Aloxi
palonosetron hydrochloride
Pharmacologic class: Selective serotonin subtype 3 (5-HT3) receptor antagonist
Therapeutic class: Antiemetic
Pregnancy risk category B
Action
Selectively binds to and antagonizes 5-HT3 receptors on vagal nerve terminals and in chemoreceptor trigger zone. This action blocks serotonin release, reducing the vomiting reflex.
Availability
Solution for injection: 0.25 mg (free base) in 5-ml single-use vial
Indications and dosages
➣ To prevent nausea and vomiting caused by cancer chemotherapy
Adults: 0.25 mg I.V. as a single dose 30 minutes before chemotherapy. Repeated doses within 7 days aren't recommended.
➣ To prevent postoperative nausea and vomiting
Adults: 0.075 mg I.V. as a single dose given over 10 seconds immediately before anesthesia induction
Contraindications
• Hypersensitivity to drug or its components
Precautions
Use cautiously in:
• hypersensitivity to other 5-HT3 receptor antagonists
• diabetes mellitus, hepatic dysfunction
• pregnant or breastfeeding patients
• children.
Administration
• Flush I.V. line with normal saline solution before and after giving.
• Deliver into I.V. line over 30 seconds. Don't mix with other drugs.
Adverse reactions
CNS: headache, fatigue, insomnia, dizziness, anxiety
CV: hypotension, vein discoloration and distention, nonsustained tachycardia, bradycardia
GI: constipation, diarrhea, abdominal pain, anorexia
GU: glycosuria
Metabolic: fluctuating electrolyte levels, hyperglycemia, metabolic acidosis, hyperkalemia
Musculoskeletal: joint pain
Other: fever, flulike symptoms
Interactions
Drug-diagnostic tests: Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood and urine glucose, potassium: increased levels
Patient monitoring
• Monitor vital signs and ECG. Watch closely for tachycardia, bradycardia, and hypotension.
• Watch electrolyte levels for fluctuations (especially hyperkalemia and metabolic acidosis).
• Evaluate temperature. Stay alert for flulike symptoms.
• Closely monitor blood and urine glucose levels in diabetic patients. Stay alert for hyperglycemia.
Patient teaching
• Explain that drug helps prevent nausea and vomiting caused by chemotherapy.
• Teach patient to recognize and report signs and symptoms of hyperkalemia and metabolic acidosis.
• Advise patient to report flulike symptoms.
• Instruct diabetic patient to closely watch blood and urine glucose levels.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.
palonosetron
(pa-lone-o-se-tron) palonosetron,Aloxi
(trade name)Classification
Therapeutic: antiemeticsPharmacologic: five ht3 antagonists
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| IV | within 30 min | unknown | 7 days |
| PO | within 1 hr | unknown | 7 days |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness
- headache
Gastrointestinal
- constipation
- diarrhea
Interactions
Drug-Drug interaction
None significant.Route/Dosage
Availability (generic available)
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.