palonosetron hydrochloride


Pharmacologic class: Selective serotonin subtype 3 (5-HT3) receptor antagonist

Therapeutic class: Antiemetic

Pregnancy risk category B


Selectively binds to and antagonizes 5-HT3 receptors on vagal nerve terminals and in chemoreceptor trigger zone. This action blocks serotonin release, reducing the vomiting reflex.


Solution for injection: 0.25 mg (free base) in 5-ml single-use vial

Indications and dosages

To prevent nausea and vomiting caused by cancer chemotherapy

Adults: 0.25 mg I.V. as a single dose 30 minutes before chemotherapy. Repeated doses within 7 days aren't recommended.

To prevent postoperative nausea and vomiting

Adults: 0.075 mg I.V. as a single dose given over 10 seconds immediately before anesthesia induction


• Hypersensitivity to drug or its components


Use cautiously in:

• hypersensitivity to other 5-HT3 receptor antagonists

• diabetes mellitus, hepatic dysfunction

• pregnant or breastfeeding patients

• children.


• Flush I.V. line with normal saline solution before and after giving.

• Deliver into I.V. line over 30 seconds. Don't mix with other drugs.

Adverse reactions

CNS: headache, fatigue, insomnia, dizziness, anxiety

CV: hypotension, vein discoloration and distention, nonsustained tachycardia, bradycardia

GI: constipation, diarrhea, abdominal pain, anorexia

GU: glycosuria

Metabolic: fluctuating electrolyte levels, hyperglycemia, metabolic acidosis, hyperkalemia

Musculoskeletal: joint pain

Other: fever, flulike symptoms


Drug-diagnostic tests: Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood and urine glucose, potassium: increased levels

Patient monitoring

• Monitor vital signs and ECG. Watch closely for tachycardia, bradycardia, and hypotension.

• Watch electrolyte levels for fluctuations (especially hyperkalemia and metabolic acidosis).

• Evaluate temperature. Stay alert for flulike symptoms.

• Closely monitor blood and urine glucose levels in diabetic patients. Stay alert for hyperglycemia.

Patient teaching

• Explain that drug helps prevent nausea and vomiting caused by chemotherapy.

• Teach patient to recognize and report signs and symptoms of hyperkalemia and metabolic acidosis.

• Advise patient to report flulike symptoms.

• Instruct diabetic patient to closely watch blood and urine glucose levels.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


(pa-lone-o-se-tron) ,


(trade name)


Therapeutic: antiemetics
Pharmacologic: five ht3 antagonists
Pregnancy Category: B


Prevention of acute and delayed nausea and vomiting caused by initial or repeat courses of moderate or highly emetogenic chemotherapy (intravenous).Prevention of acute nausea and vomiting caused by initial or repeat courses of moderately emetogenic chemotherapy (oral).Prevention of postoperative nausea and vomiting (PONV) for up to 24 hr after surgery (intravenous).


Blocks the effects of serotonin at receptor sites (selective antagonist) located in vagal nerve terminals and in the chemoreceptor trigger zones in the CNS.

Therapeutic effects

Decreased incidence and severity of nausea and vomiting following emetogenic chemotherapy or surgery.


Absorption: IV administration results in complete bioavailability; oral bioavailability = 97%.
Distribution: Unknown.
Metabolism and Excretion: 50% metabolized; 40% excreted unchanged in urine.
Half-life: 40 hr.

Time/action profile

IVwithin 30 minunknown7 days
POwithin 1 hrunknown7 days


Contraindicated in: Hypersensitivity; cross sensitivity with other 5-HT3 antagonists may occur; Lactation: Lactation.
Use Cautiously in: Obstetric / Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache


  • constipation
  • diarrhea


Drug-Drug interaction

None significant.


Intravenous (Adults) Prevention of chemotherapy-induced nausea/vomiting—0.25 mg 30 min before start of chemotherapy; Prevention of PONV—0.075 mg given immediately before induction of anesthesia.
Oral (Adults) 0.5 mg given 1 hr before start of chemotherapy.

Availability (generic available)

Solution for IV injection: 0.05 mg/mL
Capsules: 0.5 mg

Nursing implications

Nursing assessment

  • Assess patient for nausea, vomiting, abdominal distention, and bowel sounds prior to and following administration.
  • Lab Test Considerations: May cause transient ↑ in serum bilirubin, AST, and ALT levels.

Potential Nursing Diagnoses

Imbalanced nutrition: less than body requirements (Indications)
Diarrhea (Side Effects)
Constipation (Side Effects)


  • First dose is administered prior to emetogenic event.
    • Repeated dose within a 7-day period is not recommended.
  • Oral: May be administered with or without food 1 hr prior to the start of chemotherapy.
  • Intravenous Administration
  • pH: 4.5–5.5.
  • Administer dose undiluted 30 min prior to chemotherapy or immediately prior to the induction of anesthesia. Flush line prior to and after administration with 0.9% NaCl. Do not administer solutions that are discolored or contain particulate matter.
  • Concentration: 0.05 mg/mL.
  • Rate: Administer over 30 seconds for chemotherapy and over 10 seconds for postoperative nausea and vomiting.
  • Syringe Compatibility: dexamethasone
  • Y-Site Compatibility: alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B liposome, ampicillin, ampicillin/sulbactam, atracurium, atropine, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium acetate, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, dantrolene, daptomycin, daunorubicin, dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxacurium, doxorubicin hydrochloride, droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, eptifibitide, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, gemcitabine, gentamicin, glycopyrrolate, haloperidol, heparin, hydralazine, hydrocortisone, hydromorphone, idarubicin, ifosfamide, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methotrexate, methyldopate, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, mitomycin, mitoxantrone, morphine, nalbuphine, naloxone, neostigmine, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxaliplatin, oxytocin, paclitaxel, pamidronate, pancuronium, pentazocine, phenobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate, sodium bicarbonate, sodium phosphates, streptozocin, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, topotecan, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, zidovudine
  • Y-Site Incompatibility: acyclovir, allopurinol, amphotericin B colloidal, diazepam, doxycycline, ganciclovir, imipenem/cilastatin, methylprednisolone, minocycline, nafcillin, pantoprazole, pentamidine, pentobarbital, phenytoin, thiopental

Patient/Family Teaching

  • Inform patient of purpose of medication.
  • Advise patient to notify health care professional if nausea or vomiting occur.

Evaluation/Desired Outcomes

  • Prevention of nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy or surgery.
Drug Guide, © 2015 Farlex and Partners
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The Group's revenue increased overall primarily due to the significant growth of the anticancer agent Lenvima mainly accompanying the acquisition of approval for use in the treatment of hepatocellular carcinoma in Japan, as well as the steady growth of fully human anti-TNF-a monoclonal antibody Humira and antiepileptic agent Fycompa, absorbing the impact of drug pricing revision in Japan and the launch of generic versions of antiemetic agent Aloxi in the United States.
Ciriello noted that the acquisition of MGI gave Eisai access to Aloxi, MGI's most important drug.
M2 PHARMA-March 28, 2018-Teva Launches Generic Version of Aloxi in US
TOKYO, Jan 18, 2018 - (JCN Newswire) - Eisai has announced today that the United States Court of Appeals for the Federal Circuit, in the patent infringement lawsuit for antiemetic agent ALOXI (palonosetron hydrochloride) injection brought by Helsinn Healthcare S.A.
Helsinn Group has signed amendments to its licensing and distribution agreements with Mundipharma for anti-emetic prophylactic agents ALOXI and AKYNZEO in order to expand the collaboration to cover additional markets, the company announced on Tuesday.
As part of the revised agreement, Eisai and Helsinn will continue to co-promote ALOXI (palonosetron HCl) injection in the US for CINV.
health regulator`s approval to start selling a generic version of anti-nausea injection Aloxi.
Accessed November 1, 2011.Generic Drug News: Roche Files Lawsuit To Block Low-Cost Version of Anti-Nausea Drug Aloxi. July 13, 2011.
Currently STA markets two world leading cancer and cancer supportive care therapies, ABRAXANE and ALOXI (palonosetron) respectively.