Adult Dosing

Prevention of chemotherapy-induced nausea and vomiting

• 0.15 mg/kg IV over 15 min q4 hrs for 3 doses. Give first dose 30 mins before chemotherapy. Subsequent doses are administered 4 and 8 hours after the first dose
• Max: 16 mg/dose
• Dilute ondansetron injection in 50 mL of 5% dextrose injection or 0.9% sodium chloride injection and infuse IV over 15 minutes

Prevention of postoperative nausea and vomiting

• 4 mg IM/IV before the end of anesthesia

Nausea and vomiting [Non-FDA Approved]

• 4-8 mg IM/IV q4-8 hours PRN

Pediatric Dosing

Prevention of chemotherapy-induced nausea and vomiting

• 6 months-18 yrs: 0.15 mg/kg IV over 15 min q4 hrs for 3 doses. Give first dose 30 mins before chemotherapy. Subsequent doses are administered 4 and 8 hours after the first dose
• Max: 16 mg/dose
• Dilute ondansetron injection in 50 mL of 5% dextrose injection or 0.9% sodium chloride injection and infuse IV over 15 minutes

Prevention of postoperative nausea and vomiting

• (1 month-12 yrs and <40 kg): 0.1-mg/kg IV over 2-5 mins immediately before the end of anesthesia
• (>12 yrs or >40 kg): 4 mg IV over 2-5 mins immediately before the end of anesthesia

Nausea and vomiting [Non-FDA Approved]

• 0.1-0.15 mg/kg IM/IV q4-8 hours PRN; max 4 mg

[Outline]

• Adult Dosing
• Pediatric Dosing

• Prevention of nausea and vomiting associated with cancer chemotherapy
• Prevention of postoperative nausea and/or vomiting

• Hypersensitivity to any of the ingredients of the product
• Concomitant use of apomorphine

• N/A

Renal Dose Adjustment

• Renal impairment: Dosage adjustments not defined

Hepatic Dose Adjustment

• Severe hepatic impairment (Child Pugh Class C): Max 8 mg IV q24 hrs

• Ondansetron causes hypersensitivity reaction in patients who have exhibited hypersensitivity to other selective 5-HT3 receptor antagonists
• Dose-dependent QT interval prolongation and Torsades de pointes reported with use of ondansetron. Avoid ondansetron in congenital long QT syndrome. Monitor ECG in patients with electrolyte abnormalities (eg, hypomagnesemia or hypokalemia), congestive heart failure, bradyarrhythmias, or patients taking other medications that lead to QT prolongation
• Ondansetron does not stimulate gastric or intestinal peristalsis; it should not be used instead of nasogastric suction. It masks a progressive ileus and/or gastric distention following surgery or chemotherapy
• Concomitant use of apomorphine is contraindicated, as it causes profound hypotension and loss of consciousness
• Intravenous ondansetron, causes transient ECG changes including QT interval prolongation

Cautions: Use cautiously in

• Hepatic impairment
• Abdominal surgery

Zofran interacts with :

Smoking

Pregnancy Category:B

Breastfeeding: Safety unknown. Manufacturer advises to use cautiously in nursing mothers.

• GI: Diarrhea, constipation
• CV: Chest pain, ECG changes, hypotension, tachycardia
• CNS: Headache, akathisia, drowsiness, anxiety
• NEURO: Acute dystonic reactions, extrapyramidal reactions, paresthesia
• HEPA: Elevate AST/ALT
• DERM: Rash, pruritus
• METABOLIC: Hypokalemia
• RESP: Bronchospasm
• MUSC: Musculoskeletal pain
• GU: Urine retension, dysuria
• HYPERSENSITIVITY: Stevens-Johnson syndrome, toxic epidermal necrolysis
• MISC: Sever hypersensitivity reaction, fever, fatigue, shiver, injection site reaction

• 5-HT3 receptor antagonist; blocks the effects of serotonin at 5-HT3 receptor sites located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS
• Metabolized by liver by hydroxylation; CYP450: 1A2, 2D6, and 3A4 substrate
• Renally excreted 5% unchanged
• Half-life: 3.5-5.5 hrs

US Trade Name(s)

• Zofran

US Availability

ondansetron (generic)

• INJ: 2 mg/mL
• INJ in 5% Dextrose: 32 mg/50 mL
• Premixed INJ: 32 mg/50 mL

Zofran

• INJ: 2 mg/mL
• INJ in 5% Dextrose: 32 mg/50 mL

Canadian Trade Name(s)

• Zofran

Canadian Availability

ondansetron (generic)

• INJ: 2 mg/mL (2, 4 mL amp, 20 mL vial)

Zofran

• INJ: 2 mg/mL (2, 4 mL amp, 20 mL vial)

UK Trade Name(s)

• Ondemet
• Zofran

UK Availability

ondansetron (generic)

• INJ: 2 mg/mL (2, 4 mL amp)

Zofran, Ondamet

• INJ: 2 mg/mL (2, 4 mL amp)

Australian Trade Name(s)

• Ondaz
• Zofran

Australian Availability

ondansetron (generic)

• INJ: 2 mg/mL (2, 4 mL amp)

Zofran, Ondaz

• INJ: 2 mg/mL (2, 4 mL amp)

[Outline]

Gastrointestinal

Antiemetics

5HT3 Receptor Antagonists