Palonosetron Fresenius Kabi (Palonosetron Hydrochloride)

Palonosetron Fresenius Kabi is a 5‑HT3 receptor antagonist indicated for several chemotherapy‑related indications.

• Chemotherapy‑induced nausea and vomiting (CINV): helps prevent both acute and delayed episodes in adult patients.
• Post‑operative nausea and vomiting (PONV): reduces the incidence of nausea and vomiting after general anesthesia.
• Radiotherapy‑induced nausea and vomiting: provides prophylaxis for patients receiving moderately emetogenic radiotherapy.
• Antiemetic prophylaxis for highly emetogenic chemotherapy regimens: offers extended protection beyond the first 24 hours.

• Palonosetron binds with high affinity to the serotonin type 3 (5‑HT3) receptor on peripheral vagal nerve terminals and centrally in the chemoreceptor trigger zone. By blocking this receptor, it prevents serotonin‑mediated activation of the vomiting centre, thereby reducing both acute and delayed nausea and vomiting associated with chemotherapy and surgery.

Palonosetron may cause adverse reactions, most of which are mild to moderate in intensity.

Common Side Effects

• Headache: mild to moderate intensity.
• Constipation: occasional, self‑limiting.
• Fatigue: generally transient.
• Diarrhoea: mild and short‑lived.
• Dizziness: occasional, resolves without intervention.
• Injection site erythema: mild redness at the site of administration.

Serious or Rare Side Effects

• Allergic reaction: rash, pruritus, or anaphylaxis.
• QT prolongation: may affect cardiac rhythm in susceptible patients.
• Serotonin syndrome: rare when combined with other serotonergic agents.
• Severe constipation or bowel obstruction: requires medical evaluation.
• Persistent hypotension: notable drop in blood pressure post‑administration.
• Neuro‑muscular weakness: very rare, may indicate a severe hypersensitivity response.

When using Palonosetron Fresenius Kabi, clinicians should consider several safety aspects.

• Cardiac monitoring: patients with known QT‑interval prolongation should be observed.
• Concomitant serotonergic drugs: assess risk of serotonin syndrome.
• Electrolyte imbalance: correct hypokalaemia or hypomagnesemia before use.
• Renal impairment: dose adjustment may be required in severe cases.
• Pregnancy and lactation: weigh benefits against potential risks; use only if clearly justified.
• Store at ambient temperature: keep in original packaging, protect from light and moisture.

Palonosetron can interact with other medicines, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• QT‑prolonging agents: concurrent use may increase risk of cardiac arrhythmias.
• CYP3A4 inhibitors strong (e.g., ketoconazole): may raise palonosetron plasma levels.

Moderate Interactions (Monitor Closely)

• Other antiemetics (e.g., dexamethasone, aprepitant): may require dose timing adjustments.
• Serotonergic agents (e.g., SSRIs, SNRIs): monitor for signs of serotonin syndrome.
• Diuretics: watch for electrolyte disturbances that could potentiate cardiac effects.
• Antifungal azoles: may modestly increase exposure.
• Opioids: observe for additive central nervous system depression.