Palonosetron with netupitant

How it works

Palonosetron blocks serotonin 5-HT3 receptors that mediate the acute emetic response, while netupitant blocks substance P at central neurokinin-1 receptors involved in delayed emesis, giving complementary antiemetic cover.

Prescribing in practice

• Netupitant is a CYP3A4 inhibitor, so doses of CYP3A4-substrate co-medications such as dexamethasone and certain chemotherapy agents must be adjusted and interacting drugs reviewed.
• Both components can prolong the QT interval, so use with caution alongside other QT-prolonging drugs and in patients with electrolyte disturbance.
• It is given as a single oral dose before the chemotherapy cycle rather than as ongoing daily therapy and is usually combined with a corticosteroid.

Monitoring

Monitor the adequacy of emetic control across the cycle and consider ECG and electrolytes where additional QT-prolonging risk factors are present.

Counselling the patient

• Take the single dose about an hour before chemotherapy starts.
• Constipation, headache and tiredness are common; report severe constipation.
• Tell the team about all other medicines, as this drug can change how some are handled.

Evidence & guidelines

The combination's efficacy in preventing chemotherapy-induced nausea and vomiting is supported by registration trials and reflected in antiemetic guidelines.