Comprehensive medication guide to Emend including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$40–$60 copay for generic aprepitant; covered by approximately 87% of insurance plans at Tier 2–3; prior authorization may be required for brand Emend when a generic is available.
Estimated Cash Pricing
$32–$170 retail for generic aprepitant depending on strength; as low as $32–$46 with GoodRx or SingleCare coupons for a single capsule; brand Emend Tripack can retail over $960 without a coupon.
Medfinder Findability Score
72/100
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Emend (aprepitant) is a prescription antiemetic medication used to prevent nausea and vomiting associated with chemotherapy and surgery. It was the first neurokinin-1 (NK1) receptor antagonist approved by the FDA, receiving initial approval in 2003. It is manufactured by Merck Sharp & Dohme and is also widely available as generic aprepitant from multiple manufacturers.
Emend is FDA-approved for prevention of acute and delayed nausea and vomiting associated with highly emetogenic cancer chemotherapy (HEC) including high-dose cisplatin, and moderately emetogenic cancer chemotherapy (MEC). The 40 mg capsule is also approved for prevention of postoperative nausea and vomiting (PONV). Emend is available as 40 mg, 80 mg, and 125 mg capsules for adults and older children, and as a powder for oral suspension for patients as young as 6 months.
Emend is not a controlled substance and has no abuse potential. It does not treat nausea that has already started—it must be taken before chemotherapy to be effective. It is typically prescribed as part of a combination antiemetic regimen with a 5-HT3 antagonist (ondansetron or granisetron) and a corticosteroid (dexamethasone).
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Emend is a selective high-affinity antagonist of the human neurokinin-1 (NK1) receptor. Substance P, an 11-amino-acid neuropeptide, is the natural ligand for NK1 receptors in the brain's vomiting center. Chemotherapy drugs trigger the release of substance P, which binds to NK1 receptors and initiates the vomiting reflex. Aprepitant blocks substance P from binding to these receptors, preventing the vomiting signal from being transmitted.
Aprepitant crosses the blood-brain barrier, confirmed by PET imaging studies, allowing it to act directly on NK1 receptors in the central nervous system. It has a plasma half-life of 9–13 hours and is primarily metabolized by CYP3A4 in the liver. Aprepitant acts as a moderate inhibitor of CYP3A4 during its short course and as an inducer of both CYP3A4 and CYP2C9 afterward, which drives its extensive drug interaction profile.
The NK1 pathway targeted by aprepitant is particularly important during the delayed phase of chemotherapy-induced nausea (days 2–5 after treatment)—the phase that older antiemetics like ondansetron address less effectively. Research has confirmed that aprepitant acts synergistically with 5-HT3 receptor antagonists, providing complementary coverage across both acute and delayed phases.
40 mg — capsule
For prevention of postoperative nausea and vomiting (PONV); taken within 3 hours before anesthesia induction
80 mg — capsule
Days 2 and 3 of the CINV regimen; taken in the morning
125 mg — capsule
Day 1 of the CINV regimen; taken 1 hour before chemotherapy
125 mg/pouch (25 mg/mL when reconstituted) — powder for oral suspension
For patients 6 months and older who cannot swallow capsules; prepared by a healthcare provider
150 mg — IV solution (fosaprepitant)
Intravenous prodrug of aprepitant; administered on Day 1 only, 30 minutes before chemotherapy
Emend is not on the FDA's active drug shortage list in 2026. Generic aprepitant is produced by multiple manufacturers, significantly improving national supply. However, retail pharmacy stock remains uneven—Emend and generic aprepitant are used in short cycles around chemotherapy, so many pharmacies keep only limited quantities on hand. Finding specific strengths, particularly the 125 mg dose or the oral suspension formulation, can still require searching multiple locations.
The most efficient way to find Emend in stock near you is to use medfinder. medfinder calls pharmacies near your zip code to check which ones can fill your prescription, then texts you the results—so you can plan ahead before your chemotherapy cycle without spending hours on hold. Cancer center in-house pharmacies and specialty pharmacies typically have the most reliable stock.
Emend (aprepitant) is not a controlled substance and can be prescribed by any licensed prescriber. In practice, it is almost always prescribed as part of a structured chemotherapy or surgical protocol. No special DEA registration is required beyond a standard prescribing license.
Medical Oncologists: Primary prescribers for CINV prevention in chemotherapy protocols
Hematologists: For blood cancer patients on emetogenic chemotherapy regimens
Pediatric Oncologists: For pediatric patients 6 months+ (oral suspension) or 12 years+ (capsules)
Anesthesiologists / CRNAs: For PONV prevention (40 mg dose) in surgical settings
Nurse Practitioners and Physician Assistants: NPs and PAs in oncology settings commonly prescribe supportive care medications including aprepitant
Telehealth availability is limited for initial oncology care but may be available for established patients needing prescription refills or supportive care management. Patients already established with an oncology team should ask about telehealth follow-up options. First-time cancer diagnoses and initial treatment planning typically require in-person visits.
No. Emend (aprepitant) is not a controlled substance and is not scheduled by the Drug Enforcement Administration (DEA). It has no recognized abuse potential, does not cause dependence, and does not produce euphoria or other effects associated with controlled substances. Aprepitant can be prescribed and refilled like any standard prescription medication, without special DEA registration requirements or refill restrictions based on scheduling. Electronic prescriptions and call-in orders are permitted without the restrictions that apply to Schedule II-V drugs.
Emend is generally well-tolerated. The most commonly reported side effects include:
Fatigue or tiredness
Diarrhea
Hiccups
Loss of appetite
Abdominal pain or discomfort
Headache and dizziness
Constipation
Anaphylaxis / severe allergic reaction: Hives, difficulty breathing, swelling of face, lips, tongue, or throat — call 911
Stevens-Johnson syndrome / toxic epidermal necrolysis: Blistering, peeling, or sores — stop medication immediately and seek care
Ifosfamide-induced neurotoxicity: Confusion, agitation, or behavioral changes in patients receiving ifosfamide — notify care team immediately
Blood clotting changes: Emend reduces warfarin levels; monitor for unusual bruising or signs of clotting in warfarin users
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Rolapitant (Varubi)
NK1 receptor antagonist with 180-hour half-life; single dose per cycle; no CYP3A4 interaction (unlike aprepitant), so no dexamethasone dose adjustment required
Akynzeo (netupitant-palonosetron / NEPA)
Fixed-dose combination of NK1 + 5-HT3 antagonists in a single capsule; some studies show superior delayed-phase CINV control vs. aprepitant-based regimens
Fosaprepitant (Emend for Injection)
IV prodrug of aprepitant; 150 mg on Day 1 only; eliminates retail pharmacy search; typically administered at infusion center
Ondansetron (Zofran)
5-HT3 receptor antagonist; highly effective for acute nausea; widely stocked at all pharmacies; generic is inexpensive; less effective for delayed nausea without an NK1 antagonist
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Pimozide (Orap)
majorAbsolutely contraindicated. Aprepitant significantly increases pimozide blood levels via CYP3A4 inhibition, risking QT prolongation and potentially fatal arrhythmias.
Warfarin (Coumadin)
majorAprepitant induces CYP2C9, decreasing warfarin levels and lowering INR. INR must be monitored 7-10 days after each aprepitant course. Risk of blood clots if not monitored.
Hormonal contraceptives
majorAprepitant reduces the effectiveness of hormonal birth control (pills, patches, rings, implants, injections) by inducing their metabolism. Use non-hormonal backup methods during treatment and for 28 days after.
Rifampin
majorStrong CYP3A4 inducer that reduces aprepitant AUC by approximately 11-fold, making Emend much less effective. Avoid combination.
Dexamethasone
moderateAprepitant inhibits CYP3A4, increasing dexamethasone blood levels by ~50% (oral) or ~25% (IV). Standard protocols reduce dexamethasone dose accordingly.
Benzodiazepines (midazolam, alprazolam, triazolam)
moderateAprepitant increases blood levels of CYP3A4-metabolized benzodiazepines, potentially increasing sedation, confusion, and respiratory depression.
Ifosfamide
majorAprepitant induces CYP3A4 metabolism of ifosfamide toward neurotoxic metabolites. Behavioral changes and neurotoxicity have been reported in pediatric patients. Close monitoring required.
St. John's Wort
moderateCYP3A4 inducer that dramatically reduces aprepitant blood levels, significantly reducing its antiemetic effectiveness. Avoid during all chemotherapy treatment.
Ketoconazole and strong CYP3A4 inhibitors
moderateSignificantly increase aprepitant blood levels, increasing risk of side effects. Use with caution.
Diltiazem
moderateMutual CYP3A4 interaction: diltiazem increases aprepitant levels ~2-fold and vice versa. Monitor blood pressure and heart rate.
Emend (aprepitant) has been a cornerstone of chemotherapy-induced nausea prevention since its FDA approval in 2003. For patients receiving highly emetogenic chemotherapy, it provides uniquely effective protection against delayed nausea—the phase most likely to impact treatment tolerance and quality of life. Generic aprepitant is now widely available from multiple manufacturers at substantially lower cost than the original brand.
The most important things to know: take it on schedule (including Days 2 and 3 even if you feel fine), be aware of its interactions with warfarin and hormonal contraceptives, and always tell your care team about every medication and supplement you take. And if you're having trouble finding it before your next chemo cycle, don't wait—reach out to your oncology team or use the tools available to find it quickly.
If you're struggling to locate Emend at a pharmacy near you, medfinder can call pharmacies in your area and text you which ones have it in stock—so you can focus on your treatment, not a pharmacy search.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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