Ondansetron

Ondansetron Brand Names- Zofran | Zofran ODT | Zuplenz

What is Ondansetron

Ondansetron is an oral and parenteral serotonin (5-HT₃) receptor antagonist. It is used as an antiemetic agent for the prevention and treatment of nausea and vomiting during chemotherapy, radiation therapy, and surgery.

Ondansetron has occasionally been utilized for the treatment of hyperemesis gravidarum refractory to other treatments.

Novel investigational uses of ondansetron include treatment of gastrointestinal motility disorders and drug dependence (e.g., alcoholism). In the pediatric population, ondansetron is also used off-label for cyclic vomiting syndrome and gastroenteritis-induced vomiting.

Ondansetron is an extremely safe and highly effective antiemetic compared to older, traditional antiemetics (e.g., metoclopramide, droperidol); however, there is a risk of dose-dependent QT-prolongation and torsade de points.

When administered at optimal doses, ondansetron and other 5HT₃ receptor antagonists (e.g., granisetron) are equally effective.

The American Society of Clinical Oncology (ASCO) and the Multinational Association of Supportive Care in Cancer (MASCC) and European Society of Clinical Oncology (ESMO) guidelines both recommend combination therapy with a 5-HT₃ receptor antagonist plus a corticosteroid in children receiving chemotherapy of moderate or high emetogenic risk.

The Society for Ambulatory Anesthesia (SAMBA) guidelines recommend the use of a 5-HT₃ receptor antagonist as the first choice for prophylaxis of postoperative nausea and vomiting in children.

Ondansetron was originally approved for the treatment of chemotherapy-induced nausea/vomiting by the FDA in January 1991 and oral dosage forms were approved for the treatment of post-operative nausea/vomiting in April 1995.

An orally disintegrating tablet, Zofran ODT, was approved by the FDA in February 1999.

The FDA accepted an NDA for Zensana oral spray in August 2006.

Indications

1. alcohol dependence
2. chemotherapy-induced nausea/vomiting prophylaxis
3. cyclic vomiting syndrome
4. gastroenteritis
5. hyperemesis gravidarum
6. post-operative nausea/vomiting (PONV)
7. post-operative nausea/vomiting (PONV) prophylaxis
8. pregnancy-induced nausea/vomiting
9. pruritus
10. radiation-induced nausea/vomiting prophylaxis

For chemotherapy-induced nausea/vomiting prophylaxis (CINV prophylaxis) and radiation-induced nausea/vomiting prophylaxis (RINV prophylaxis)

Side Effects

1. agitation
2. anaphylactoid reactions
3. angina
4. angioedema
5. anxiety
6. atrial fibrillation
7. AV block
8. blurred vision
9. bradycardia
10. bronchospasm
11. cardiac arrest
12. chest pain (unspecified)
13. chills
14. constipation
15. diarrhea
16. dizziness
17. drowsiness
18. dyspnea
19. dystonic reaction
20. elevated hepatic enzymes
21. fatigue
22. fever
23. flushing
24. headache
25. hepatic failure
26. hiccups
27. hypokalemia
28. hypotension
29. injection site reaction
30. laryngeal edema
31. laryngospasm
32. malaise
33. palpitations
34. paresthesias
35. premature ventricular contractions (PVCs)
36. pruritus
37. QT prolongation
38. rash
39. respiratory arrest
40. seizures
41. serotonin syndrome
42. sinus tachycardia
43. ST-T wave changes
44. Stevens-Johnson syndrome
45. supraventricular tachycardia (SVT)
46. syncope
47. torsade de pointes
48. toxic epidermal necrolysis
49. urinary retention
50. urticaria
51. ventricular tachycardia
52. visual impairment

Monitoring Parameters

• ECG
• LFTs
• serum electrolytes

Contraindications

• apheresis
• AV block
• bradycardia
• breast-feeding
• cardiomyopathy
• celiac disease
• children
• dolasetron hypersensitivity
• females
• fever
• geriatric
• GI obstruction
• granisetron hypersensitivity
• heart failure
• hepatic disease
• hepatitis
• human immunodeficiency virus (HIV) infection
• hyperparathyroidism
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypothermia
• hypothyroidism
• ileus
• infants
• long QT syndrome
• myocardial infarction
• neonates
• ondansetron hypersensitivity
• palonosetron hypersensitivity
• phenylketonuria
• pheochromocytoma
• pregnancy
• QT prolongation
• rheumatoid arthritis
• sickle cell disease
• sleep deprivation
• stroke
• systemic lupus erythematosus (SLE)

Interactions

• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Codeine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Tramadol
• Aclidinium; Formoterol
• Albuterol
• Albuterol; Ipratropium
• Alfentanil
• Alfuzosin
• Amiodarone
• Amlodipine; Celecoxib
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Anagrelide
• Apomorphine
• Aprepitant, Fosaprepitant
• Arformoterol
• Aripiprazole
• Arsenic Trioxide
• Artemether; Lumefantrine
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atazanavir
• Atazanavir; Cobicistat
• Atomoxetine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Azelastine; Fluticasone
• Azithromycin
• Barbiturates
• Beclomethasone
• Bedaquiline
• Benzhydrocodone; Acetaminophen
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Bepridil
• Betamethasone
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Boceprevir
• Bosentan
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Budesonide
• Budesonide; Formoterol
• Buprenorphine
• Buprenorphine; Naloxone
• Carbamazepine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carvedilol
• Celecoxib
• Ceritinib
• Chloroquine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpromazine
• Ciclesonide
• Ciprofloxacin
• Cisapride
• Citalopram
• Clarithromycin
• Clofazimine
• Clozapine
• Cobicistat
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Conivaptan
• Corticosteroids
• Cortisone
• Crizotinib
• Cyclophosphamide
• Daclatasvir
• Darunavir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Dasatinib
• Deflazacort
• Degarelix
• Desflurane
• Desvenlafaxine
• Deutetrabenazine
• Dexamethasone
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Disopyramide
• Dofetilide
• Dolasetron
• Dolutegravir; Rilpivirine
• Donepezil
• Donepezil; Memantine
• Dronedarone
• Droperidol
• Duloxetine
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elbasvir; Grazoprevir
• Eliglustat
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Encorafenib
• Enflurane
• Entrectinib
• Eribulin
• Erythromycin
• Erythromycin; Sulfisoxazole
• Escitalopram
• Etravirine
• Ezogabine
• Fenfluramine
• Fentanyl
• Fingolimod
• Flecainide
• Fluconazole
• Fludrocortisone
• Flunisolide
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Fluticasone
• Fluticasone; Salmeterol
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Fluvoxamine
• Formoterol
• Formoterol; Mometasone
• Fosamprenavir
• Foscarnet
• Fosphenytoin
• Gemifloxacin
• Gemtuzumab Ozogamicin
• Gilteritinib
• Glasdegib
• Glecaprevir; Pibrentasvir
• Glycopyrrolate; Formoterol
• Goserelin
• Granisetron
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Halogenated Anesthetics
• Haloperidol
• Halothane
• Histrelin
• Homatropine; Hydrocodone
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydrocortisone
• Hydromorphone
• Hydroxychloroquine
• Hydroxyzine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Ibutilide
• Idelalisib
• Iloperidone
• Indacaterol
• Indacaterol; Glycopyrrolate
• Inotuzumab Ozogamicin
• Ipecac
• Isavuconazonium
• Isocarboxazid
• Isoflurane
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Itraconazole
• Ivosidenib
• Ixabepilone
• Ketoconazole
• Lapatinib
• Lasmiditan
• Ledipasvir; Sofosbuvir
• Lefamulin
• Lenvatinib
• Leuprolide
• Leuprolide; Norethindrone
• Levalbuterol
• Levofloxacin
• Levomethadyl
• Levomilnacipran
• Levorphanol
• Linezolid
• Lithium
• Lofexidine
• Long-acting beta-agonists
• Loop diuretics
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Lumacaftor; Ivacaftor
• Macimorelin
• Maprotiline
• Mefloquine
• Meperidine
• Meperidine; Promethazine
• Mesoridazine
• Metaproterenol
• Methadone
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methylene Blue
• Methylprednisolone
• Metronidazole
• Midostaurin
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• Mirabegron
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• Mitotane
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• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Moxifloxacin
• Nalbuphine
• Nilotinib
• Norfloxacin
• Octreotide
• Ofloxacin
• Olanzapine
• Olodaterol
• Ombitasvir; Paritaprevir; Ritonavir
• Omeprazole; Amoxicillin; Rifabutin
• Oritavancin
• Osilodrostat
• Osimertinib
• Oxaliplatin
• Oxybutynin
• Oxycodone
• Oxymorphone
• Ozanimod
• Paliperidone
• Panobinostat
• Paroxetine
• Pasireotide
• Pazopanib
• Pentamidine
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenylephrine; Promethazine
• Phenytoin
• Pimavanserin
• Pimozide
• Pirbuterol
• Pitolisant
• Posaconazole
• Prednisolone
• Prednisone
• Primaquine
• Procainamide
• Prochlorperazine
• Promethazine
• Propafenone
• Quetiapine
• Quinidine
• Quinine
• Ranolazine
• Remifentanil
• Ribociclib
• Ribociclib; Letrozole
• Rifabutin
• Rifampin
• Rifapentine
• Rilpivirine
• Risperidone
• Ritonavir
• Rolapitant
• Romidepsin
• Salmeterol
• Sapropterin
• Saquinavir
• Selegiline
• Selpercatinib
• Sertraline
• Sevoflurane
• Short-acting beta-agonists
• Siponimod
• Sofosbuvir; Velpatasvir; Voxilaprevir
• Solifenacin
• Sorafenib
• Sotalol
• Sparfloxacin
• St. John’s Wort, Hypericum perforatum
• Sufentanil
• Sunitinib
• Tacrolimus
• Tamoxifen
• Tapentadol
• Telaprevir
• Telavancin
• Telithromycin
• Telotristat Ethyl
• Terbutaline
• Tetrabenazine
• Thiazide diuretics
• Thioridazine
• Tiotropium; Olodaterol
• Tolterodine
• Tolvaptan
• Toremifene
• Tramadol
• Tranylcypromine
• Trazodone
• Triamcinolone
• Triclabendazole
• Tricyclic antidepressants
• Trifluoperazine
• Triptorelin
• Umeclidinium; Vilanterol
• Vandetanib
• Vardenafil
• Vemurafenib
• Venlafaxine
• Vilazodone
• Voriconazole
• Vorinostat
• Ziprasidone
• Zonisamide