Palonosetron Hydrochloride and Varenicline tartrate

• 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.

• Generic Name: varenicline
• Dosage Forms: n.a.
• Other Brand Names: Chantix, Chantix Starter Pack, Chantix Continuing Month

Adjunct in the cessation of cigarette smoking.

USPHS guideline for the treatment of tobacco use and dependence recommends varenicline as one of several first-line drugs that may reliably increase long-term smoking abstinence rates.

In clinical studies, varenicline therapy increased continuous abstinence rates compared with placebo or active comparator (e.g., bupropion). Also reduced urge to smoke.

In studies in patients with stable, documented cardiovascular disease and patients with mild to moderate COPD, efficacy of varenicline was comparable to that in the general smoking population without these conditions.

Also evaluated in patients with stable major depressive disorder in a postmarketing study; benefits also observed in this population without evidence of increased neuropsychiatric effects. (See Neuropsychiatric Symptoms and Suicidality under Cautions.)

Efficacy and safety of varenicline given in conjunction with other smoking cessation therapies (e.g., bupropion, nicotine replacement therapy) not established.