Palonosetron is a medication that's used to prevent nausea and vomiting from cancer medications (chemotherapy) and surgery. The dose is usually a one-time injection through the veins that's given by a healthcare provider in a clinic or hospital. The most common side effects are headache and constipation. Palonosetron is still available as a generic medication, but its brand name Aloxi is now discontinued.
Palonosetron is a serotonin antagonist that works as an antiemetic (antinausea) medication. It blocks the actions of serotonin in the gut and in the part of your brain that's responsible for causing nausea and vomiting. This helps you feel less nauseous and less of an urge to vomit.
| Common Brands | Aloxi |
|---|---|
| Drug Class | Antiemetic |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Contact your healthcare provider immediately if you experience any of the following.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
Less common
Blurred vision
chest pain or discomfort
confusion
difficult breathing
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
fainting
irregular heartbeats that continue
sweating
unusual tiredness or weakness
Rare
Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
extra heartbeats
nervousness
pain in the shoulders, arms, jaw, or neck
pounding in the ears
slow or fast heartbeat
Incidence not known
Agitation
overactive reflexes
poor coordination
restlessness
shivering
talking or acting with excitement you cannot control
trembling or shaking
twitching
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Bluish color of the fingernails, lips, skin, palms, or nail beds
collapse
gasping to breathe
paleness of the skin
seizures
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Difficulty having a bowel movement (stool)
headache
Less common
Acid or sour stomach
belching
bloated or full feeling
blood in the urine
bloody or black, tarry stools
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in vision
chills
continuing ringing or buzzing
decrease in frequency of urination
decrease in urine volume
deep breathing
difficulty in passing urine
drowsiness
excess air or gas in the stomach or intestines
excessive sleeping
fear
feeling happy
feeling of warmth
flushed dry skin
fruit-like breath odor
general feeling of discomfort or illness
hearing loss
hiccups
impaired vision
increased hunger
increased thirst
increased urination
indigestion
joint pain
large, flat, blue or purplish patches in the skin
loss of appetite
muscle aches and pains
muscle tremors
numbness or tingling in the hands, feet, or lips
painful knees and ankles
passing gas
raised red swellings on the skin, the buttocks, legs or ankles
rash
red, sore eyes
redness of the face, neck, arms, and occasionally, upper chest
stomach discomfort, upset, or pain
sugar in the urine
swelling or protruding veins
trouble sleeping
unexplained noise in the ears
unexplained weight loss
unusually deep sleep
unusually long duration of sleep
vein discoloration
weakness or heaviness of the legs
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Palonosetron can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Some people have experienced an allergic reaction to palonosetron. These reactions can be life-threatening and include facial swelling, hives, and anaphylaxis (e.g., closing of the throat). Get medical attention right away if you notice dizziness; fast heartbeat; a choking sensation; difficulty breathing; swelling around your eyes, lips, or tongue; or any signs of a severe skin reaction after taking palonosetron.
Some people taking serotonin antagonists like palonosetron have developed a rare, but potentially life-threatening condition called serotonin syndrome. This condition happens where there's too much serotonin in the brain. Your risk for serotonin syndrome goes up if you take palonosetron with other medications that can raise your serotonin levels, such as certain antidepressants, mental health medications, pain medications, and migraine medications.
Let your provider know about all the medications you take before starting palonosetron, as well as any medications you plan to take. Get medical help if you have any symptoms of serotonin syndrome, such as fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
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Based on a small study, it can take just a few minutes for Palonosetron to reach the highest amount in the body after a single dose of medication. This should suggest that Palonosetron starts working to prevent nausea and vomiting quickly. Typically, Palonosetron is given at least 30 minutes before chemotherapy. By the time the side effects of the cancer medication kick in, there should be enough Palonosetron in the body ready to prevent nausea and vomiting from the chemotherapy.
The effects of a single dose of Palonosetron can last for a long time. Studies show that a single dose of Palonosetron can help prevent nausea and vomiting for up to 5 days after chemotherapy.
Both Palonosetron and ondansetron (Zofran) are serotonin antagonists that work well for preventing nausea and vomiting. But a study comparing the two medications showed that Palonosetron might work better because it lasts longer and also has less side effects than ondansetron (Zofran). Another difference between both medications is that Palonosetron is only available as an IV injection, but ondansetron (Zofran) is available as oral tablets, orally dissolving tablets, oral liquid, and an injection.
Yes, Palonosetron can be given with other antinausea medications that belong to different drug classes and work differently from each other. This can help prevent nausea and vomiting better. In fact, cancer treatment guidelines recommend taking a combination of antiemetic medications if you're taking a chemotherapy regimen with a risk for nausea and vomiting. Palonosetron belongs to the class of medications called serotonin antagonists. Depending on your chemotherapy regimen, additional antinausea medications belonging to different drug classes that your provider might prescribe include aprepitant (Emend) and dexamethasone.
