Palonosetron

Palonosetron Brand Name– Aloxi

What is Palonosetron

Palonosetron is a highly selective 5-HT3 receptor antagonist indicated for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) associated with initial and repeat courses of moderately or highly emetogenic chemotherapy and for the prevention of delayed emesis following moderately emetogenic chemotherapy.

Palonosetron is also used for the prevention of post-operative nausea and vomiting (PONV).

Palonosetron (Aloxi) is available in a parenteral formulation and as an oral capsule.

Palonosetron has a long half-life (roughly 40 hours) which enhances efficacy in the treatment of delayed-CINV and allows for one-time dosing within a 7-day period.

Palonosetron’s superior efficacy in controlling delayed emesis has been demonstrated against both ondansetron and dolasetron.

However, the superiority of palonosetron in acute-CINV, as compared to ondansetron or dolasetron, has not been consistently determined.

Results from two pivotal phase III clinical trials for the prevention of PONV have demonstrated the safety and efficacy of palonosetron in producing a complete response (no emesis or use of rescue medication) for a 24-hour time period following surgery.

In July 2003, palonosetron received FDA approval for use in CINV. In February 2008, palonosetron received FDA approval for the prevention of PONV for up to 24 hours after surgery.

In August 2008, palonosetron capsules received FDA approval for the prevention of acute CINV. Palonosetron injection was FDA-approved for the prevention of acute CINV in pediatric patients >= 1 month in May 2014

Indications

  • chemotherapy-induced nausea/vomiting prophylaxis
  • post-operative nausea/vomiting (PONV) prophylaxis

For chemotherapy-induced nausea/vomiting prophylaxis (CINV prophylaxis)

for acute chemotherapy-induced nausea/vomiting (CINV) prophylaxis associated with initial and repeat courses of highly emetogenic cancer chemotherapy

Side Effects

  1. abdominal pain
  2. amblyopia
  3. anaphylactic shock
  4. anaphylactoid reactions
  5. anorexia
  6. anxiety
  7. arthralgia
  8. bradycardia
  9. bronchospasm
  10. chills
  11. constipation
  12. contact dermatitis
  13. diarrhea
  14. dizziness
  15. drowsiness
  16. dyskinesia
  17. dyspepsia
  18. dyspnea
  19. edema
  20. elevated hepatic enzymes
  21. erythema
  22. euphoria
  23. fatigue
  24. fever
  25. flatulence
  26. glycosuria
  27. headache
  28. hiccups
  29. hot flashes
  30. hyperbilirubinemia
  31. hyperglycemia
  32. hyperkalemia
  33. hypersalivation
  34. hypertension
  35. hypokalemia
  36. hypotension
  37. hypoventilation
  38. injection site reaction
  39. insomnia
  40. laryngospasm
  41. metabolic acidosis
  42. ocular irritation
  43. paresthesias
  44. pruritus
  45. QT prolongation
  46. rash
  47. serotonin syndrome
  48. sinus tachycardia
  49. thrombocytopenia
  50. tinnitus
  51. urinary retention
  52. weakness
  53. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • breast-feeding
  • dolasetron hypersensitivity
  • granisetron hypersensitivity
  • neonates
  • ondansetron hypersensitivity
  • palonosetron hypersensitivity
  • pregnancy

Interactions

  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Codeine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Tramadol
  • Alfentanil
  • Alosetron
  • Apomorphine
  • Aprepitant, Fosaprepitant
  • Artemether; Lumefantrine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzhydrocodone; Acetaminophen
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Citalopram
  • Cobicistat
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Desvenlafaxine
  • Dextromethorphan; Quinidine
  • Dichlorphenamide
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Dronedarone
  • Duloxetine
  • Elbasvir; Grazoprevir
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Escitalopram
  • Fenfluramine
  • Fentanyl
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluvoxamine
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Homatropine; Hydrocodone
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen; Oxycodone
  • Ipecac
  • Isavuconazonium
  • Isocarboxazid
  • Lasmiditan
  • Levomilnacipran
  • Levorphanol
  • Linezolid
  • Lithium
  • Meperidine
  • Meperidine; Promethazine
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methylene Blue
  • Milnacipran
  • Mirabegron
  • Mirtazapine
  • Mitotane
  • Monoamine oxidase inhibitors
  • Morphine
  • Morphine; Naltrexone
  • Nalbuphine
  • Oxycodone
  • Oxymorphone
  • Ozanimod
  • Paroxetine
  • Peginterferon Alfa-2b
  • Phenelzine
  • Quinidine
  • Remifentanil
  • Selegiline
  • Sertraline
  • Sufentanil
  • Tapentadol
  • Telotristat Ethyl
  • Tramadol
  • Tranylcypromine
  • Venlafaxine
  • Vilazodone
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