Treatment Name: Palonosetron (Aloxi®)
Palonosetron (Aloxi®) is a Supportive Care Therapy to prevent Nausea and VomitingWe've made it easy for you to learn more. Click the orange links and we'll show you extra information. Click this one to give it a try.
How does palonosetron (Aloxi®) work?
Palonosetron (Aloxi®) is designed to block certain receptors in your body that control nausea and vomiting. These are called “serotonin type” (5-HT) receptors. 5-HT3 is a specific serotonin receptor that is located mostly in your brain, nervous system, and intestines. When serotonin is released in the intestines and brain and binds to serotonin receptors, the body can trigger vomiting. Palonosetron binds to 5HT3 receptors instead of serotonin, and thereby stops the reflex to vomit.
Goals of therapy:
Palonosetron (Aloxi®) is given to prevent nausea and vomiting from chemotherapy and is commonly given on a scheduled basis, 30 – 60 minutes before chemotherapy. Palonosetron is not usually used to treat active nausea and vomiting. When a medicine is given to prevent nausea and vomiting, it is known as prophylaxis, or prophylactic therapy.
Schedule
Palonosetron (Aloxi®) is usually given in an outpatient infusion center, approximately 30 – 60 minutes before chemotherapy to prevent nausea and vomiting. For chemotherapy regimens associated with a high rate of nausea or vomiting, palonosetron is commonly given with one or two additional preventative anti-nausea medications, such as dexamethasone (Decadron®) and aprepitant (Emend®).
- Palonosetron 0.25 mg intravenous push (I.V. push) over 30 seconds on Day 1 of chemotherapy
Palonosetron is a long acting medication that has a duration of action of 3 to 5 days. In most instances, only one dose needs to be given to prevent nausea and vomiting from chemotherapy. However, in some cases where chemotherapy is given for more than three days in a row, a second dose of palonosetron may be given.
Palonosetron is typically given for chemotherapy regimens that have a moderate to high risk of nausea and vomiting. Duration of therapy depends upon response, tolerability, and number of cycles chemotherapy prescribed.
Side Effects
In the prescribing label information (palonosetron package insert), the most commonly reported side effects from palonosetron (Aloxi®) are shown here. The exact percentages of patients that will experience palonosetron side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials:
- Headache (9%)
- Constipation (5%)
- Diarrhea (1%)
- Dizziness (1%)
- Fatigue (<1%)
- Stomach pain (<1%)
- Trouble sleeping (<1%)
Palonosetron should be used in pregnant women only if the potential benefits to the mother outweigh the potential risks to the unborn baby.
There is a small risk of serotonin syndrome associated with the use of palonosetron. Most reports were from patients also receiving medications that can increase serotonin such as certain antidepressants known as SSRIs, or SNRIs, mirtazapine, tramadol, and others.
Very rarely, palonosetron may cause hives, face swelling, trouble breathing, or chest pain. Tell your nurse and doctor if you experience any of these symptoms after receiving palonosetron.
Side effect videos 
Nausea and Vomiting
Constipation
Nausea and Vomiting
Constipation
Monitoring
How often is monitoring needed?
Labs (blood tests) typically do not need to be monitored for palonosetron, but may be checked before each chemotherapy treatment.
How often is imaging needed?
An electrocardiogram (“ECG” or “EKG”) may be need to be done to check your heart rhythm as palonosetron can prolong the QTc interval and cause a heart arrhythmia, especially if you are on other medications that can also prolong the QTc interval. However, in one trial palonosteron had no significant effect on the QTc interval.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue palonosetron as planned or switch to an alternative therapy.
Questions to Ask Your...
A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!
Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.
Doctor
Nurse
PharmacistChemoExperts Tips
- Do not take ondansetron (Zofran®) at home for 3 days (72 hours) after receiving palonosetron. Ondansetron works in a similar way to palonosetron and since palonosetron lasts for about 3 days in the body, taking ondansetron during this time may cause more side effects without helping with nausea. During this time period, use an alternative anti-nausea medication such as prochlorperazine (Compazine®), promethazine (Phenergan®), lorazepam (Ativan®), or another medication as prescribed by your doctor. If you have nausea or vomiting after receiving palonosetron, talk with your doctor or pharmacist to figure out the best time to resume ondansetron treatment
- Those with a history of migraines or chronic headaches may be at higher risk for headaches from palonosetron. If your headaches noticeably worsen shortly after taking palonosetron, contact your doctor to see if other preventative anti-nausea medicines with a lower risk of headache may be better for you to receive
- If you are experiencing constipation from palonosetron, over-the-counter laxatives and stool softeners can help. Work with your doctor or pharmacist on a plan to keep your bowel movements regular
- Although the potential for significant drug interactions with palonosetron appears to be low, a pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
Patient Assistance & Co-payment Coverage
References
Palonosetron prescribing label information (Aloxi® package insert).
Created: September 3, 2017 Updated: November 13, 2018
What is Nausea and Vomiting?
Nausea is the sensation that there is a need to vomit. Nausea can be acute and short-lived, or it can be prolonged. When prolonged, it is a debilitating symptom. Nausea (and vomiting) can be psychological or physical in origin.
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.
×What is an I.V. Push?
An intravenous medication that is usually prepared in a syringe and infused by vein over a short period of time, such as 15 minutes or less×Effect of palonosetron in QTc interval
Morganroth J, et al. Effect of single doses of IV palonosetron, up to 2.25 mg, on the QTc interval duration: a double-blind, randomized, parallel group study in healthy volunteers. Support Care Cancer. 2016;24:621-627.
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