Ondansetron
Generic Name: ondansetron
(oral) (on DAN se tron)
Brand Names: Zofran, Zofran ODT, Zuplenz
What is ondansetron?
Ondansetron blocks the actions
of chemicals in the body that can trigger nausea and vomiting.
Ondansetron is used to prevent
nausea and vomiting that may be caused by surgery, cancer chemotherapy, or radiation treatment.
Ondansetron may be used for
purposes not listed in this medication guide.
Important information
You should not use ondansetron
if you are also using apomorphine (Apokyn).
You should not use ondansetron
if you are allergic to it or to similar medicines such as dolasetron (Anzemet),
granisetron (Kytril), or palonosetron (Aloxi).
Before taking ondansetron,
tell your doctor if you have liver disease, or a personal or family history of
Long QT syndrome.
Ondansetron orally
disintegrating tablets may contain phenylalanine. Tell your doctor if you have
phenylketonuria (PKU).
Serious side effects of
ondansetron include blurred vision or temporary vision loss (lasting from only
a few minutes to several hours), slow heart rate, trouble breathing, anxiety,
agitation, shivering, feeling like you might pass out, and urinating less than
usual or not at all. Stop taking this medicine and call your doctor at once if
you have any of these side effects. Ondansetron may impair your thinking or
reactions. Be careful if you drive or do anything that requires you to be
alert.
Before taking ondansetron
You should not use ondansetron
if:
·
you are also using apomorphine
(Apokyn); or
·
you are allergic to
ondansetron or similar medicines (dolasetron, granisetron, palonosetron).
To make sure ondansetron is
safe for you, tell your doctor if you have:
·
liver disease;
·
an electrolyte imbalance (such
as low levels of potassium or magnesium in your blood);
·
congestive heart failure, slow
heartbeats;
·
a personal or family history
of long QT syndrome; or
·
a blockage in your digestive
tract (stomach or intestines).
Ondansetron is not expected to
harm an unborn baby. Tell your doctor if you are pregnant.
It is not known whether
ondansetron passes into breast milk or if it could harm a nursing baby. Tell
your doctor if you are breast-feeding a baby.
Ondansetron is not approved
for use by anyone younger than 4 years old.
Ondansetron orally
disintegrating tablets may contain phenylalanine. Tell your doctor if you have
phenylketonuria (PKU).
How should I take ondansetron?
Take ondansetron exactly as
prescribed by your doctor. Follow all directions on your prescription label. Do
not take this medicine in larger or smaller amounts or for longer than
recommended.
Ondansetron can be taken with
or without food.
The first dose is usually
taken before the start of your surgery, chemotherapy, or radiation treatment.
Follow your doctor's dosing instructions very carefully.
Take the ondansetron regular
tablet with a full glass of water.
To take the orally
disintegrating tablet (Zofran ODT):
·
Keep the tablet in its blister
pack until you are ready to take it. Open the package and peel back the foil.
Do not push a tablet through the foil or you may damage the tablet.
·
Use dry hands to remove the
tablet and place it in your mouth.
·
Do not swallow the tablet
whole. Allow it to dissolve in your mouth without chewing.
·
Swallow several times as the
tablet dissolves.
To use ondansetron oral
soluble film (strip) (Zuplenz):
·
Keep the strip in the foil
pouch until you are ready to use the medicine.
·
Using dry hands, remove the
strip and place it on your tongue. It will begin to dissolve right away.
·
Do not swallow the strip
whole. Allow it to dissolve in your mouth without chewing.
·
Swallow several times after
the strip dissolves. If desired, you may drink liquid to help swallow the
dissolved strip.
·
Wash your hands after using
Zuplenz.
Measure liquid medicine with
the dosing syringe provided, or with a special dose-measuring spoon or medicine
cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Store at room temperature away
from moisture, heat, and light. Store liquid medicine in an
upright position.
See also: Dosage Information (in
more detail)
What happens if I miss a dose?
Take the missed dose as soon
as you remember. Skip the missed dose if it is almost time for your next
scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical
attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include
sudden loss of vision, severe constipation, feeling light-headed, or fainting.
What should I avoid while taking ondansetron?
Ondansetron may impair your
thinking or reactions. Be careful if you drive or do anything that requires you
to be alert.
Ondansetron side effects
Get emergency medical help if
you have signs of an allergic reaction to ondansetron: rash,
hives; fever, chills, difficult breathing; swelling of your face, lips, tongue,
or throat.
Call your doctor at once if
you have:
·
severe constipation, stomach
pain, or bloating;
·
headache with chest pain and
severe dizziness, fainting, fast or pounding heartbeats;
·
fast or pounding heartbeats;
·
jaundice (yellowing of the
skin or eyes);
·
blurred vision or temporary
vision loss (lasting from only a few minutes to several hours);
·
high levels of serotonin in
the body--agitation, hallucinations, fever, fast heart rate, overactive
reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting.
Common ondansetron side
effects may include:
·
diarrhea or constipation;
·
headache;
·
drowsiness; or
·
tired feeling.
This is not a complete list of
side effects and others may occur. Call your doctor for medical advice about
side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Side
effects (in more detail)
Ondansetron dosing information
Usual Adult Dose of
Ondansetron for Nausea/Vomiting -- Chemotherapy Induced:
Oral:
Highly Emetogenic Cancer Chemotherapy (HEC):
-Recommended dose: 24 mg orally 30 minutes before the start of single-day HEC
(including cisplatin doses of 50 mg/m2 or greater)
Moderately Emetogenic Cancer Chemotherapy (MEC):
-Recommended dose: 8 mg orally twice a day, with the first dose administered 30
minutes before the start of chemotherapy and the subsequent dose 8 hours later;
then 8 mg orally 2 times a day (every 12 hours) for 1 to 2 days after the
completion of chemotherapy
Parenteral:
-Recommended dose: 0.15 mg/kg IV, with the first dose (infused over 15 minutes)
30 minutes before the start of emetogenic chemotherapy and subsequent doses
given 4 and 8 hours after the first dose.
-Maximum dose: 16 mg per dose
Comments:
-Multi-day, single-dose administration of 24 mg orally for HEC has not been studied.
-The injection formulation should be diluted prior to IV administration.
Uses:
-Prevention of nausea and vomiting associated with HEC or MEC
-Prevention of nausea and vomiting associated with initial and repeat courses
of emetogenic chemotherapy
Usual Adult Dose of
Ondansetron for Nausea/Vomiting:
Oral:
Highly Emetogenic Cancer Chemotherapy (HEC):
-Recommended dose: 24 mg orally 30 minutes before the start of single-day HEC
(including cisplatin doses of 50 mg/m2 or greater)
Moderately Emetogenic Cancer Chemotherapy (MEC):
-Recommended dose: 8 mg orally twice a day, with the first dose administered 30
minutes before the start of chemotherapy and the subsequent dose 8 hours later;
then 8 mg orally 2 times a day (every 12 hours) for 1 to 2 days after the
completion of chemotherapy
Parenteral:
-Recommended dose: 0.15 mg/kg IV, with the first dose (infused over 15 minutes)
30 minutes before the start of emetogenic chemotherapy and subsequent doses
given 4 and 8 hours after the first dose.
-Maximum dose: 16 mg per dose
Comments:
-Multi-day, single-dose administration of 24 mg orally for HEC has not been
studied.
-The injection formulation should be diluted prior to IV administration.
Uses:
-Prevention of nausea and vomiting associated with HEC or MEC
-Prevention of nausea and vomiting associated with initial and repeat courses
of emetogenic chemotherapy
Usual Adult Dose of
Ondansetron for Nausea/Vomiting -- Postoperative:
Oral:
-Recommended dose: 16 mg orally 1 hour before the induction of anesthesia
Parenteral:
-Recommended dose: 4 mg IV (undiluted) immediately before induction of
anesthesia or postoperatively (nausea and/or vomiting within 2 hours after
surgery)
-Alternative route: 4 mg IM (undiluted)
Comment:
-Administration of a second dose does not provide additional control of nausea
and vomiting.
Use:
-Prevention of postoperative nausea and vomiting
Usual Adult Dose for
Nausea/Vomiting--Radiation Induced:
Recommended dose: 8 mg orally
3 times a day
-Total Body Irradiation: 8 mg orally 1 to 2 hours before each fraction of
radiotherapy administered each day
-Single High-dose Fraction Radiotherapy to the Abdomen: 8 mg orally 1 to 2
hours before radiotherapy, with subsequent doses every 8 hours after the first
dose for 1 to 2 days after the completion of radiotherapy
-Daily Fractionated Radiotherapy to the Abdomen: 8 mg orally 1 to 2 hours
before radiotherapy, with subsequent doses every 8 hours after the first dose
for each day radiotherapy is given
Use:
-Prevention of nausea and vomiting associated with radiotherapy, either as
total body irradiation, single high-dose fraction, or daily fractions to the
abdomen
Usual Pediatric Dose for
Nausea/Vomiting -- Postoperative:
Parenteral:
1 month to 12 years:
Less than 40 kg:
-Recommended dose: 0.1 mg/kg IV over 2 to 5 minutes immediately prior
to/following anesthesia induction or postoperatively (nausea and/or vomiting
occurring shortly after surgery)
40 kg and greater:
-Recommended dose: 4 mg IV over 2 to 5 minutes immediately prior to/following
anesthesia induction or postoperatively (nausea and/or vomiting occurring
shortly after surgery)
Use:
-Prevention of postoperative nausea and vomiting
Usual Pediatric Dose for
Nausea/Vomiting -- Chemotherapy Induced:
Oral:
4 to 11 years:
-Recommended dose: 4 mg orally 3 times a day, with the first dose administered
30 minutes before the start of chemotherapy, and subsequent doses 4 and 8 hours
after the first dose; then 4 mg orally 3 times a day (every 8 hours) for 1 to 2
days after the completion of chemotherapy
12 years and older:
-Recommended dose: 8 mg orally twice a day, with the first dose administered 30
minutes before the start of chemotherapy and the subsequent dose 8 hours later;
then 8 mg orally 2 times a day (every 12 hours) for 1 to 2 days after the completion
of chemotherapy
Parenteral:
6 months to 18 years:
-Recommended dose: 0.15 mg/kg IV, with the first dose (infused over 15 minutes)
30 minutes before the start of emetogenic chemotherapy, and subsequent doses
given 4 and 8 hours after the first dose
-Maximum dose: 16 mg (per dose)
Comments:
-The injection formulation should be diluted in 50 mL prior to IV
administration.
-This drug should be used to prevent nausea and vomiting associated with
moderately to highly emetogenic chemotherapy.
Uses:
-Prevention of nausea and vomiting associated with moderately emetogenic cancer
chemotherapy
-Prevention of nausea and vomiting associated with initial and repeat courses
of emetogenic chemotherapy
What other drugs will affect ondansetron?
Ondansetron can cause a
serious heart problem, especially if you use certain medicines at the same
time, including antibiotics, antidepressants, heart rhythm medicine,
antipsychotic medicines, and medicines to treat cancer, malaria, HIV or AIDS.
Tell your doctor about all medicines you use, and those you start or stop using
during your treatment with ondansetron.
Taking ondansetron while you
are using certain other medicines can cause high levels of serotonin to
build up in your body, a condition called "serotonin syndrome," which
can be fatal. Tell your doctor if you also use:
·
medicine to treat depression;
·
medicine to treat a
psychiatric disorder;
·
a narcotic (opioid)
medication; or
·
medicine to prevent nausea and
vomiting.
This list is not complete and
many other drugs can interact with ondansetron. This includes prescription and
over-the-counter medicines, vitamins, and herbal products. Give a list of all
your medicines to any healthcare provider who treats you.
