Aprepitant (Aprecap, Emend) — The Medicine for Delayed Nausea
Aprepitant is the medicine in your pack that targets nausea starting the day after chemotherapy. It works differently from ondansetron — targeting a different pathway — which is exactly why both are prescribed together.
Medically reviewed by Dr. Naresh Gundu, Medical Oncologist, MBBS (Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar) · DNB Internal Medicine (Sir Gangaram Hospital, New Delhi) · DM Medical Oncology (AIIMS) · Last reviewed September 2026
- Not a cancer treatment — Aprepitant does not treat your cancer. It prevents delayed nausea so your body can tolerate the treatment that does.
- Targets delayed nausea — Nausea that begins the day after chemotherapy is driven by a different pathway than same-day nausea. Aprepitant targets that pathway.
- Part of a combination — It works alongside ondansetron and dexamethasone, not instead of them — the combination NCCN, ASCO and ESMO recommend for high-risk regimens.
- For specific regimens only — Not every patient needs it. Your oncologist included it because your chemotherapy falls into the highly emetogenic category.
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Aprepitant (sold in India as Aprecap, also known as Emend) prevents nausea and vomiting that begins the day after chemotherapy and can last for several days. It targets a pathway — the NK1 receptor — that ondansetron does not reach. NCCN, ASCO and ESMO recommend it for highly emetogenic regimens.
What is aprepitant and why is it in my medicine pack?
Aprepitant — sold in India as Aprecap and internationally as Emend — is an NK1 receptor antagonist. It blocks a chemical called substance P, which is the main driver of nausea and vomiting in the days after chemotherapy, not the hours.
Your other anti-nausea medicine, such as ondansetron, targets a different pathway — one that controls acute nausea on treatment day. Aprepitant fills the gap that ondansetron cannot reach. That is why both are prescribed together.
It does not treat your cancer. It is there so that delayed nausea does not become severe enough to stop you eating, drinking, or completing your treatment.
Which chemotherapy regimens typically include aprepitant?
- Cisplatin-containing chemotherapy, which is classified as highly emetogenic across cancer types
- AC chemotherapy (anthracycline plus cyclophosphamide), the standard backbone for many breast cancer regimens
- Other highly emetogenic combinations that NCCN, ASCO and ESMO classify as requiring NK1 receptor antagonist cover
- Some moderately emetogenic regimens where your oncologist judges the nausea risk to be high enough
- If you are unsure why your regimen includes it, ask your oncologist or pharmacist at your next visit
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Why is aprepitant given over several days and not just once?
Chemotherapy-induced nausea has two distinct phases. The acute phase peaks in the first hours after treatment and is mainly driven by serotonin. The delayed phase begins the following day and can continue for several days — driven by substance P, not serotonin.
Ondansetron works on the acute phase. Aprepitant is designed for the delayed phase. The multi-day course is timed to maintain protective levels during the window when delayed nausea is most likely to peak.
Do not stop taking it early because you feel well — feeling well may mean it is working. Call your team the same day if you miss a dose or are unsure whether to take the next one.
Did you know?
Before NK1 receptor antagonists like aprepitant became available, delayed nausea — not same-day nausea — was the side effect most likely to lead patients to delay or decline a subsequent chemotherapy cycle.
ASCO and ESMO antiemetic guidelines now classify NK1 receptor antagonists as a required element of the antiemetic regimen for highly emetogenic chemotherapy.
Source: ASCO Clinical Practice Guideline Update: Antiemetics in Oncology
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Frequently asked questions
Is aprepitant a chemotherapy drug?
No. Aprepitant is a supportive medicine — it does not target or treat your cancer in any way. Its only purpose is to prevent the delayed nausea and vomiting that certain chemotherapy regimens cause. Many people find it in their pack without a clear explanation of what it is for. It is there to protect your quality of life and your ability to continue treatment, not to add to your cancer therapy.
I already have ondansetron. Why do I need aprepitant as well?
Because they target completely different pathways. Ondansetron blocks serotonin receptors and works mainly in the first hours after chemotherapy. Aprepitant blocks NK1 receptors and works mainly in the days that follow. Neither covers the other's window. The combination of both — alongside dexamethasone in most regimens — is what NCCN, ASCO and ESMO recommend for highly emetogenic chemotherapy, because no single medicine covers both phases.
Why does my regimen include aprepitant but a friend on chemotherapy does not have it?
Not every chemotherapy regimen carries the same nausea risk. Aprepitant is specifically recommended for highly emetogenic regimens — those where severe nausea would be expected in a large proportion of patients without antiemetics. If your friend is on a different regimen, or one with a lower emetogenic classification, the guidelines may not require it. The decision is based on the specific medicines in your regimen, not on your cancer type.
Can I skip aprepitant on a day I feel fine?
No — aprepitant is preventive, not something you take after nausea starts. It needs to be taken on the schedule your oncologist and pharmacist set, even when you feel well, because feeling well may be a sign that it is working. If you have missed a dose or are unsure whether to take the next one, call your treating team the same day rather than deciding on your own.
Does aprepitant interact with other medicines?
Yes, and this matters. Aprepitant is known to interact with several medicines including some steroids, blood thinners, and other drugs processed by the liver. Your oncologist chose your antiemetic regimen with those interactions already in mind. Before each cycle, tell your team about every medicine you are taking — prescription, over the counter, herbal, and Ayurvedic — so interactions can be checked and managed.
What side effects should I tell my team about while taking aprepitant?
Tell your team about any new symptom, including hiccups that do not settle, unusual fatigue, or digestive changes. Because aprepitant is taken alongside several other medicines, it can be hard to know which is causing what — and that is exactly why your team needs to hear about any new symptom rather than you attributing it to chemotherapy alone and waiting.
My pack says Aprecap, not Emend. Is this the same medicine?
Yes. Aprecap is a brand of aprepitant manufactured for the Indian market. Emend is the same active molecule under a different brand name used internationally. Both contain aprepitant. If your prescription says either brand name or the generic name aprepitant, you are being given the same medicine. If you have any doubt about what is in your pack, show it to your oncologist or pharmacist.
What should I do if I vomit shortly after taking an aprepitant tablet?
Call your treating team or the CION helpline the same day. Do not take an additional tablet on your own judgment — whether to repeat a dose is a clinical decision that depends on timing and what else you have taken. Your team will advise you on that day and whether anything needs to be adjusted before your next cycle.
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