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DWIGHT D. KLOTH, PHARM.D., FCCP, BCOP, is Director of Pharmacy, Fox Chase Cancer Center, 333 Cottman Avenue, Room H4-131, Philadelphia, PA 19111, (Dwight.Kloth{at}fccc.edu).

Purpose. Research regarding new pharmacologic findings in regards to the treatment of postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) are discussed. Summary. PONV and PDNV have many important negative outcomes, including medical complications and financial consequences. Great strides in basic research have identified a plethora of mechanisms involved in regulating and processing the emetic reflex, and subsequent development of antiemetic treatments has lessened these burdens. The currently available antiemetic agents are not able to individually ameliorate PONV, so guidelines have been developed that recommend administering a combination of antiemetic treatments from different drug classes as prophylaxis, especially for high-risk patients. Recent research has indicated that due to the unique structural characteristics of palonosetron that impact receptor binding, this 5-HT3 receptor antagonist has a pharmacokinetic and pharmacologic profile different from other inhibitors within the drug class. Implications of the high affinity, allosteric, and positive cooperative binding properties of palonosetron include longer and tighter binding to the 5-HT3 receptor, making palonosetron a very efficient antagonist and less likely to be displaced by the binding of serotonin. Conclusion. Ongoing research is warranted in order to better prevent and manage PONV and PDNV. Index terms: Antiemetics; Mechanism of action; Palonosetron; Pharmacokinetics; Postoperative nausea and vomiting; Protocols