Dihydroergotamine Mesylate and Palonosetron Hydrochloride

• Generic Name: dihydroergotamine
• Dosage Forms: n.a.
• Other Brand Names: DHE. 45, Migranal

Acute treatment of migraine attacks (with or without aura) or cluster headaches.

One of several preferred initial therapies in moderate to severe migraines or mild to moderate migraines that respond poorly to NSAIAs.

IV treatment of intractable migraines (e.g., status migrainosus); usually used in combination with IV antiemetic.

Not recommended for management of hemiplegic or basilar migraine or for prophylaxis or chronic daily management of migraine.

Used in combination with low-dose heparin therapy for prevention of postoperative DVT and pulmonary embolism; generally has been replaced by other more effective therapies (e.g., low molecular weight heparin alone, warfarin).

• Generic Name: palonosetron
• Dosage Forms: n.a.
• Other Brand Names: Aloxi

Palonosetron is used IV for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy.

Palonosetron also is used IV for the prevention of acute nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy.

For prevention of nausea and vomiting associated with highly emetogenic chemotherapy regimens (including an anthracycline plus cyclophosphamide), ASCO recommends a 3-drug antiemetic regimen consisting of an NK1 receptor antagonist (e.g., either oral aprepitant or IV fosaprepitant), a 5-HT3 receptor antagonist (e.g., dolasetron, granisetron, ondansetron, palonosetron), and dexamethasone. ASCO states that fixed-combination netupitant and palonosetron plus dexamethasone is an additional treatment option.

For moderately emetogenic chemotherapy regimens, ASCO recommends a 2-drug antiemetic regimen preferably consisting of palonosetron and dexamethasone. If palonosetron is not available, a first-generation 5-HT3 receptor antagonist (preferably granisetron or ondansetron) may be substituted. Limited evidence suggests that aprepitant may be added to this regimen; in such cases, use of any 5-HT3 receptor antagonist is appropriate.

For chemotherapy regimens with a low emetogenic risk, ASCO recommends administration of a single dose of dexamethasone prior to chemotherapy.

For chemotherapy regimens with minimal emetogenic risk, ASCO states that routine antiemetic administration is not necessary.

Palonosetron is used IV for the prevention of postoperative nausea and vomiting for up to 24 hours following surgery. Efficacy of the drug beyond 24 hours not demonstrated.

Routine prophylaxis not recommended in patients in whom there is little expectation that nausea and/or vomiting will occur postoperatively.

Recommended for patients in whom nausea and/or vomiting must be avoided postoperatively, even when anticipated incidence is low.