosage as needed to maintain the target INR range.
- Strong CYP3A4 inducers (e.g., rifampin): A strong CYP3A inducer can decrease the efficacy of AKYNZEO by substantially reducing plasma concentrations of the netupitant component. Avoid concomitant use in patients chronically using a strong CYP3A4 inducer.
- Strong CYP3A4 inhibitors (e.g., ketoconazole): Can increase the systemic exposure to the netupitant component of AKYNZEO. No dosage adjustment is necessary for single dose administration of AKYNZEO.
- Serotonergic drugs (SSRIs, SNRIs): Serotonin syndrome (altered mental status, autonomic instability, neuromuscular symptoms) has been described following concomitant use of 5-HT3 receptor antagonists and other serotonergic drugs. If symptoms occur, discontinue AKYNZEO and initiate supportive treatment.
Read the label’s full interactions text
7 DRUG INTERACTIONS CYP3A4 Substrates: inhibition of CYP3A4 by netupitant can result in increased plasma concentrations of the concomitant drug for 6 days after single dosage administration of AKYNZEO; avoid concomitant CYP3A4 substrates for one week, if feasible. If not avoidable, consider dose reduction of the CYP3A4 substrate ( 7.1 ) CYP3A4 Inducers (e.g., rifampin): decreased plasma concentrations of netupitant; avoid use ( 7.2 ) 7.1 Effects of AKYNZEO on Other Drugs Interaction with CYP3A4 Substrates Netupitant is a moderate inhibitor of CYP3A4. AKYNZEO should be used with caution in patients receiving concomitant medications that are primarily metabolized through CYP3A4. A single oral dose of netupitant 300 mg significantly inhibits CYP3A4 for 6 days. Avoid concomitant use of drugs that are CYP3A4 substrates for one week, if feasible. If not avoidable, consider dose reduction of CYP3A4 substrates. Dexamethasone A single oral dose of netupitant 300 mg or a single fosnetupitant infusion of 235 mg increased the systemic exposure of concomitant dexamethasone more than 2-fold on Days 2 and 4. Administer a reduced dose of dexamethasone with AKYNZEO [see Dosage and Administration ( 2.1 ), Clinical Pharmacology ( 12.3 )] . Midazolam When administered with netupitant, the systemic exposure to midazolam was significantly increased. Consider the potential effects of increased plasma concentrations of midazolam or other benzodiazepines metabolized via CYP3A4 (alprazolam, triazolam) when administering these drugs with AKYNZEO [see Clinical Pharmacology ( 12.3 )] . Chemotherapeutic Agents The systemic exposure of chemotherapy agents metabolized by CYP3A4 can increase when administered with AKYNZEO. Chemotherapy agents that are known to be metabolized by CYP3A4 include docetaxel, paclitaxel, etoposide, irinotecan, cyclophosphamide, ifosfamide, imatinib, vinorelbine, vinblastine, and vincristine [see Clinical Pharmacology ( 12.3 )] .
Excerpted — the section continues on the label. Read the full Drug Interactions section on DailyMed →
Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.
Before taking Netupitant and Palonosetron
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- There are no contraindications listed.
- Pregnancy: may cause fetal harm based on animal data.
- Breastfeeding: no data; discuss benefits and risks with your doctor.
- Under 18: safety and effectiveness have not been established.
- Older adults: side effects were similar to younger adults.
- Avoid in severe liver impairment.
- Avoid in severe kidney impairment or end-stage kidney disease.
Netupitant and Palonosetron overdose
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In an overdose, the medicine should be stopped and general supportive care and monitoring given. Because the medicine prevents vomiting, trying to induce vomiting may not work. Dialysis is unlikely to help.
What Netupitant and Palonosetron does in the body
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In a brain imaging study, netupitant crossed into the brain and occupied most NK-1 receptors for days. Occupancy was about 92% at 6 hours and about 76% at 96 hours. At higher than recommended doses, it did not prolong the QT interval (a heart rhythm measure) to a clinically relevant extent.
How your body processes Netupitant and Palonosetron
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After Akynzeo capsules are taken, both drugs are measurable within 1 hour and peak in about 4 to 5 hours. Food does not meaningfully change how much is absorbed. Both drugs spread widely through the body, and netupitant is more than 99.5% bound to proteins. Netupitant is cleared slowly, with a half-life of roughly 80 to 96 hours. It is mainly broken down by CYP3A4, and palonosetron mainly by CYP2D6.
How to store Netupitant and Palonosetron
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AKYNZEO capsules should be stored at 20 °C to 25 °C (68 °F to 77 °F); excursions permitted from 15 °C to 30 °C (59 °F to 86 °F) . Store AKYNZEO for injection in carton, protected from light at 2° to 8°C ( F to 46.
Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
Supplements & herbs that interact with Netupitant and Palonosetron
158 supplements and herbal products have documented interactions with Netupitant and Palonosetron in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 4
- Moderate · 113
- Minor · 41
Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.
Netupitant and Palonosetron: pharmacist answers to common questions
Quick, plain-English answers to the questions patients ask most about Netupitant and Palonosetron — the kind of thing our pharmacy team would talk through with you at the counter.
What is this medicine for?
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How do I take the capsule?
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What side effects should I expect?
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When should I call for help?
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Can I take my other medicines with it?
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Is it safe in pregnancy?
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Is Netupitant and Palonosetron available over the counter?
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When was Netupitant and Palonosetron first available?
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Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
More about Netupitant and Palonosetron on HelloPharmacist
Netupitant and Palonosetron forms and strengths (how it comes)
Netupitant and Palonosetron is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.
Need a version that does not list lactose, a gluten source, a dye or gelatin? Inactive ingredients differ by manufacturer: see Netupitant and Palonosetron inactive ingredients by manufacturer.
Capsule
How this form is used
- Akynzeo capsules are used with dexamethasone in adults to prevent acute and delayed nausea and vomiting from chemotherapy, including highly emetogenic chemotherapy.
- Akynzeo capsules are taken as one capsule by mouth about 1 hour before chemotherapy starts.
- Akynzeo capsules can be taken with or without food.
Netupitant and Palonosetron on the U.S. market: products, makers and brands
How Netupitant and Palonosetron appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
1 company lists 1 Netupitant and Palonosetron product record with the FDA, mostly as capsule; the earliest marketing or approval year on record is 2014. Brand names on the directory include Akynzeo; the rest are generics.
How widely Netupitant and Palonosetron is used (Medicaid data)
A general measure of how commonly Netupitant and Palonosetron is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.
Think of this as a proxy for how widely Netupitant and Palonosetron is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.
How commonly is Netupitant and Palonosetron prescribed? Of the 1,601 medications we measure, Netupitant and Palonosetron ranks #977 by Medicaid prescriptions — more than 39% of them.
Utilization by Netupitant and Palonosetron product
Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.
20 ML fosnetupitant 11.75 MG/ML / palonosetron 0.0125 MG/ML Injection Most dispensed
Summed across the 2 of 2 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 2374366
fosnetupitant 235 MG / palonosetron 0.25 MG Injection
Summed across the 1 of 1 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 2044429
netupitant 300 MG / palonosetron 0.5 MG Oral Capsule
Summed across the 1 of 2 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 1552343
Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.
Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Netupitant and Palonosetron, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 4 of 5 listed Netupitant and Palonosetron NDCs with Medicaid activity.
Compare Netupitant and Palonosetron products
A representative set of FDA-listed product records for Netupitant and Palonosetron — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Strength | Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|---|
| 💊Capsule | ||||
| NETUPITANT 300 mg/1; PALONOSETRON 0.5 mg | Oral | Helsinn Therapeutics (U.S.), Inc. | NDA | View NDC → |
Showing 1 of 1 products — FDA National Drug Code Directory. See every product, package size and price: browse all 1 Netupitant and Palonosetron NDCs →
Netupitant and Palonosetron side effects reported to the FDA (FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Netupitant and Palonosetron — a signal of what to watch for, not proof the drug caused it.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Netupitant and Palonosetron in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
Netupitant and Palonosetron FDA approval history
How Netupitant and Palonosetron went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
Netupitant and Palonosetron recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
The FDA’s enforcement reports list no Netupitant and Palonosetron recalls since July 2021.
✅No Netupitant and Palonosetron recalls on record since July 2021Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.
Netupitant and Palonosetron supply and shortage status
Whether Netupitant and Palonosetron is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
Netupitant and Palonosetron brand names
Netupitant and Palonosetron is sold under one brand name in the FDA directory — Akynzeo. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.
Who makes Netupitant and Palonosetron: manufacturers and labelers
One company lists Netupitant and Palonosetron products with the FDA. By number of product records, the largest are Helsinn Therapeutics (U.S.), Inc.. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.
Netupitant and Palonosetron drug class (RxNorm)
Netupitant and Palonosetron belongs to the Substance P/Neurokinin-1 Receptor Antagonist class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
Sources for this Netupitant and Palonosetron page
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How this page is built
HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. Helsinn Therapeutics (U.S.), Inc. is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →