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Life sciences · Journal article
Indian Journal of Pharmacy and Pharmacology · October 12, 2026
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Introduction: Chemotherapy-induced nausea and vomiting (CINV) continues to be a major treatment-related problem for patients receiving anticancer therapy and can interfere with quality of life, adherence to treatment, and clinical recovery. Although several 5-hydroxytryptamine-3 (5-HT₃) receptor antagonists are routinely used for prophylaxis, comparative data describing their clinical and economic performance in Indian patients are limited.Objectives: To compare the efficacy, safety, and pharmacoeconomic profiles of Ondansetron, Granisetron, and Palonosetron for prevention of acute and delayed CINV in patients receiving moderately or highly emetogenic chemotherapy.Materials and Methods: This prospective, randomized, open-label comparative study was carried out in the Department of Oncology of a tertiary care teaching hospital in Andhra Pradesh. Ninety patients undergoing moderately or highly emetogenic chemotherapy were assigned equally to three treatment groups (30 per group) and received intravenous Ondansetron 8 mg, Granisetron 3 mg, or Palonosetron 0.75 mg before chemotherapy, together with dexamethasone. Participants were observed for 72 hours. Nausea, vomiting control, and complete response were used to assess efficacy; adverse drug reactions were recorded for safety evaluation. Direct acquisition costs were used for the pharmacoeconomic assessment.Results: Palonosetron produced the most favorable overall antiemetic response during the 72-hour observation period. Nausea occurred in 26.7% of patients receiving Palonosetron, compared with 40.0% with Granisetron and 56.7% with Ondansetron (p = 0.01). Complete response was highest in the Palonosetron group, with the clearest difference among patients receiving highly emetogenic chemotherapy (p < 0.05). The three regimens were generally well tolerated; constipation, headache, and dizziness were the commonly recorded adverse events, and no serious adverse drug reactions occurred. The acquisition cost per chemotherapy cycle was INR 414 for Palonosetron, INR 104 for Granisetron, and INR 68 for Ondansetron.Conclusion: In this study, Palonosetron provided better control of CINV than Ondansetron or Granisetron, with the greatest advantage observed for delayed symptoms and vomiting among patients receiving highly emetogenic chemotherapy. Its acquisition cost was higher, but the greater observed clinical benefit may support its use when reliable antiemetic control is a priority.