Palonosetron

(pal-on-ah-suh-tron)

Trade/other name(s): Aloxi

Why would this drug be used?

Palonosetron is an anti-nausea medicine, which is used to prevent nausea and vomiting from chemotherapy. It is also used to prevent nausea and vomiting after surgery (due to the anesthesia).

How does this drug work?

Palonosetron is part of a general class of drugs called serotonin antagonists. It blocks two pathways of serotonin release to help prevent chemotherapy-related nausea and vomiting. It binds to the serotonin receptors in the gastrointestinal tract (lining of the intestines), to keep the vomiting center in the brain from being stimulated. In addition, it responds to high levels of serotonin released after chemotherapy injures the cells lining the stomach. This helps to decrease the chance of delayed nausea and vomiting after chemotherapy.

Before taking this medicine

Tell your doctor…

• If you are allergic to anything, including medicines, dyes, additives, or foods.
• If you have an abnormal heart rhythm, heart block, heart failure, or any problem with the heart's electrical system. Palonosetron can slow down the heart's electrical impulses and make these problems worse.
• If you have low potassium or low magnesium, or if you are taking medicines such as diuretics ("water pills") that may cause your potassium or magnesium levels to drop. Palonosetron can slow down the heart's electrical impulses and these problems may make it more dangerous.
• If you have taken chemotherapy drugs that can damage the heart, such as daunorubicin, doxorubicin, epirubicin, or idarubicin. These medicines may worsen the effects on the heart.
• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. It is not known if this drug causes birth defects or other problems.
• If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Medicines that make you urinate more (diuretics or "water pills") may worsen electrical problems with the heart by lowering your potassium and magnesium levels. Medicines that are used to help irregular heartbeat may worsen the effect of palonosetron on the heart's electrical system. Many drugs that are used for mental health conditions (certain antidepressants, antipsychotics, and sedatives) can cause electrical problems in the heart that may be worsened by palonosetron.

Check with your doctor, nurse, or pharmacist about whether any of the medicines, vitamins, herbs, and supplements you are taking can cause problems with palonosetron.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Palonosetron can either be given as an injection or taken as a capsule.

As an injection, it is given into a vein (IV) about 30 minutes before your chemotherapy. If you are having surgery, it is given just before you get anesthesia.

As a capsule, it is taken about one hour before the start of chemotherapy. It can be taken with or without food. The dose (0.5 mg) is the same for all adults.

Store this drug in a tightly closed container away from light, heat, and moisture. Keep out of the reach of children and pets.

Precautions

Palonosetron can cause changes in the heart's rhythm, some of which can be dangerous. Get emergency help if you have irregular heart beat, blue nail beds or skin, gasping for breath, or seizure.

Very rarely, this drug can cause a severe allergic reaction. If you notice hives (skin welts), itching, dizziness, trouble breathing or swallowing, or swelling of the face, eyes, or mouth, get emergency help.

Possible side effects

Should you have any of the following side effects, talk to your doctor or nurse. They can help you understand these side effects and help you deal with them.

Common

• headache
• constipation

Rare

• dizziness
• diarrhea
• fatigue
• abdominal pain
• trouble sleeping
• increased or decreased blood pressure
• irregular heart beat*
• slow or fast heart rate
• stomach area pain
• changes in the electrical impulses in the heart, which can be dangerous*
• rash or itching
• serious allergic reaction*

*See the "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 2003.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.