Alternate Name(s):
Aloxi
Classification:
Antiemetic, 5-HT3 Receptor Antagonist
Original Date:
June 2026
Indications:
Restricted to:
- Oncology patients receiving highly or moderately emetogenic chemotherapy experiencing inadequate control of chemotherapy-induced nausea and vomiting with ondansetron and granisetron.
- Oncology patients receiving highly or moderately emetogenic chemotherapy who cannot receive dexamethasone or aprepitant as part of their chemotherapy-induced nausea and vomiting prevention regimen
Reconstitution and Stability:
| VIAL SIZE | 0.9% NaCl FOR INJECTION REQUIRED | FINAL CONCENTRATION |
| 0.25 mg | N/A | 0.05 mg/mL |
Compatibility:
- Solutions compatible: 0.9% NaCl, D5W, Lactated ringers, D5W-0.45% NaCl, D5W-LR
- Additive/Above cassette compatible: Palonosetron should NOT be mixed with other drugs
- Y-Site Compatible: amphotericin B (Liposomal), caspofungin, famotidine, fluconazole, fosaprepitant, furosemide, hydromorphone, heparin, lorazepam, levofloxacin, magnesium sulfate, morphine sulfate, piperacillin-tazobactam, potassium chloride, sodium bicarbonate
- Incompatible: acyclovir, diazepam, ganciclovir, gemtuzumab ozogamicin, methylprednisolone succinate, pentobarbital, pantoprazole, pentamidine, phenytoin
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Push | YES Usual Dilution: 0.05 mg/mL (undiluted) Infusion Time: 30 seconds Flush the line with 0.9% NaCl BEFORE and AFTER administration |
| IV Intermittent Infusion | Yes Give 30 minutes prior to the start of chemotherapy Usual dilution: 5 - 30 mcg/mL Infusion Time: 15 minutes Flush the line with 0.9% NaCl BEFORE and AFTER administration |
| IV Continuous Infusion | NO |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Infants, Children, and Adolescents <17 years:
- 20 mcg/kg/dose (0.02 mg/kg/dose) IV ONCE given 30 minutes prior to the start of chemotherapy (maximum dose = 1.5 mg). May be repeated once in 48 hours for multi-day chemotherapy regimens
Adolescents ≥ 17 years old:
- 250 mcg (0.25 mg) IV ONCE given 30 minutes prior to the start of chemotherapy. May be repeated once in 48 hours for multi-day chemotherapy regimens
No dose adjustments for renal or hepatic dysfunction
Potential hazards of parenteral administration:
- Immediate hypersensitivity reactions, including anaphylaxis, flushing, erythema, and dyspnea have occurred during infusion of palonosetron. Discontinue infusion and administer appropriate therapy.
- Irritation at the infusion site including pain, erythema, and infusion site reactions
Notes:
- Possible Adverse Effects:
- headache, constipation, dizziness, fatigue, insomnia, chest pain, bradycardia, serotonin syndrome, QTc prolongation
- Flush the line with 0.9% NaCl BEFORE and AFTER administration. Do NOT mix with other medications
- Avoid simultaneous use with other 5-HT3 antagonists (e.g. ondansetron, granisetron)
- Switching from palonosetron to ondansetron/granisetron
- Avoid use of ondansetron/granisetron within 48 hours of last dose of palonosetron
- Switching from ondansetron/granisetron to palonosetron
- Avoid use of palonosetron within 8 hours of last dose of ondansetron, and avoid use of palonosetron within 12 hours of last dose of granisetron
- Long half-life (compared with other 5-HT3 antagonists):
- Adults: ~ 40 hours
- Pediatrics: ~30 hours
- Minimal risk of QTc prolongation compared to other 5-HT3 antagonists
References:
- ALOXI Product Monograph
- Lexicomp
- King's Guide