Long-acting 5-HT3 antagonist
Palonosetron
Brand names: Aloxi
Adult dose
Dose: 250 micrograms IV single dose 30 min before chemotherapy. PO 500 micrograms 1h before
Route: IV/PO
Frequency: single per cycle
Clinical pearls
- CINV — particularly delayed-phase coverage due to long half-life
- Pair with NK1 antagonist + dexamethasone for highly emetogenic chemotherapy
Contraindications
- Concurrent strong QT-prolonging drugs (caution)
- Hypersensitivity
Side effects
- Headache
- Constipation
- QT prolongation (less than ondansetron)
- Serotonin syndrome with serotonergic agents
Interactions
- QT-prolonging drugs
- Serotonergic drugs
Monitoring
- ECG if QT risk
Reference: BNF; NICE TA313; ESMO; https://bnf.nice.org.uk/drugs/palonosetron/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Pathways
- Acute Myeloid Leukaemia Presentation · BSH; NICE — NG146
- Tumour Lysis Syndrome · Cairo-Bishop; BSH; NICE — Best Practice
- Lower Gastrointestinal Bleed · BSG 2019; NICE NG141
- Variceal Upper GI Bleed · BSG 2015; Baveno VII (2022)
- Spontaneous Bacterial Peritonitis (SBP) · BSG / EASL 2018
- Hepatorenal Syndrome · EASL 2018; ICA 2015