Fosnetupitant and Palonosetron (a fixed antiemetic combination) injection was approved by FDA in April 2018 to prevent chemotherapy-induced nausea and vomiting.
Fosnetupitant and Palonosetron combination is prescribed along with dexamethasone for adult patients to prevent nausea and vomiting who are under highly emetogenic cancer chemotherapy.
Fosnetupitant is a pro-drug of netupitant and prevents nausea and vomiting during the acute phase and delayed phase after cancer chemotherapy.
Palonosetron prevents nausea and vomiting only during the acute phase after cancer chemotherapy.
Fosnetupitant and Palonosetron work by preventing the signals to the brain which can lead to nausea and vomiting.
Fosnetupitant and Palonosetron should not be used in patients-
Allergic to Fosnetupitant and Palonosetron
Taking anthracycline chemotherapy (e.g., Daunorubicin, Doxorubicin, Epirubicin)
Taking cyclophosphamide chemotherapy
Below 18 years old
The recommended dose of fosnetupitant and palonosetron injection is a single vial containing 235 mg of fosnetupitant and 0.25 mg of palonosetron administered as a reconstituted solution.
The vial should be reconstituted with 5% dextrose or 0.9% sodium chloride injection and must be administered 30 minutes before starting chemotherapy.
Dexamethasone 12 mg should also be taken 30 minutes before initiating chemotherapy.
The fixed emetogenic combination of fosnetupitant and palonosetron is available as an injection for administering directly into the vein by a healthcare provider.
The vial should be reconstituted aseptically with 20 ml of 5% dextrose or 0.9% sodium chloride introduced into an infusion bag containing 30 ml of 5% dextrose or 0.9% sodium chloride to make up a volume of 50 ml solution.
The reconstitution procedures should be done gently to avoid foaming.
The final diluted solution should be administered slowly for at least 30 minutes into the vein starting 30 minutes before chemotherapy.
The IV line should be flushed with the same solution used for reconstitution at the end of the infusion to ensure complete drug administration.
The total time right from reconstitution to the start of infusion should not be more than 3 hours.
Serious allergic reactions such as anaphylaxis may occur during fosnetupitant and palonosetron therapy, and therefore the patient must be monitored accordingly.
Patients should be observed for the risk of developing serotonin syndrome which includes symptoms such as tremors, seizures, changes in mental state, and abnormal heartbeat.
Treatment should be discontinued when such serotonin syndrome occurs, and adequate supportive measures should be initiated immediately.
Pain in the stomach
Reddening of the skin
Hoarseness of the voice
The patient should be advised to consult the physician immediately if rashes, itching, difficulty in breathing, or swelling of hands occur.
The reconstituted solution should be checked for the presence of any particulate matter or discoloration and should be discarded immediately if such things are present.
The reconstituted solution or the final diluted solution should be stored at room temperature not exceeding 3 hours.
Always use a separate IV line to inject other intravenous medications. If the same line is used, flush the IV line with the solution used for reconstitution (e.g., 5% dextrose or 0.9% sodium chloride solution).
Following drugs should not be used together with fosnetupitant and palonosetron as seroius interactions may occur.
Antidepressants (e.g., Amitriptyline, escitalopram)
Migraine treating drugs (e.g., Naratriptan, Almotriptan)
Intravenous solutions containing calcium and magnesium in Lactated Ringers or Hartmanns solution
Using tobacco, alcohol, or herbal supplements containing St. Johns Wort can also cause serious interactions while taken together with fosnetupitant and palonosetron.
Fosnetupitant and palonosetron injection should be stored in the original container and should be protected from light.
Keep in a refrigerator at a temperature between 2°C and 8°C.
Do not freeze or shake the vial.