Nurses Compass
Drug Guide
Palonosetron Hydrochloride
Classification
Therapeutic: Antiemetic
Pharmacological: 7-HT3 receptor antagonist
FDA Approved Indications
- Prevention of nausea and vomiting associated with chemotherapy and surgery.
Mechanism of Action
Palonosetron is a selective 5-HT3 receptor antagonist that prevents serotonin from binding to its receptor, thereby blocking nausea and vomiting signals in the central nervous system and gastrointestinal tract.
Dosage and Administration
Adult: Liquid form administered IV; typically, 0.25 mg administered 30 minutes before chemotherapy or surgery.
Pediatric: Dose varies based on age and clinical scenario; consult specific guidelines.
Geriatric: Adjust dose if needed based on renal and hepatic functions.
Renal Impairment: Adjust dose for severe impairment; specific guidelines necessary.
Hepatic Impairment: Use with caution; no specific dose adjustment but monitor closely.
Pharmacokinetics
Absorption: Rapid absorption after IV administration
Distribution: Widely distributed, crosses the blood-brain barrier
Metabolism: Partially metabolized in the liver via CYP2D6, CYP3A4, CYP1A2
Excretion: Primarily via feces; minimal renal excretion
Half Life: Approximately 40 hours, providing prolonged antiemetic effect
Contraindications
- Hypersensitivity to palonosetron or other 5-HT3 antagonists.
Precautions
- Use with caution in patients with QT prolongation or on other QT-prolonging drugs.
Adverse Reactions - Common
- Headache (Common)
- Constipation (Common)
- Dizziness (Common)
Adverse Reactions - Serious
- QT prolongation and arrhythmias (Uncommon)
- Anaphylaxis (Rare)
Drug-Drug Interactions
- QT-prolonging agents such as certain antiarrhythmics, antipsychotics, and antibiotics.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for signs of allergic reactions, evaluate baseline QT interval, assess patient for nausea/vomiting relief.
Diagnoses:
- Risk for electrolyte imbalance related to vomiting and potential arrhythmias.
Implementation: Administer IV over 30 seconds to 2 minutes as prescribed. Monitor cardiac rhythm.
Evaluation: Assess effectiveness in preventing nausea and vomiting.
Patient/Family Teaching
- Report any signs of allergic reactions or prolonged QT (dizziness, palpitations).
- Follow instructions on timing of medication administration.,
Special Considerations
Black Box Warnings:
- QT prolongation leading to arrhythmias, including torsades de pointes.
Genetic Factors: Patients with familial long QT syndrome should be monitored carefully.
Lab Test Interference: May cause false-negative results in some cardiac monitoring tests.
Overdose Management
Signs/Symptoms: QT prolongation, arrhythmias, dizziness, headache.
Treatment: Supportive care; monitor cardiac status; use appropriate management for arrhythmias.
Storage and Handling
Storage: Store at room temperature away from light and moisture.
Stability: Stable for specified shelf life as per the manufacturer’s instructions.