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Palonosetron

    Brands

    DEA Class; Rx

    Common Brand Names; Aloxi

    • Antiemetics, Selective 5-HT3 Antagonist

    Parenteral 5-HT3 receptor antagonist
    Used for prevention of post-operative nausea and vomiting and acute and delayed chemotherapy-induced nausea and vomiting
    Long half-life allows for one-time dosing within a 7-day period for CINV

    Indicated for prevention of acute N/V associated with moderately or highly emetogenic chemotherapeutic agents; also for delayed N/V associated moderately emetogenic chemotherapeutic agents

    Indicated for prevention of PONV following surgery; efficacy beyond 24 hr has not been demonstrated

    Hypersensitivity to drug, other selective 5-HT3 receptor antagonists (eg, granisetron), or any other component

    Coadministration with apomorphine; combination reported to cause profound hypotension and loss of consciousness

    • Prolonged QT interval (up to 5%)
    • Anxiety
    • Dizziness
    • Headache
    • Weakness
    • Constipation
    • Diarrhea
    • Prutitus
    • Hyperkalemia
    • LFT’s increased
    • First degree atrioventricular block
    • Second degree atrioventricular block

    Use caution in patients with congenital long QT syndrome or other factors that may prolong QT interval

    Serotonin syndrome reported with 5-HT3 receptor antagonists alone but particularly with concomitant use of serotonergic drugs including SSRIs, SNRIs, MAO inhibitors, lithium, tramadol, methylene blue IV, and mirtazapine

    Hypersensitivity reactions, including anaphylaxis, reported with or without known hypersensitivity to other 5-HT3 receptor antagonists

    For chemotherapy, the drug should follow a specific schedule, and not be administered as needed

    Drug is not recommended in PONV if expectation for nausea or vomiting is very small; use only if the expectation is low or it is essential to avoid nausea and vomiting in the postoperative period

    There are no available data on palonosetron HCl use in pregnant women to inform a drug-associated risk

    There are no data on presence in human milk, effects on breastfed infant, or on milk production

    Adults

    0.25 mg IV or 0.5 mg PO as a single dose.

    Geriatric

    0.25 mg IV or 0.5 mg PO as a single dose.

    Adolescents

    20 mcg/kg/dose IV (Max: 1.5 mg/dose).

    Children

    20 mcg/kg/dose IV (Max: 1.5 mg/dose).

    Infants

    20 mcg/kg/dose IV.

    Neonates

    Safety and efficacy have not been established.

    Palonosetron hydrochloride

    injectable solution: single-use vials

    • 0.05mg/mL