Palonosetron: — The Injection That Covers Delayed Nausea
You may have had ondansetron before. Palonosetron is a newer medicine in the same family, and it is given because it is designed to keep working after you get home — through the days when delayed nausea can return.
Medically reviewed by Dr. N. Kiranmayee, Medical Oncologist · Last reviewed September 2026
- A longer-acting anti-nausea medicine — Palonosetron stays active well beyond the first day after chemotherapy, covering the delayed nausea window that shorter-acting medicines may miss.
- Given once, before your chemotherapy starts — A single injection into your vein before the infusion begins. You do not take anything extra for it at home.
- Part of a wider nausea plan — Your team almost always combines it with other medicines, such as dexamethasone, chosen for your specific chemotherapy regimen.
- Delayed nausea belongs in your report — If you still felt sick in the days after your last cycle, tell your team — that is exactly the information they need to adjust the plan.
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Palonosetron is an anti-nausea injection given by IV before your chemotherapy starts. It belongs to a class of medicines called 5-HT3 antagonists. Unlike shorter-acting medicines in the same class, palonosetron is designed to cover both the nausea in the first day and the delayed nausea that can continue in the days that follow.
How is palonosetron different from ondansetron?
Both palonosetron and ondansetron belong to the same family of medicines — 5-HT3 antagonists — which work by blocking the serotonin signals that trigger nausea and vomiting. The key difference is how long palonosetron stays active in the body.
Chemotherapy-induced nausea has two phases. The first starts within hours of your infusion and usually settles within a day. The second — called delayed nausea — can begin a day after treatment and continue for several days.
Ondansetron is effective for the first phase. Palonosetron is designed to cover both. This is why ASCO and NCCN guidelines name it as a preferred option when your chemotherapy carries a higher risk of delayed nausea.
Palonosetron is given as a single injection into your vein before your infusion begins. It needs to go directly into the bloodstream, which is why it is given in the hospital or day care unit — not taken at home as a tablet.
It is almost always given alongside at least one other medicine. Dexamethasone is the most common partner. For chemotherapy with a high risk of nausea, your team may add a third medicine from a different class, such as aprepitant or netupitant.
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What should I tell my team about my nausea?
- Any nausea or vomiting after your last cycle, especially if it started a day or more after you went home
- Whether you could eat and drink normally in the days after your last treatment
- All other medicines, supplements, and herbal remedies you are currently taking
- Any constipation, headache, or dizziness — these are side effects worth mentioning
- If you felt the nausea cover seemed to stop working too soon after your last cycle
- Any new symptom you are not sure whether to connect to your treatment
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Frequently asked questions
What is the brand name of palonosetron available in India?
Palonosetron is sold under the brand name Aloxi, which is the originator brand. Several generic versions are also available in India under different names. Your hospital pharmacy will dispense whichever formulation your oncologist has prescribed. The active medicine is the same across brands; the brand name is simply the label under which a particular manufacturer markets it.
Why am I being given palonosetron when I had ondansetron before?
Your team may have switched because your previous cycle caused delayed nausea — the kind that starts a day or more after treatment rather than immediately — or because your new chemotherapy carries a higher risk of that pattern. Palonosetron is designed to cover that delayed window more effectively. It is not a sign that something has gone wrong; it is the team adjusting the plan to fit your treatment and your experience.
Will palonosetron stop the nausea completely?
For many people it reduces nausea significantly, but it does not always prevent it entirely. How much nausea you experience depends on the chemotherapy itself, your individual response, and what else is given alongside palonosetron. ASCO and NCCN guidance frames anti-nausea medicines as aiming to reduce and control nausea rather than to guarantee none at all. If you still feel sick after treatment, tell your team — the plan can be adjusted.
What are the side effects of palonosetron?
The most commonly reported side effects are headache, constipation, and dizziness. These are generally mild. Constipation is worth mentioning proactively — tell your team if it becomes a problem, because simple measures can help. Serious reactions are uncommon. If you notice anything unusual after the injection — a skin reaction, swelling, or feeling faint — tell your nurse before you leave the unit.
Why is it given as an injection rather than a tablet I can take at home?
The injection form ensures the medicine reaches your bloodstream directly and is already active before your chemotherapy begins. A tablet taken at home would take time to absorb, and there is a risk you could vomit it before it works. Giving it intravenously in the clinic, just before the infusion starts, means the full effect is in place when your chemotherapy enters your body.
Do I need palonosetron before every chemotherapy cycle?
That depends on your regimen and how you have responded. Many people receive it before each cycle of chemotherapy that carries a significant risk of nausea. Your oncologist decides this based on your specific treatment and your individual experience. If palonosetron is not listed for a particular cycle, ask your nurse or oncologist rather than assuming it was left out by mistake.
Can palonosetron be given with other anti-nausea medicines at the same time?
Yes, and it usually is. ASCO and NCCN guidelines for moderately and highly emetogenic chemotherapy recommend combining palonosetron with dexamethasone, and sometimes a third medicine from a different class such as aprepitant or netupitant. Your team decides the combination based on your specific chemotherapy. Tell them everything else you are taking, including over-the-counter medicines and supplements, so they can check for any interactions.
I still felt sick for several days after my last cycle. What should I tell my team?
Tell them exactly that: when the nausea started after treatment, how severe it was on each day, whether you vomited, and whether you could eat and drink. This pattern — nausea that continues or peaks a day or more after treatment — is delayed nausea, and it is specifically what palonosetron and medicines like aprepitant are intended to address. Knowing your exact experience lets your team decide whether to adjust your pre-treatment medicines or add something you can take at home after your next cycle.
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