Palonosetron

Class: 5-HT3 Receptor Antagonists
ATC Class: A04AA
VA Class: GA605
Chemical Name: (S)-2-[(3S)-Quinuclidin-3-yl]-2,3,3a,4,5,6-hexahydro-1H-benzo[de]isoquinolin-1-one hydrochloride
Molecular Formula: C₁₉H₂₄N₂O•HCl
CAS Number: 135729-62-3
Brands: Aloxi

Medically reviewed by Drugs.com on Feb 22, 2022. Written by ASHP.

Introduction

Antiemetic; selective, second-generation inhibitor of type 3 serotonergic (5-HT₃) receptors.

Uses for Palonosetron

Cancer Chemotherapy-induced Nausea and Vomiting

Palonosetron is used IV for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy.

Palonosetron also is used IV for the prevention of acute nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy.

For prevention of nausea and vomiting associated with highlyemetogenic chemotherapy regimens (including an anthracycline plus cyclophosphamide), ASCO recommends a 3-drug antiemetic regimen consisting of an NK₁ receptor antagonist (e.g., either oral aprepitant or IV fosaprepitant), a 5-HT₃ receptor antagonist (e.g., dolasetron, granisetron, ondansetron, palonosetron), and dexamethasone. ASCO states that fixed-combination netupitant and palonosetron plus dexamethasone is an additional treatment option.

For moderatelyemetogenic chemotherapy regimens, ASCO recommends a 2-drug antiemetic regimen preferably consisting of palonosetron and dexamethasone. If palonosetron is not available, a first-generation 5-HT₃ receptor antagonist (preferably granisetron or ondansetron) may be substituted. Limited evidence suggests that aprepitant may be added to this regimen; in such cases, use of any 5-HT₃ receptor antagonist is appropriate.

For chemotherapy regimens with a low emetogenic risk, ASCO recommends administration of a single dose of dexamethasone prior to chemotherapy.

For chemotherapy regimens with minimal emetogenic risk, ASCO states that routine antiemetic administration is not necessary.

Postoperative Nausea and Vomiting

Palonosetron is used IV for the prevention of postoperative nausea and vomiting for up to 24 hours following surgery. Efficacy of the drug beyond 24 hours not demonstrated.

Routine prophylaxis not recommended in patients in whom there is little expectation that nausea and/or vomiting will occur postoperatively.

Recommended for patients in whom nausea and/or vomiting must be avoided postoperatively, even when anticipated incidence is low.

Palonosetron Dosage and Administration

Administration

IV Administration

Administer IV. Visually inspect solution for particulate matter and discoloration prior to administration.

Do not mix with other drugs; flush tubing with 0.9% sodium chloride injection before and after administration.

Rate of Administration

For prevention of cancer chemotherapy-induced nausea and vomiting in adults, administer IV ov...