II. Indications
- Prevention of Postoperative Nausea and Vomiting
-
Chemotherapy associated Nausea
- Not effective in treating Nausea after it occurs
- Most effective in preventing delayed Emesis
- Longer Half-Life (>40 hours) and higher 5-HT affinity than other 5HT3 Antagonists
III. Mechanism
- Blocks peripheral and central 5HT3 receptors
- Peripheral 5HT3 receptors at vagal nerve terminals
- Central 5HT3 receptors at ChemoreceptorTrigger Zone in Medulla (area postrema controls Vomiting)
IV. Adverse Effects
V. Dosing: Palonosetron (Aloxi)
- Precautions
- Do NOT repeat dose more than once weekly
- Prevention of Nausea with Chemotherapy
- Adult: 0.25 mg IV over 30 seconds, given 30 min before Chemotherapy
- Child: 20 mcg/kg up to 1.5 mg IV over 15 min, given 30 min before Chemotherapy
- Prevention of Surgery Related Nausea
- Give 0.075 mg IV over 10 seconds, before Anesthesia
VI. Dosing: Palonosetron AND Netupitant (Akynzeo)
- Palonosetron is combined with the NK1 Antagonist Netupitant (Akynzeo)
- See Netupitant
- Pregnancy Category C
- Avoid in severe Chronic Kidney Disease or hepatic dysfunction
- Prevention of Nausea with Chemotherapy (adults only)
- Typically combined with Dexamethasone
- Capsules: 0.5 mg Palonosetron AND 300 mg Netupitant
- Take 1 capsule orally 1 hour prior to Chemotherapy
- Injection: 0.25 mg Palonosetron AND 235 mg fosNetupitant per vial
- Inject 1 vial in 50 ml IV over 30 minutes prior to Chemotherapy
VII. Safety
- Pregnancy Category B
- Unknown safety in Lactation
VIII. Resources
- Palonosetron (DailyMed)
IX. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- (2004) Med Lett Drugs Ther 46(1179): 27-8 [PubMed]
- Siddiqui (2004) Drugs 64(10):1125-32 +PMID: 15139789 [PubMed]