Aloxi has been used for more than 20 years to prevent nausea and vomiting caused by chemotherapy (CINV). The solution for injection is used in adults and children 1 month of age or older for chemotherapy with medicines that are either a strong trigger of nausea and vomiting (such as cisplatin) or a moderate trigger (such as cyclophosphamide, doxorubicin or carboplatin). The capsules are only used in adults for chemotherapy that is a moderate trigger of nausea and vomiting in adults. Aloxi is also approved for use in a number of countries at a lower dose for the prevention of post-operative nausea and vomiting (PONV).

US Full Prescribing Information

EMA Approval details

How does Aloxi work?

The active substance in Aloxi®, palonosetron, is a ‘5HT3 antagonist’. This means that it stops a chemical in the body called 5-hydroxytryptamine (5HT, also known as serotonin) from attaching to 5HT3 receptors in the gut. When 5HT attaches to these receptors, it normally causes nausea and vomiting. These drugs work by blocking the binding of serotonin to its receptor, which in turn stops the transmission of signals to the vomiting center in the brain.

By blocking these receptors, Aloxi® prevents the nausea and vomiting that often happen after chemotherapy. 5-HT3 receptor antagonists are considered to be one of the most effective classes of antiemetic drugs in the prevention of CINV during the first 24 hours after chemotherapy (also known as the acute phase) 1. With Aloxi® long half-life and for certain chemotherapies, coverage with Aloxi® extends beyond 24 hours and into the delayed phase.

CINV (Chemotherapy-induced nausea and vomiting)

Chemotherapy-induced nausea and vomiting (known as “CINV”) are common unpleasant and debilitating side effects of many cancer treatments5. CINV is one of the most feared side effects of chemotherapy for both patients and caregivers and, without adequate antiemetic prophylaxis, can occur in >90% of patients. The pathophysiology of CINV is a complex process that involves several molecules, such as neurotransmitters [serotonin (5-hydroxytryptamine or 5-HT3), substance P (neurokinin-1), and dopamine] and their respective receptors in the central nervous system and the gastrointestinal tract, following activation by certain chemotherapy5. Consequences of uncontrolled CINV include dehydration and electrolyte imbalance, malnutrition, impaired daily functioning and quality of life, postponement or dose reduction of chemotherapy, and increased resource use and costs7. Patients tend to experience nausea more often than vomiting, and antiemetic medications (those intended to prevent, lessen or relieve CINV) are generally less effective in controlling nausea5.

Who is at risk of CINV?

Factors leading to the development of CINV can be related to the chemotherapy itself or to characteristics specific to the patient taking the anticancer drug. Historically, the risk of CINV was determined only by considering the emetogenic potential of the chemotherapy agent. A classification system details the emetogenicity of different chemotherapeutic agents and this has formed the basis for antiemetic treatment.4 Highly emetogenic agents can cause CINV in >90% of patients without antiemetic prophylaxis; moderately emetogenic agents can cause CINV in 30–90% of patients; low emetogenic agents in 10–30% of patients; and minimally emetogenic agents have <10% risk of causing CINV without antiemetic prophylaxis. More recently, individual patient-related risk factors that may increase the chance of experiencing CINV have been identified. These include younger age, female gender, having had CINV previously, little or no previous alcohol use, being susceptible to motion sickness, having experienced morning sickness with pregnancy, anxiety/high pre-treatment expectation of nausea.7

Can CINV be prevented?

Significant advances in this field have made the complete prevention of nausea and vomiting the goal of clinical management. A range of drugs are available for the management of CINV, with the choice of drugs guided by the type of chemotherapy agent(s) used and its ability to induce vomiting, along with patient-specific risk factors. The three key families of drugs used to prevent CINV are serotonin receptor antagonists (5-HT3 RAs), which block the serotonin receptor, neurokinin-1 (NK-1) RAs, which block the NK-1 receptor, and corticosteroids. 5 Olanzapine, a potent antipsychotic that inhibits multiple receptors, is also a recent effective option. Antiemetic guidelines are available that advise prescribing clinicians on the optimal combinations of antiemetic agents.6,7

More about PONV

Postoperative nausea and vomiting (PONV) is a common complication following surgery under anesthesia. it is typically defined as any nausea, retching, or vomiting that occurs during the first 24 to 48 hours after surgery.1

PONV can complicate recovery from surgery and, while it usually resolves or is treated without serious consequences, it may sometimes require unanticipated hospital admission and delay discharge from the recovery room1. In some cases, vomiting or retching can lead to more severe complications such as wound dehiscence, esophageal rupture, aspiration, dehydration and increased intracranial pressure1.

PONV refers to symptoms that occur in the post-anesthesia care unit or within the immediate 24/48 hours postoperatively. When similar symptoms occur after discharge from outpatient procedures, it is referred to as postdischarge nausea and vomiting (PDNV) 1. The pathophysiology of PONV involves a variety of central and peripheral mechanisms, with the involvement of several neurotransmitter receptors being targets for PONV prevention or treatment2.


  1. Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review.Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H.F1000Res. 2020 Aug 13;9:F1000 Faculty Rev-983. doi: 10.12688/f1000research.21832.1. eCollection 2020.

  2. Tateosian VS, Champagne K, Gan TJ. What is new in the battle against postoperative nausea and vomiting? Best Pract Res Clin Anaesthesiol. 2018;32:137–48.

Can PONV be prevented?

The currently available antiemetic drugs for the treatment and prevention of PONV include the 5-hydroxytryptamine (5-HT 3) receptor antagonists, neurokinin-1 (NK-1) receptor antagonists, corticosteroids, butyrophenones, metoclopramide, phenothiazine, prochlorperazine, antihistamines, and anticholinergics.

A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In order to reduce the likelihood of patients developing PONV and PDNV after surgery strategies to reduce the baseline risk of PONV should be implemented in addition to utilize the adequate antiemetic prophylaxis1.


  1. Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review.Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H.F1000Res. 2020 Aug 13;9:F1000 Faculty Rev-983. doi: 10.12688/f1000research.21832.1. eCollection 2020.


  1. Aapro M, Jordan K, Scotté F, et al. Netupitant-palonosetron (NEPA) for Preventing Chemotherapy-induced Nausea and Vomiting: From Clinical Trials to Daily Practice. Curr Cancer Drug Targets 2022;22(10):806-824.
  2. Aapro M, Molassiotis A, Dicato M, et al. The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER). Ann Oncol. 2012 Aug;23(8):1986-1992.
  3. Feyer P, Jordan K. Update and new trends in antiemetic therapy: the continuing need for novel therapies. Ann Oncol. 2011; 22(1):30-38.
  4. Hesketh PJ, Kris MG, Grunberg SM, et al. Proposal for classifying the acute emetogenicity of cancer chemotherapy. J Clin Oncol. 1997 Jan;15(1):103-9.
  5. Navari RM, Aapro M. Antiemetic prophylaxis for chemotherapy-induced nausea and vomiting. N. Engl. J. Med., 2016, 374(14), 1356-1367.
  6. Multinational Association of Supportive Care in Cancer. MASCC/ESMO antiemetic guidelines. 2019.
  7. National Comprehensive Cancer Network. NCCN Clinical practice guidelines in oncology (NCCN Guidelines).1. 2023.
  8. Akynzeo 300 mg/0.50 mg hard capsules; Akynzeo 235 mg/0.25 mg powder for concentrate for solution for infusion, Akynzeo 235 mg/0.25 mg concentrate for solution for infusion [Summary of Product Characteristics] Dublin, Ireland: Helsinn Birex Pharmaceuticals Ltd; 2024.