Treatment Name: Palonosetron (Aloxi®)
Palonosetron (Aloxi®) is a Supportive Care Therapy to prevent Nausea and Vomiting
How does palonosetron (Aloxi®) work?
Palonosetron (Aloxi®) is designed to block certain receptors in your body that control nausea and vomiting. These are called “serotonin type” (5-HT) receptors. 5-HT3 is a specific serotonin receptor that is located mostly in your brain, nervous system, and intestines. When serotonin is released in the intestines and brain and binds to serotonin receptors, the body can trigger vomiting. Palonosetron binds to 5HT3 receptors instead of serotonin, and thereby stops the reflex to vomit.
Goals of therapy:
Palonosetron (Aloxi®) is given to prevent nausea and vomiting from chemotherapy and is commonly given on a scheduled basis, 30 – 60 minutes before chemotherapy. Palonosetron is not usually used to treat nausea and vomiting. When a medicine is given to prevent nausea and vomiting, it is known as prophylaxis, or prophylactic therapy.
Palonosetron (Aloxi®) is usually given in an outpatient infusion center, approximately 30 – 60 minutes before chemotherapy to prevent nausea and vomiting. For chemotherapy regimens associated with a high rate of nausea or vomiting, palonosetron is commonly given with one or two additional preventative anti-nausea medications, such as dexamethasone (Decadron®) and aprepitant (Emend®).
- Palonosetron 0.25 mg intravenous push (I.V. push) over 30 seconds on Day 1 of chemotherapy
Palonosetron is a long acting medication that has a duration of action of 3 to 5 days. In most instances, only one dose needs to be given to prevent nausea and vomiting from chemotherapy. However, in some cases where chemotherapy is given for more than three days in a row, a second dose of palonosetron may be given.
Palonosetron is typically given for chemotherapy regimens that have a moderate to high risk of nausea and vomiting. Duration of therapy depends upon response, tolerability, and number of cycles chemotherapy prescribed.
In the prescribing label information (palonosetron package insert), the most commonly reported side effects from palonosetron (Aloxi®) are shown here. The exact percentages of patients that will experience palonosetron side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials:
- Headache (9%)
- Constipation (5%)
- Diarrhea (1%)
- Dizziness (1%)
- Fatigue (<1%)
- Abdominal pain (<1%)
- Trouble sleeping (<1%)
Palonosetron should be used in pregnant women only if the potential benefits to the mother outweigh the potential risks to the unborn baby
There is a small risk of serotonin syndrome associated with the use of palonosetron. Most reports were from patients also receiving medications that can increase serotonin such as certain antidepressants known as SSRIs, or SNRIs, mirtazapine, tramadol, and others.
Very rarely, palonosetron may cause hives, face swelling, trouble breathing, or chest pain. Tell your nurse and doctor if you experience any of these symptoms after receiving palonosetron.
How often is monitoring needed?
Labs (blood tests) typically do not need to be monitored for palonosetron, but may be checked before each chemotherapy treatment.
How often is imaging needed?
An electrocardiogram (“ECG” or “EKG”) may be need to be done to check your heart rhythm as palonosetron can prolong the QTc interval and cause a heart arrhythmia, especially if you are on other medications that can also prolong the QTc interval. However, in one trial palonosteron had no significant effect on the QTc interval.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue palonosetron as planned or switch to an alternative therapy.
- Do not take ondansetron (Zofran®) at home for 3 days (72 hours) after receiving palonosetron. Ondansetron works in a similar way to palonosetron and since palonosetron lasts for about 3 days in the body, taking ondansetron during this time may cause more side effects without helping with nausea. During this time period, use an alternative anti-nausea medication such as prochlorperazine (Compazine®), promethazine (Phenergan®), lorazepam (Ativan®), or another medication as prescribed by your doctor. If you have nausea or vomiting after receiving palonosetron, talk with your doctor or pharmacist to figure out the best time to resume ondansetron treatment
- Those with a history of migraines or chronic headaches may be at higher risk for headaches from palonosetron. If your headaches noticeably worsen shortly after taking palonosetron, contact your doctor to see if other preventative anti-nausea medicines with a lower risk of headache may be better for you to receive
- If you are experiencing constipation from palonosetron, over-the-counter laxatives and stool softeners can help. Work with your doctor or pharmacist on a plan to keep your bowel movements regular
- Although the potential for significant drug interactions with palonosetron appears to be low, a pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Palonosetron (Aloxi®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Palonosetron (Aloxi®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Palonosetron (Aloxi®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.