Indications |
Oral Prophylaxis of postoperative nausea and vomiting Adult: 16 mg taken 1 hr before anaesthesia; or 8 mg taken 1 hr before anaesthesia followed by 2 more doses of 8 mg at 8-hr intervals. Hepatic impairment: Moderate or severe hepatic impairment: Max: 8 mg daily. Oral Nausea and vomiting associated with cancer chemotherapy Adult: 24 mg, as a single dose, 30 minutes before the start of single-day chemotherapy. Child: 4-11 yr: 4 mg 30 minutes before chemotherapy; repeat dose at 4 and 8 hr after initial dose, then 4 mg every 8 hr for 1-2 days after completion of chemotherapy. Hepatic impairment: Moderate or severe hepatic impairment: Max: 8 mg daily. Oral Nausea and vomiting associated with cancer chemotherapy or radiotherapy Adult: For less emetogenic chemotherapy and/or radiotherapy: 8 mg 2 hr before treatment followed by 8 mg 8-12 hr later. Hepatic impairment: Moderate or severe hepatic impairment: Max: 8 mg daily. Oral Prevent delayed emesis following chemotherapy Adult: 8 mg bid, for up to 5 days after the end of a course of chemotherapy. Hepatic impairment: Moderate or severe hepatic impairment: Max: 8 mg daily. Parenteral Nausea and vomiting associated with cancer chemotherapy Adult: For highly emetogenic chemotherapy: 8 mg as a single dose, given via IM or slow IV inj immediately before treatment; or 8 mg IM or slow IV inj given immediately before treatment followed by either continuous IV infusion of 1 mg/hr for up to 24 hr or by a further 2 doses of 8 mg 2-4 hr apart; or 32 mg as a single dose via IV infusion over ≥15 minutes immediately before treatment; or 150 mcg/kg via IV infusion over 15 minutes (beginning 30 minutes before chemotherapy) and repeated 4 and 8 hr after the 1st dose. Anti-emetic efficacy can be enhanced by giving 20 mg dexamethasone sodium phosphate via IV admin before chemotherapy. Child: ≥6 mth: 150 mcg/kg via IV infusion 30 minutes before the start of chemotherapy, repeat dose at 4 and 8 hr after the first dose; or 0.45 mg/kg/day as a single dose. Hepatic impairment: Moderate or severe hepatic impairment: Max: 8 mg daily. Parenteral Prophylaxis of postoperative nausea and vomiting Adult: 4 mg as a single dose via IM or slow IV inj at induction of anaesthesia. Child: ≥1 mth: ≤40 kg: 100 mcg/kg as a single dose; >40 kg: 4 mg as a single dose. Max Dosage: Child: 4 mg. Hepatic impairment: Moderate or severe hepatic impairment: Max: 8 mg daily. Parenteral Postoperative nausea and vomiting Adult: 4 mg IM or slow IV inj as a single dose. Child: ≥1 mth: 100 mcg/kg slow IV injection, up to a maximum of 4 mg. Hepatic impairment: Moderate or severe hepatic impairment: Max: 8 mg daily. Rectal Nausea and vomiting associated with cancer chemotherapy Adult: As suppository: 16 mg given 1-2 hr before treatment. Hepatic impairment: Moderate or severe hepatic impairment: Max: 8 mg daily. Rectal Prevent delayed emesis following chemotherapy Adult: As suppository: 16 mg once daily, for up to 5 days after the end of a course of chemotherapy. Hepatic impairment: Moderate or severe hepatic impairment: Max: 8 mg daily. Reconstitution: Prior to IV infusion, dilute in 50 ml D5W or normal saline. Incompatibility: Y-site incompatibility: Acyclovir, allopurinol, aminophylline, furosemide, ganciclovir, lorazepam, amphotericin B, amphotericin B cholesteryl sulfate complex, ampicillin, ampicillin/sulbactam, piperacillin, sargramostim, sodium bicarbonate, amsacrine, cefepime, cefoperazone, methylprednisolone sodium succinate. |
Contraindications |
Use with apomorphine (profound hypotension). |
Warnings / Precautions |
May cause QT prolongation; caution when used in cardiac diseases, patients who are on medications that can prolong QT or patients with electrolyte abnormalities. Severe hepatic impairment. May mask progressive ileus and/or gastric distension. Pregnancy, lactation. |
Adverse Reactions |
Headache, malaise/fatigue, constipation; drowsiness, fever, dizziness, anxiety, cold sensation; pruritus, rash; diarrhoea; gynaecological disorder, urinary retention; elevated transaminase; local inj site reaction (pain, redness, burning); paresthesia; hypoxia. Rarely: Anaphylaxis, angina, bronchospasm, ECG changes, extrapyramidal symptoms, grand mal seizure, hypokalaemia, tachycardia, vascular occlusive events. |
Overdose Reactions |
Sudden transient blindness, severe constipation, hypotension, and vasovagal episode with transient secondary heart block. Treatment is supportive. |
Drug Interactions |
Rifampicin and other CYP3A4 inducers reduce levels/effects of ondansetron. Potentially Fatal: Concurrent use may increase the hypotensive effect of apomorphine; avoid concurrent use. See Below for More ondansetron Drug Interactions |
Food Interactions |
Extent of absorption increased with food. St John's wort may reduce serum levels of ondansetron. |
Mechanism of Actions |
Ondansetron antagonises 5-HT3 receptor, blocking serotonin, both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone. Onset: Approx 30 minutes. Absorption: Peak plasma concentrations: Oral: 1.5 hr; rectal: 6 hr. Distribution: Extensively distributed. Protein-binding: 70-75%. Metabolism: Hepatic via multiple enzymatic pathways. Excretion: Via urine (44-60% as metabolites, 5-10% as unchanged), faeces (approx 25%). Terminal elimination half-life: Oral/parenteral: 3 hr; rectal: 6 hr; elderly/renal impairment: prolonged, approx 5 hr; severe hepatic impairment: 15-32 hr. |
Administration |
May be taken with or without food. |
Storage Conditions |
Oral: Oral solution: Store at 15-30 °C. Protect from light. Tablet: Store at 2-30°C . Parenteral: Vial: Store at 2-30°C. Protect from light. Stable with D5W or normal saline for 48 hr at room temperature. |
ATC Classification |
A04AA01 - ondansetron ; Belongs to the class of serotonin (5HT3) antagonists. Used for the prevention of nausea and vomiting. |
Storage |
Oral: Oral solution: Store at 15-30 °C. Protect from light. Tablet: Store at 2-30°C . Parenteral: Vial: Store at 2-30°C. Protect from light. Stable with D5W or normal saline for 48 hr at room temperature. |
Available As |
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Ondansetron
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Ondansetron Containing Brands
Ondansetron is used in following diseases
Drug - Drug Interactions of Ondansetron
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