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Ondissolve ODF(trade name),
Zofran ODT(trade name),
Pregnancy Category: B
Pharmacologic: five ht3 antagonists
Pharmacologic: five ht3 antagonists
Prevention of nausea and vomiting associated with highly or moderately emetogenic chemotherapy. Oral: Prevention of nausea and vomiting associated with radiation therapy.Prevention and treatment of postoperative nausea and vomiting.
Blocks the effects of serotonin at 5-HT3–receptor sites (selective antagonist) located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS.
Decreased incidence and severity of nausea and vomiting following chemotherapy or surgery.
Absorption: IV administration results in complete bioavailability; 100% absorbed following oral administration.
Metabolism and Excretion: Extensively metabolized by the liver (primarily by CYP3A4); 5% excreted unchanged by the kidneys.
Half-life: Adults—3.5–5.5 hr; Children 5 mo–12 yr—2.9 hr.
Time/action profile (antiemetic effect)
|PO, IV||rapid||15–30 min||4–8 hr|
Contraindicated in: Hypersensitivity;Orally disintegrating tablets contain aspartame and should not be used in patients with phenylketonuria;Congenital long QT syndrome;Concurrent use of apomorphine.
Use Cautiously in: Hepatic impairment (daily dose not to exceed 8 mg);Abdominal surgery (may mask ileus); Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children ≤3 yr (PO) or <1 mo (parenteral) (safety not established).
Adverse Reactions/Side Effects
Central nervous system
- headache (most frequent)
- torsade de pointes (life-threatening)
- QT interval prolongation
- constipation (most frequent)
- diarrhea (most frequent)
- abdominal pain
- dry mouth
- ↑ liver enzymes
- extrapyramidal reactions
Drug-Drug interactionUse with apomorphine ↑ risk of severe hypotension and loss of consciousness; concurrent use contraindicated.Carbamazepine, phenytoin, and rifampin may ↓ levels.
Oral (Adults) Prevention of nausea/vomiting associated with highly-emetogenic chemotherapy—24 mg 30 min prior to chemotherapy.
Oral (Adults and Children >11 yr) Prevention of nausea/vomiting associated with moderately emetogenic chemotherapy—8 mg 30 min prior to chemotherapy and repeated 8 hr later; 8 mg q 12 hr may be given for 1–2 days following chemotherapy. Prevention of radiation-induced nausea/vomiting—8 mg 1–2 hr prior to radiation; may be repeated q 8 hr, depending on type, location, and extent of radiation. Prevention of postoperative nausea/vomiting—16 mg 1 hr before induction of anesthesia.
Oral (Children 4–11 yr) Prevention of nausea/vomiting associated with moderately emetogenic chemotherapy—4 mg 30 min prior to chemotherapy and repeated 4 and 8 hr later; 4 mg q 8 hr may be given for 1–2 days following chemotherapy.
Intravenous (Adults) Prevention of chemotherapy-induced nausea/vomiting—0.15 mg/kg (max dose = 16 mg) 30 min prior to chemotherapy, repeated 4 and 8 hr later.
Intramuscular Intravenous (Adults) Prevention of postoperative nausea/vomiting—4 mg before induction of anesthesia or postoperatively.
Intravenous (Children 6 mo–18 yr) Prevention of chemotherapy-induced nausea/vomiting—0.15 mg/kg (max dose = 16 mg) 30 min prior to chemotherapy, repeated 4 and 8 hr later.
Intravenous (Children 1 mo–12 yr and >40 k g) Prevention of postoperative nausea/vomiting—4 mg.
Intravenous (Children 1 mo–12 yr and ≤40 kg) Prevention of postoperative nausea/vomiting—0.1 mg/kg.
Hepatic ImpairmentOral Intramuscular Intravenous (Adults) Severe hepatic impairment—Not to exceed 8 mg/day.
Availability (generic available)
Orally disintegrating tablets (contain aspartame)strawberry flavor: 4 mg, 8 mg Cost: Generic — 4 mg $668.78 / 30, 8 mg $1,113.95 / 30
Oral soluble film (Zuplenz): 4 mg, 8 mg Cost: All strengths $16.50 / 1
Tablets: 4 mg, 8 mg, 24 mg Cost: Generic — 4 mg $735.05 / 30, 8 mg $1,217.42 / 30, 24 mg $105.50 / 1
Oral solutionstrawberry flavor: 4 mg/5 mL Cost: $269.74 / 50 mL
Solution for injection: 2 mg/mL
- Assess patient for nausea, vomiting, abdominal distention, and bowel sounds prior to and following administration.
- Assess patient for extrapyramidal effects (involuntary movements, facial grimacing, rigidity, shuffling walk, trembling of hands) periodically during therapy.
- Monitor ECG in patients with hypokalemia, hypomagnesemia, HF, bradyarrhythmias, or patients taking concomitant medications that prolong the QT interval.
- Lab Test Considerations: May cause transient ↑ in serum bilirubin, AST, and ALT levels.
Potential Nursing DiagnosesImbalanced nutrition: less than body requirements (Indications)
Diarrhea (Side Effects)
Constipation (Side Effects)
- First dose is administered prior to emetogenic event.
- Oral: For orally disintegrating tablets, do not attempt to push through foil backing; with dry hands, peel back backing and remove tablet. Immediately place tablet on tongue; tablet will dissolve in seconds, then swallow with saliva. Administration of liquid is not necessary.
- Administer undiluted (2 mg/mL) immediately before induction of anesthesia or postoperatively if nausea and vomiting occur shortly after surgery.
- Rate: Administer over at least 30 sec and preferably over 2–5 min.
- Intermittent Infusion: Diluent: Dilute doses for prevention of nausea and vomiting associated with chemotherapy in 50 mL of D5W, 0.9% NaCl, D5/0.9% NaCl, D5/0.45% NaCl. Solution is clear and colorless. Stable for 7 days at room temperature following dilution.Concentration: 1 mg/mL.
- Rate: Administer each dose over 15 min.
- Y-Site Compatibility: acetaminophen, aldesleukin, alemtuzumab, alfentanil, amifostine, amikacin, aminocaproic acid, anakinra, anidulafungin, argatroban, ascorbic acid, atropine, azithromycin, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride, calcium gulconate, carboplatin, carmustine, caspofungin, cefazolin, cefotaxime, cefoxitin, ceftaroline, ceftazidime, cefuroxime, chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, daunorubicin, dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doripenem, doxorubicin, doxorubicin liposome, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, filgrastim, floxuridine, fluconazole, fludarabine, folic acid, fosaprepritant, gemcitabine, gentamicin, glycopyrrolate, heparin, hetastarch, hydrocortisone sodium succinate, hydrocortisone sodium phosphate, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, methotrexate, methoxamine, methyldopate, metoclopramide, metoprolol, metronidazole, midazolam, mitomycin, mitoxantrone, morphine, moxifloxacin, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxacillin, oxaliplatin, oxytocin, paclitaxel, pamidronate, pancuronium, papaverine, penicillin G, pentamidine, pentazocine, pentostatin, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, ranitidine, remifentanil, rocuronium, sodium acetate, sodium phosphates, streptokinase, streptozocin, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, topotecan, vancomycin, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
- Y-Site Incompatibility: acyclovir, allopurinol, aminophylline, amphotericin B cholesteryl, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin/sulbactam, azathioprine, cefepime, cefoperazone, chloramphenicol, dantrolene, diazoxide, ertapenem, furosemide, ganciclovir, indomethacin, lorazepam, micafungin, milrinone, pantoprazole, pemetrexed, pentobarbital, phenobarbital, phenytoin, rituximab, sargramostim, sodium bicarbonate, thiopental, trastuzumab, trimethoprin/sulfamethoxazole
- Instruct patient to take ondansetron as directed.
- Advise patient to notify health care professional immediately if symptoms of irregular heart beat or involuntary movement of eyes, face, or limbs occur.
- Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy.
- Prevention of postoperative nausea and vomiting.
- Prevention of nausea and vomiting due to radiation therapy.
A trademark for the drug ondansetron hydrochloride.