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Palonosetron

From Wikipedia, the free encyclopedia
Pharmaceutical drug

Pharmaceutical compound
Palonosetron
Clinical data
Pronunciation/pæləˈnoʊsətrɒn/pal-ə-NOH-sə-tron
Trade namesAloxi
AHFS/Drugs.comMonograph
MedlinePlusa610002
License data
Pregnancy
category
Routes of
administration		Intravenous,by mouth
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability97% (oral)
Protein binding62%
MetabolismLiver, 50% (mostlyCYP2D6-mediated,CYP3A4 andCYP1A2 also involved)
Eliminationhalf-lifeApproximately 40–50 hours
ExcretionKidney, 80% (of which 49% unchanged); fecal (5 to 8%)
Identifiers
  • (3aS)-2-[(3S)-1-Azabicyclo[2.2.2]oct-3-yl]-2,3,3a,4,5,6-hexahydro-1H-benz[de]isoquinolin-1-one
CAS Number
PubChemCID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
PDB ligand
CompTox Dashboard(EPA)
Chemical and physical data
FormulaC19H24N2O
Molar mass296.414 g·mol−1
3D model (JSmol)
Specific rotation[α]D −136°
[α]D –94.1° (HCl)
Melting point87 to 88 °C (189 to 190 °F)
  • O=C5N([C@H]2C1CCN(CC1)C2)C[C@@H]4c3c5cccc3CCC4
  • InChI=1S/C19H24N2O/c22-19-16-6-2-4-14-3-1-5-15(18(14)16)11-21(19)17-12-20-9-7-13(17)8-10-20/h2,4,6,13,15,17H,1,3,5,7-12H2/t15-,17-/m1/s1 checkY
  • Key:CPZBLNMUGSZIPR-NVXWUHKLSA-N checkY
 ☒NcheckY (what is this?)  (verify)

Palonosetron, sold under the brand nameAloxi, is a medication used for the prevention and treatment ofchemotherapy-induced nausea and vomiting (CINV).[2][4][5] It is a5-HT3 antagonist.[2][4][5]

Palonosetron is administeredintravenously,[6] or as a single oral capsule.[7] It has a longer duration of action than other 5-HT3 antagonists. The oral formulation was approved on in August 2008, for prevention of acute CINV alone, as a large clinical trial did not show oral administration to be as effective as intravenous use against delayed CINV.[7] Palonosetron is a therapeutic alternative on theWorld Health Organization's List of Essential Medicines.[8]

The oral combinationnetupitant/palonosetron is approved for both acute and delayed CINV.[9][10][11][12]

Adverse effects

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The most common adverse effects are headache, which occurs in 4–11% of patients, and constipation in up to 6% of patients. In less than 1% of patients, othergastrointestinal disorders occur, as well assleeplessness,first- andsecond-degree atrioventricular block,muscle pain andshortness of breath. Palonosetron is similarly well tolerated as other 5-HT3 antagonists, and slightly less thanplacebo.[13][14]

Interactions

[edit]

Palonosetron does not relevantly inhibit or inducecytochrome P450 liver enzymes. There are case reports aboutserotonin syndrome when the drug is combined withserotonergic substances, such asselective serotonin reuptake inhibitors (SSRIs) andserotonin–norepinephrine reuptake inhibitors (SNRIs), two common types of antidepressants.[13][14]

Pharmacology

[edit]

Mechanism of action

[edit]

Palonosetron is a5-HT3 antagonist, commonly known as asetron. These drugs act by blockingserotonin from binding to the5-HT3 receptor.[15]

Pharmacokinetics

[edit]

Orally taken palonosetron is absorbed well from the gut and has abioavailability of 97%. Highest blood plasma levels are reached after 5.1±1.7 hours, independently of food intake, andplasma protein binding is 62%. 40% of the substance are eliminated in the unchanged form, and a further 45–50% are metabolized by the liver enzymeCYP2D6 and to a lesser extent byCYP3A4 andCYP1A2. The two main metabolites, theN-oxide and ahydroxy derivative, have less than 1% of palonosetron's antagonistic effect and are thus practically inactive.[13][14]

Palonosetron and its metabolites are mainly (to 80–93%) eliminated via the kidney.Biological half-life in healthy persons was 37±12 hours in a study, and 48±19 hours in cancer patients. In 10% of patients, half-life is over 100 hours.[13][14] Most other marketed setrons have half-lives in the range of about two to 15 hours.

The main metabolites of palonosetron, palonosetronN-oxide (left) and 6S-hydroxy-palonosetron (right)[10]

Chemistry

[edit]

The substance is solid at room temperature and melts at 87 to 88 °C (189 to 190 °F).[16] The infusions and capsules contain palonosetronhydrochloride,[13] which is also a solid. The hydrochloride is easily soluble in water, soluble inpropylene glycol, and slightly soluble inethanol andisopropyl alcohol.[14][17]

The molecule has twoasymmetric carbon atoms. It is used in form of the pure (S,S)-stereoisomer.[17]

Society and culture

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Economics

[edit]

Palonosetron was developed byHelsinn around 2001. In January 2003, Helsinn filed a provisional patent application on palonosetron. Over the next 10 years, Helsinn filed four patent applications that claimed priority to the January 2003 date. Relevant here, Helsinn filed its fourth patent application in 2013. That patent (the '219 patent) covers a fixed dose of 0.25 mg of palonosetron in a 5 ml solution. While developing the drug, Helsinn entered into a confidential licensing agreement with a company called MGI to sell palonosetron in the United States. This licensing agreement contained chemical information about palonosetron and dosage requirements. However, Helsinn did not file for a patent on palonosetron until two years after they had signed their agreement with MGI.[1]

In 2011Teva Pharmaceuticals - a generic drug manufacturer- challenged the validity of Helsinn's patent(s) by filing an application for a generic version of palonosetron with theFDA. Teva claimed that, because Helsinn disclosed/sold the 0.25 mg dose of palonosetron to MGI in 2003, which is more than a year (actually about 2 years) before the priority date of its '219 patent, this "secret" sale barredHelsinn from receiving a patent. This conclusion results from the language of theAmerica Invents Act, which bars patents on inventions, which were "in public use, on sale, or otherwise available to the public before the effective filing date of the claimed invention," 35 U. S. C. §102(a)(1).

The District Court held that the AIA's "on sale" provision did not apply, because the public disclosure of the agreements did not disclose the 0.25 mg dose. The Federal Circuit reversed, holding that the sale was publicly disclosed, regardless of whether the details of the invention were publicly disclosed in the terms of the sale agreements. TheSCOTUS agreed with theFederal Circuit, that in this case a commercial sale to a third party, who is required to keep the invention confidential, nevertheless placed the invention "on sale" under USC §102(a).[2]

References

[edit]
  1. ^ab"AusPAR: Palonosetron hydrochloride | Therapeutic Goods Administration (TGA)". Archived fromthe original on 2024-01-02. Retrieved2025-03-18.
  2. ^abc"Aloxi 250 micrograms solution for injection - Summary of Product Characteristics (SmPC)".(emc). 18 May 2018.Archived from the original on 24 January 2022. Retrieved23 January 2022.
  3. ^"Aloxi 500 micrograms soft capsules - Summary of Product Characteristics (SmPC)".(emc). 18 May 2018.Archived from the original on 24 January 2022. Retrieved24 January 2022.
  4. ^abc"Aloxi- palonosetron hydrochloride injection".DailyMed.Archived from the original on 24 January 2022. Retrieved23 January 2022.
  5. ^abc"Aloxi EPAR".European Medicines Agency. 13 March 2009.Archived from the original on 14 April 2021. Retrieved23 January 2022.
  6. ^De Leon A (October 2006)."Palonosetron (Aloxi): a second-generation 5-HT₃ receptor antagonist for chemotherapy-induced nausea and vomiting".Proceedings.19 (4):413–6.doi:10.1080/08998280.2006.11928210.PMC 1618755.PMID 17106506.
  7. ^abWaknine Y (September 4, 2008)."FDA Approvals: Nplate, Aloxi, Vidaza".Medscape.Archived from the original on 2008-12-02. Retrieved2008-09-04. Freely available with registration.
  8. ^World Health Organization (2025).The selection and use of essential medicines, 2025: WHO Model List of Essential Medicines, 24th list. Geneva: World Health Organization.hdl:10665/382243.
  9. ^"Akynzeo EPAR".European Medicines Agency. 23 June 2015.Archived from the original on 19 March 2020. Retrieved23 January 2022.
  10. ^ab"Akynzeo: Summary of Product Characteristics"(PDF).European Medicines Agency.Archived(PDF) from the original on 26 June 2016. Retrieved12 July 2016.
  11. ^"Akynzeo 300 mg/0.5 mg hard capsules - Summary of Product Characteristics (SmPC)".(emc). 11 February 2020.Archived from the original on 24 January 2022. Retrieved23 January 2022.
  12. ^"Akynzeo- netupitant and palonosetron capsule Akynzeo- fosnetupitant and palonosetron injection".DailyMed.Archived from the original on 18 October 2020. Retrieved24 January 2022.
  13. ^abcdeHaberfeld H, ed. (2015).Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag.
  14. ^abcdeDinnendahl V, Fricke U, eds. (2010).Arzneistoff-Profile (in German). Vol. 7 (23 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag.ISBN 978-3-7741-9846-3.
  15. ^Billio A, Morello E, Clarke MJ (January 2010). Billio A (ed.). "Serotonin receptor antagonists for highly emetogenic chemotherapy in adults".The Cochrane Database of Systematic Reviews (1) CD006272.doi:10.1002/14651858.CD006272.pub2.hdl:11379/614814.PMID 20091591. (Retracted, seedoi:10.1002/14651858.CD006272.pub3, PMID 24323437,  Retraction Watch)
  16. ^The Merck Index: An Encyclopedia of Chemicals, Drugs, and Biologicals (14 ed.). Merck & Co. 2006. p. 1206.ISBN 978-0-911910-00-1.
  17. ^ab"Chemistry Revire – Aloxi (Palonosetron HCl) Capsules, 0.5 mg"(PDF).Center for Drug Evaluation and Research. 13 August 2008. Archived fromthe original(PDF) on 5 August 2019. Retrieved13 July 2016.
5-HT3 serotonin ion
channel antagonists
5-HT serotonin G-protein
receptor antagonists
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