Palonosetron Fresenius Kabi (Palonosetron)

Palonosetron is a selective 5‑HT3 receptor antagonist indicated for the prevention of chemotherapy‑induced and postoperative nausea and vomiting.

• Chemotherapy‑induced nausea and vomiting (CINV): helps reduce the incidence of acute and delayed nausea and vomiting following highly emetogenic chemotherapy.
• Post‑operative nausea and vomiting (PONV): reduces the frequency and severity of nausea and vomiting after general anesthesia.
• Radiotherapy‑induced nausea and vomiting: provides prophylaxis against nausea and vomiting associated with radiation treatment.

• Palonosetron binds with high affinity to the serotonin 5‑HT3 receptors located on vagal afferent nerves in the gastrointestinal tract and the chemoreceptor trigger zone. By blocking these receptors, it prevents serotonin‑mediated activation of the vomiting centre in the brain, thereby inhibiting both acute and delayed emetic responses.

Palonosetron is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Headache
• Constipation
• Fatigue
• Diarrhoea
• Dizziness

Serious or Rare Side Effects

• QT interval prolongation
• Severe hypersensitivity reactions (anaphylaxis, angio‑edema)
• Serotonin syndrome (when combined with other serotonergic agents)
• Cardiac arrhythmias
• Severe hypotension

When using Palonosetron, clinicians should consider several safety aspects.

• Cardiac monitoring: assess baseline ECG in patients with known cardiac disease or electrolyte abnormalities.
• Concomitant serotonergic drugs: evaluate risk of serotonin syndrome when used with other serotonergic agents.
• Pregnancy: avoid use unless clearly needed; discuss potential risks with the patient.
• Breastfeeding: weigh benefits against potential infant exposure through milk.
• Renal or hepatic impairment: adjust monitoring as needed for patients with severe organ dysfunction.
• Store at room temperature: keep in the original packaging, protect from light and moisture.

Palonosetron may interact with other medications, requiring attention to the interaction severity.

Major Interactions (Avoid)

• Other 5‑HT3 antagonists: concurrent use can increase the risk of cardiac conduction abnormalities.
• QT‑prolonging drugs: co‑administration may exacerbate QT interval prolongation.

Moderate Interactions (Monitor Closely)

• Serotonergic agents (e.g., SSRIs, SNRIs, triptans): monitor for signs of serotonin syndrome.
• CYP3A4 inhibitors/inducers: may alter plasma levels of Palonosetron, requiring clinical observation.
• Anticholinergic medications: can mask constipation, a common side effect.
• Diuretics: monitor electrolytes to reduce risk of cardiac effects.
• Anesthetic agents: observe for additive effects on blood pressure and heart rate.