Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

ondansetron (Rx)Brand and Other Names:Zofran, Zofran ODT, more...Zuplenz

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 2mg/mL

tablet

  • 4mg
  • 8mg
  • 24mg

oral solution

  • 4mg/5mL

oral soluble film

  • 4mg
  • 8mg

orally disintegrating tablets

  • 4mg
  • 8mg
more...

Chemotherapy-Induced Nausea & Vomiting

Prophylaxis

PO

  • Moderately emetogenic chemotherapy: 8 mg started 30 minutes before chemotherapy, then q12hr for 1-2 days after chemotherapy
  • Highly emetogenic chemotherapy: 24 mg started 30 minutes before chemotherapy
  • Zofran ODT: Using dry hands, carefully remove from blister pack immediately before use

IV

  • 0.15 mg/kg over 15 min administered 30 min before chemotherapy, then 4 and 8 hr after first dose; not to exceed 16 mg (32 mg no longer recommended because of increased risk of QT prolongation) 

Postoperative Nausea & Vomiting

Prophylaxis

4 mg IV/IM immediately before anesthesia or after procedure or 16 mg PO 1 hr before anesthesia; patients >80 kg may need additional 4 mg IV

Radiation-Induced Nausea & Vomiting

Prophylaxis

Total body radiation therapy: 8 mg PO 1-2 hours before radiation therapy; administered each day

Single high-dose fraction therapy to abdomen: 8 mg PO 1-2 hr before radiation therapy; administer subsequent doses every 8 hr after first dose 1-2 days after completion of therapy

Daily fractions to abdomen: Administer 8 mg PO 1-2 hr before radiotherapy; administer subsequent doses every 8 hr after first dose each day radiotherapy is given

Dosage Modifications

Renal impairment: Dose adjustment not necessary

Severe hepatic impairment (Child-Pugh score ≥10): Not to exceed 8 mg/day

Cholestatic Pruritus (Off-label)

8 mg divided q12hr or 8 mg q8-12hr PO for 7 days up to 5 months

Alternatively, 4-8 mg intermittent short-term IV dosing used in adults; single dose of 4 mg single dose used in pregnancy

Uremic Pruritus (Off-label)

8 mg divided q12hr or 8 mg q8-12hr PO for 14 days up to 5 months

Spinal Opioid-Induced Pruritus (Off-label)

Prophylaxis: 4-8 mg IV 20-30 min prior to spinal opioid therapy; may repeat dosing at 12, 24, 36, 48 hr after spinal opioid dosing

Treatment: 4-8 mg IV

Rosacea (Off-label)

4-8 mg PO q12hr for up to 3 weeks

Alternatively, 12 mg IV daily for 4 days

Hyperemesis Gravidarum

10 mg IV q8hr PRN

Dosage Forms & Strengths

injectable solution

  • 2mg/mL

tablet

  • 4mg
  • 8mg

oral solution

  • 4mg/5mL

oral soluble film

  • 4mg
  • 8mg

orally disintegrating tablets

  • 4mg
  • 8mg
more...

Chemotherapy-Induced Nausea & Vomiting

Prophylaxis

PO

  • <4 years old: Safety and efficacy not established
  • 4-12 years: 4 mg started 30 min before chemotherapy, then 4 and 8 hr after first dose, then q8hr for 1-2 days after chemotherapy
  • >12 years: 8 mg started 30 min before chemotherapy, then q12hr for 1-2 days after chemotherapy, or single dose of 24 mg

IV

  • <6 months: Safety and efficacy not established
  • ≥6 months: 0.15 mg/kg over 15 min administered 30 min before chemotherapy, then repeated 4 and 8 hr after first dose; not to exceed 16 mg/dose (32 mg no longer recommended because of increased risk of QT prolongation)  

Postoperative Nausea & Vomiting

Prophylaxis

1 month-12 years

  • <40 kg, 0.1 mg/kg IV 
  • >40 kg, 4 mg IV

>12 years

  • 4 mg IV/IM immediately before anesthesia or after procedure or 16 mg PO 1 hr before anesthesia; patients >80 kg may need additional 4 mg IV

Chemotherapy-Induced Nausea & Vomiting (Orphan)

Ondansetron inhalation powder: Prevention of chemotherapy-induced nausea and vomiting due to highly emetogenic chemotherapy in pediatric patients (aged birth through 16 yr)

Sponsor

  • Luxena Pharmaceuticals, Inc; 1400 Coleman Avenue, Suite D27; Santa Clara, California 95050
Next

Interactions

Interaction Checker

ondansetron and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            >10%

            Headache (9-27%)

            Malaise/fatigue (9-13%)

            Constipation (6-11%)

            1-10%

            Hypoxia (9%)

            Drowsiness (8%)

            Diarrhea (2-7%)

            Dizziness (7%)

            Fever (2-8%)

            Gynecologic disorder (7%)

            Anxiety (6%)

            Urinary retention (5%)

            Pruritus (2-5%)

            Injection-site pain (4%)

            Paresthesia (2%)

            Cold sensation (2%)

            Elevated liver function test results (1-5%)

            <1%

            Cardiac: Arrhythmias (including ventricular and supraventricular tachycardia, premature ventricular contractions, and atrial fibrillation), bradycardia, electrocardiographic alterations (including second-degree heart block, QT/QTc interval prolongation, and ST segment depression), palpitations, and syncope; rarely and predominantly with intravenous ondansetron, transient ECG changes including QT/QTc interval prolongation have been reported

            Gastrointestinal: Nausea and vomiting

            Anaphylaxis

            ECG alterations: Arrhythmias; prolongation of PR, QRS, and QT intervals

            Hepatobiliary: Specific hepatic enzyme abnormalities, hepatic necrosis, and abnormal hepatic function

            General: Flushing, rare cases of hypersensitivity reactions, sometimes severe (eg, anaphylactic reactions, angioedema, bronchospasm, cardiopulmonary arrest, hypotension, laryngeal edema, laryngospasm, shock, shortness of breath, stridor)

            Local reactions: Pain, redness, and burning at injection site

            Lower respiratory: Hiccups

            Neurological: Oculogyric crisis, appearing alone, as well as with other dystonic reactions; transient dizziness during or shortly after intravenous infusion

            Skin and subcutaneous tissue: Urticaria, Stevens-Johnson syndrome, and toxic epidermal necrolysis

            Eye Disorders: Transient blindness (predominantly during IV administration) reported to resolve within a few minutes up to 48 hr; transient blurred vision

            Musculoskeletal and connective tissue: Arthralgia

            Previous
            Next

            Warnings

            Contraindications

            Hypersensitivity

            Coadministration with apomorphine; combination reported to cause profound hypotension and loss of consciousness

            Cautions

            Reduce dose with severe hepatic impairment

            Use according to schedule, not PRN

            Do not use instead of nasogastric suction

            Ondansetron may mask progressive ileus or gastric distention in patients who are undergoing abdominal surgery or experiencing chemotherapy-induced nausea and vomiting

            Serotonin syndrome reported with 5-HT3 receptor antagonists alone but particularly with concomitant use of serotonergic drugs including SSRIs, SNRIs, MAO inhibitors, lithium, tramadol, methylene blue IV, and mirtazapine

            Cross-sensitivity among selective serotonin antagonists may occur

            Zofran ODT contains phenylalanine (caution for phenylketonurics)

            Dose-dependent QT prolongation; avoid in patients with congenital long QT syndrome; ECG monitoring recommended in patients who have electrolyte abnormalities, CHF, or bradyarrhythmias or who are also receiving other medications that cause QT prolongation

            Previous
            Next

            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Not known whether drug crosses into breast milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next

            Pharmacology

            Mechanism of Action

            Mechanism not fully characterized; selective 5-HT3 receptor antagonist; binds to 5-HT3 receptors both in periphery and in CNS, with primary effects in GI tract

            Has no effect on dopamine receptors and therefore does not cause extrapyramidal symptoms

            Absorption

            Bioavailability: 56-71% (PO); food increases extent of absorption (17%)

            Onset: 30 min

            Peak plasma time: IV, end of infusion; IM, 30 min; PO, 2 hr (tablet) or 1 hr (soluble film)

            Distribution

            Protein bound: 70-76%

            Vd: Children, 1.7-3.7 L/kg; adults, 2.2-2.5 L/kg

            Metabolism

            Extensive hepatic metabolism, with hydroxylation followed by glucuronide (indole ring) or sulfate conjugation; metabolized by CYP2D6 and partly by CYP1A2 and CYP3A4

            Metabolites: Glucuronide conjugate, sulfate conjugate (inactive)

            Elimination

            Half-life: 2-7 hr (children <15 years); 3-7 hr (adults); patients with mild to moderate hepatic impairment, 12 hr; patients with severe hepatic impairment (Child-Pugh class C), 20 hr

            Renal Clearance: 0.26-0.38 L/hr/kg

            Total body clearance: 600-700 mL/min

            Excretion: Primarily urine (30-70%); feces (25%)

            Previous
            Next

            Administration

            IV Incompatibilities

            Syringe: Droperidol

            Y-site: Acyclovir, allopurinol, aminophylline, amphotericin B, amphotericin B cholesteryl sulfate, ampicillin, ampicillin/sulbactam, amsacrine, cefepime, cefoperazone, 5-fluorouracil (5-FU; at 1 mg/mL ondansetron and 16 mg/mL 5-FU; may be compatible at 0.8 mg/mL 5-FU and up to 160 mcg/mL ondansetron), furosemide, ganciclovir, lorazepam, meropenem (at 50 mg/mL meropenem and 1 mg/mL ondansetron; may be compatible at 1 mg/mL each), methylprednisolone, piperacillin, sargramostim, sodium bicarbonate

            IV Compatibilities

            Solution: Compatible with most common solvents

            Additive (partial list): Cisplatin, cyclophosphamide, cytarabine, decarbazine, dacarbazine with doxorubicin(?), doxorubicin, etoposide, hydromorphone, meropenem (incompatible at 20 g/L meropenem), methotrexate, morphine sulfate

            Syringe: Alfentanil, atropine, dexamethasone (incompatible at 0.67 mg/mL dexamethasone and 1.07 mg/mL ondansetron), fentanyl, glycopyrrolate, meperidine, metoclopramide, midazolam, morphine sulfate, naloxone, neostigmine, propofol

            Y-site (partial list): Alatrofloxacin, aldesleukin, azithromycin, bleomycin, carboplatin, cisplatin, cladribine, clindamycin, cyclophosphamide, cytarabine, dactinomycin, dopamine, heparin, hydromorphone, magnesium sulfate, meperidine, morphine sulfate, paclitaxel, potassium chloride, topotecan, vancomycin, vinblastine, vincristine, zidovudine

            IV Preparation

            No dilution necessary for premixed injection

            Postoperative nausea and vomiting: No dilution necessary for 2 mg/mL vials

            Chemotherapy-induced nausea and vomiting: Dilute IV injection (2 mg/mL vials, not premixed injection) in 50 mL D5W or NS

            IV Administration

            Infuse over 15 minutes after further dilution with 50 mL NS/D5W

            Inject undiluted over at least 30 seconds, preferably over 2-5 minutes

            IM Administration

            No dilution necessary for premixed injection

            Storage

            Store at room temperature or refrigerate

            Protect from light, excessive heat, and freezing

            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.