palonosetron

palonosetron

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

Aloxi

(trade name)

Classification

Therapeutic: antiemetics
Pharmacologic: five ht3 antagonists

Pregnancy Category: B

Indications

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).

Action

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.

Pharmacokinetics

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

ROUTE	ONSET	PEAK	DURATION
IV	within 30 min	unknown	7 days
PO	within 1 hr	unknown	7 days

Contraindications/Precautions

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

Gastrointestinal

• constipation
• diarrhea

Interactions

Drug-Drug interaction

None significant.

Route/Dosage

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)

Implementation

• 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.