DRUG SUPPLIED DOSE COMMENTS
PALONOSETRON (Paeds)
(Aloxi)

Mechanism of action:

5-HT3 antagonist used in the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV)




Ref:
524, 525

1.    Flank J, Robinson PD, Holdsworth M, Phillips R, Portwine C et al. Guideline for the treatment of breakthrough and the prevention of refractory chemotherapy-induced nausea and vomiting in children with cancer. Pediatr Blood Cancer 2016;63:1144-51
2.    Patel P, Robinson PD, Thackray J, Flank K, Holdsworth MT et al. Guideline for the prevention of acute chemotherapy-induced nausea and vomiting in pediatric cancer patients: A focused update. Pediatr Blood Cancer 2017;64:e26542
3.    Kovacs G,Wachtel AE, Basharova EV, Spinelli T, Nicolas P, Kabickova E. Palonosetron versus ondansetron for prevention of chemotherapy induced nausea and vomiting in paediatric patients with cancer receiving moderately or highly emetogenic chemotherapy: a randomised, phase 3, double-blind, double-dummy, non-inferiority study. Lancet Oncol. 2016;17(3):332-344.







Last update: 2022-04-09		 0.05 mg/mL - 5 mL vial Chemotherapy induced nausea and vomiting:

Children 2-16 yrs
0.02 mg/kg/dose IV once prior to chemotherapy (Max. 1.5 mg/dose)

Children >16 yrs and adults
0.25 mg/dose IV once prior to chemotherapy
 Restricted to the following patients:
Pediatric patients with refractory chemotherapy induced nausea and vomiting (CINV) despite maximal antiemetic therapy.

Prevention of CINV in pediatric patients receiving highly emetogenic chemotherapy who cannot receive dexamethasone and experience breakthrough CINV.
Palonosetron has a long half-life (30h) and there is limited information about re-dosing palonosetron or other 5HT3 receptor antagonists. Do not give ondansetron or granisetron for 72h following palonosetron.

Maximum pediatric dose exceeds usual adult doses due to pharmacokinetic/dynamic differences.



Standard Prescription:

Palonosetron __ mg IV once prior to chemotherapy (__ mg/kg/dose)