Home Drug Guide Palonosetron Hydrochloride

Drug Guide

Generic Name

Palonosetron Hydrochloride

Brand Names Aloxi, Posfrea

Classification

Therapeutic: Antiemetic

Pharmacological: 7-HT3 receptor antagonist

FDA Approved Indications

  • Prevention of nausea and vomiting associated with chemotherapy and surgery.

Mechanism of Action

Palonosetron is a selective 5-HT3 receptor antagonist that prevents serotonin from binding to its receptor, thereby blocking nausea and vomiting signals in the central nervous system and gastrointestinal tract.

Dosage and Administration

Adult: Liquid form administered IV; typically, 0.25 mg administered 30 minutes before chemotherapy or surgery.

Pediatric: Dose varies based on age and clinical scenario; consult specific guidelines.

Geriatric: Adjust dose if needed based on renal and hepatic functions.

Renal Impairment: Adjust dose for severe impairment; specific guidelines necessary.

Hepatic Impairment: Use with caution; no specific dose adjustment but monitor closely.

Pharmacokinetics

Absorption: Rapid absorption after IV administration

Distribution: Widely distributed, crosses the blood-brain barrier

Metabolism: Partially metabolized in the liver via CYP2D6, CYP3A4, CYP1A2

Excretion: Primarily via feces; minimal renal excretion

Half Life: Approximately 40 hours, providing prolonged antiemetic effect

Contraindications

  • Hypersensitivity to palonosetron or other 5-HT3 antagonists.

Precautions

  • Use with caution in patients with QT prolongation or on other QT-prolonging drugs.

Adverse Reactions - Common

  • Headache (Common)
  • Constipation (Common)
  • Dizziness (Common)

Adverse Reactions - Serious

  • QT prolongation and arrhythmias (Uncommon)
  • Anaphylaxis (Rare)

Drug-Drug Interactions

  • QT-prolonging agents such as certain antiarrhythmics, antipsychotics, and antibiotics.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of allergic reactions, evaluate baseline QT interval, assess patient for nausea/vomiting relief.

Diagnoses:

  • Risk for electrolyte imbalance related to vomiting and potential arrhythmias.

Implementation: Administer IV over 30 seconds to 2 minutes as prescribed. Monitor cardiac rhythm.

Evaluation: Assess effectiveness in preventing nausea and vomiting.

Patient/Family Teaching

  • Report any signs of allergic reactions or prolonged QT (dizziness, palpitations).
  • Follow instructions on timing of medication administration.,

Special Considerations

Black Box Warnings:

  • QT prolongation leading to arrhythmias, including torsades de pointes.

Genetic Factors: Patients with familial long QT syndrome should be monitored carefully.

Lab Test Interference: May cause false-negative results in some cardiac monitoring tests.

Overdose Management

Signs/Symptoms: QT prolongation, arrhythmias, dizziness, headache.

Treatment: Supportive care; monitor cardiac status; use appropriate management for arrhythmias.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable for specified shelf life as per the manufacturer’s instructions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.