What is the recommended dosage of ondansetron for different conditions. How should ondansetron be administered for chemotherapy-induced nausea. What are the dosage adjustments for special populations. How is ondansetron used in pediatric patients.

Understanding Ondansetron: A Powerful Antiemetic Medication

Ondansetron is a widely prescribed medication used to prevent and treat nausea and vomiting associated with various medical conditions and treatments. This comprehensive guide will explore the different uses, dosage recommendations, and administration methods for ondansetron across various patient populations.

Ondansetron for Chemotherapy-Induced Nausea and Vomiting

One of the primary uses of ondansetron is in managing chemotherapy-induced nausea and vomiting (CINV). The dosage and administration method can vary depending on the emetogenic potential of the chemotherapy regimen.

Highly Emetogenic Chemotherapy (HEC)

For patients undergoing highly emetogenic chemotherapy, such as cisplatin doses of 50 mg/m2 or greater, the recommended oral dose is:

• 24 mg taken orally 30 minutes before the start of single-day HEC

It’s important to note that multi-day, single-dose administration of 24 mg orally for HEC has not been studied extensively.

Moderately Emetogenic Chemotherapy (MEC)

For moderately emetogenic chemotherapy, the dosing schedule is as follows:

• 8 mg orally twice a day
• First dose: 30 minutes before the start of chemotherapy
• Second dose: 8 hours after the first dose
• Continue with 8 mg orally twice daily (every 12 hours) for 1 to 2 days after completing chemotherapy

Intravenous Administration for CINV

When administering ondansetron intravenously for chemotherapy-induced nausea and vomiting, the recommended dose is:

• 0.15 mg/kg IV
• First dose: Infused over 15 minutes, 30 minutes before the start of emetogenic chemotherapy
• Subsequent doses: Given 4 and 8 hours after the first dose
• Maximum dose: 16 mg per dose

It’s crucial to note that the injection formulation should be diluted prior to IV administration.

Ondansetron for Postoperative Nausea and Vomiting

Ondansetron is also effective in preventing postoperative nausea and vomiting (PONV). The dosage and administration method differ from its use in CINV.

Oral Administration for PONV

For oral administration to prevent PONV, the recommended dose is:

• 16 mg taken orally 1 hour before the induction of anesthesia

Parenteral Administration for PONV

When administering ondansetron parenterally for PONV, the guidelines are as follows:

• 4 mg IV (undiluted) immediately before induction of anesthesia or postoperatively
• Alternative route: 4 mg IM (undiluted)

It’s important to note that administering a second dose does not provide additional control of nausea and vomiting in this context.

Ondansetron for Radiation-Induced Nausea and Vomiting

Ondansetron is also effective in managing nausea and vomiting associated with radiotherapy. The dosing schedule varies depending on the type of radiation treatment.

General Dosing for Radiation-Induced Nausea

The general recommended dose for radiation-induced nausea is:

• 8 mg orally three times a day

Total Body Irradiation

For patients undergoing total body irradiation, the dosing schedule is:

• 8 mg orally 1 to 2 hours before each fraction of radiotherapy administered each day

Single High-dose Fraction Radiotherapy to the Abdomen

When a patient is receiving a single high-dose fraction of radiotherapy to the abdomen, the dosing schedule is:

• 8 mg orally 1 to 2 hours before radiotherapy
• Subsequent doses: Every 8 hours after the first dose for 1 to 2 days after completing radiotherapy

Daily Fractionated Radiotherapy to the Abdomen

For daily fractionated radiotherapy to the abdomen, the dosing schedule is:

• 8 mg orally 1 to 2 hours before radiotherapy
• Subsequent doses: Every 8 hours after the first dose for each day radiotherapy is given

Pediatric Dosing of Ondansetron

Ondansetron is also used in pediatric patients, with dosing adjusted based on age and weight.

Postoperative Nausea and Vomiting in Children

For children aged 1 month to 12 years, the dosing guidelines for preventing postoperative nausea and vomiting are:

• Less than 40 kg: 0.1 mg/kg IV over 2 to 5 minutes
• 40 kg and greater: 4 mg IV over 2 to 5 minutes

This dose should be administered immediately prior to or following anesthesia induction, or postoperatively if nausea and/or vomiting occur shortly after surgery.

Chemotherapy-Induced Nausea and Vomiting in Children

For children aged 4 to 11 years undergoing chemotherapy, the recommended oral dosing is:

• 4 mg orally three times a day
• First dose: Administered 30 minutes before the start of chemotherapy
• Subsequent doses: 4 and 8 hours after the first dose

Special Considerations and Dosage Adjustments

While ondansetron is generally well-tolerated, certain patient populations may require dosage adjustments or special considerations.

Renal Impairment

Patients with renal impairment may require dosage adjustments. However, specific guidelines for renal dose adjustments are not provided in the available information. It’s crucial to consult with a healthcare provider or refer to up-to-date prescribing information for guidance on dosing in patients with kidney dysfunction.

Hepatic Impairment

Similarly, patients with liver impairment may need dosage adjustments. The exact adjustments are not specified in the given information, emphasizing the importance of consulting current prescribing information or a healthcare provider for appropriate dosing in patients with hepatic dysfunction.

Elderly Patients

While not explicitly mentioned in the provided information, elderly patients may be more sensitive to the effects of ondansetron. Healthcare providers may consider starting with lower doses and titrating as needed based on individual patient response and tolerability.

Precautions and Contraindications

While ondansetron is generally safe and effective, there are several precautions and potential contraindications to consider:

• Hypersensitivity: Patients with known hypersensitivity to ondansetron or any of its components should not use this medication.
• QT Prolongation: Ondansetron can cause dose-dependent QT interval prolongation. Caution is advised in patients with risk factors for QT prolongation or those taking other medications that can affect the QT interval.
• Serotonin Syndrome: There is a potential risk of serotonin syndrome, particularly when ondansetron is used in combination with other serotonergic drugs.
• Pregnancy and Breastfeeding: The safety of ondansetron during pregnancy and breastfeeding should be carefully evaluated, weighing the potential benefits against the risks.

Healthcare providers should conduct a thorough assessment of a patient’s medical history and current medications before prescribing ondansetron.

Administration Guidelines and Best Practices

To ensure the safe and effective use of ondansetron, consider the following administration guidelines and best practices:

• Timing: Administer oral doses of ondansetron at least 30 minutes before the start of emetogenic therapy for optimal effect.
• Food Interactions: Ondansetron can be taken with or without food, but consistent administration with respect to meals may help maintain steady drug levels.
• Intravenous Administration: When administering ondansetron intravenously, ensure proper dilution and infusion rates as specified in the prescribing information.
• Monitoring: Regularly assess patients for efficacy and potential side effects, particularly when initiating therapy or adjusting doses.
• Patient Education: Provide clear instructions to patients regarding dosing schedules, potential side effects, and when to seek medical attention.

By following these guidelines, healthcare providers can optimize the therapeutic benefits of ondansetron while minimizing the risk of adverse effects.

Ondansetron is a versatile and effective antiemetic medication used across various clinical scenarios. Its dosing and administration methods can vary significantly depending on the indication, patient age, and route of administration. Healthcare providers should always consult the most current prescribing information and consider individual patient factors when determining the appropriate ondansetron regimen. Regular monitoring and patient education are key to ensuring safe and effective use of this important medication in managing nausea and vomiting.

Ondansetron Dosage Guide + Max Dose, Adjustments

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Medically reviewed by Drugs.com. Last updated on Nov 28, 2022.

Applies to the following strengths: 4 mg/5 mL; 32 mg/50 mL-D5%; 2 mg/mL; 4 mg; 8 mg; 24 mg; 32 mg/50 mL-NaCl 0.9%

Usual Adult Dose for:

• Nausea/Vomiting – Chemotherapy Induced
• Nausea/Vomiting
• Nausea/Vomiting – Postoperative
• Nausea/Vomiting – Radiation Induced

Usual Pediatric Dose for:

• Nausea/Vomiting – Postoperative
• Nausea/Vomiting – Chemotherapy Induced

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Precautions
• Dialysis
• Other Comments

Usual Adult Dose 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 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 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

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

• Mild to moderate hepatic impairment (Child-Pugh less than 10): No adjustment recommended.
• Severe hepatic impairment: (Child-Pugh 10 or greater): 8 mg IV over 30 minutes before the start of emetogenic chemotherapy; maximum 8 mg per day

Precautions

Safety and efficacy have not been established in patients younger than 6 months (parenteral formulations) and 4 years (oral formulations).

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Do not push oral dissolving tablets (ODTs) through the foil backing.
• ODT and film formulations should be used with dry hands and immediately placed on the tongue. The dosage form should dissolve in saliva. Administration with additional liquid is not necessary. In patients requiring multiple films per dose, each film should be allowed to completely dissolve before administering the next film.
• IV doses greater than 8 mg should be slowly injected over at least 15 minutes. Single IV doses greater than 16 mg should be avoided.
• IM doses should be administered undiluted at a rate slower than 30 seconds (e.g., 2 to 5 minutes).
• The suppository formulation is not recommended for use in children.

Storage requirements:

• The manufacturer product information should be consulted.

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.

IV compatibility:

• The manufacturer product information should be consulted.

General:

• The lowest effective dose should be used.
• Oral, rectal, IV, and IM routes have shown to be equally effective over the first 24 hours of chemotherapy.
• Use of the ODT formulation in the prevention of nausea and vomiting associated with highly-emetogenic chemotherapy, radiotherapy, or in postoperative situations has not been studied in pediatric patients.
• Concomitant use with dexamethasone may potentiate the antiemetic effects of this drug.
• Routine prophylaxis is not recommended for postoperative patients with little expectation of nausea and vomiting; however, use is recommended for patients who should avoid postoperative nausea and vomiting, even with low risk of postoperative nausea and vomiting.

Monitoring:

• Electrolyte levels, especially in patients at risk for hypomagnesemia or hypokalemia
• ECG, especially in patients with a history of QT prolongation, bradycardia, congestive heart failure, or those on drugs which could prolong the QT interval or result in electrolyte abnormalities
• Signs/symptoms of respiratory events or hypersensitivity reactions

Patient advice:

• Inform patients that this drug may cause drowsiness, and they should avoid driving or operating machinery until the full effects of the drug are seen.
• Patients should be advised to immediately report any signs/symptoms associated with serotonin syndrome or hypersensitivity reactions to their prescribers. Patients should also report lightheadedness, syncope episodes, or any perceived changes in heart rate.
• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
• Tell patients to report all concurrent prescription and nonprescription medications or herbal products they are taking.

Frequently asked questions

• Can you take ondansetron while pregnant?

More about ondansetron

• Check interactions
• Compare alternatives
• Pricing & coupons
• Reviews (473)
• Drug images
• Side effects
• Patient tips
• During pregnancy
• Support group
• Drug class: 5HT3 receptor antagonists
• Breastfeeding

Patient resources

• Drug Information
• Ondansetron injection
• Ondansetron (Injection) (Advanced Reading)
• Ondansetron (Oral, Oromucosal) (Advanced Reading)
• Ondansetron Oral Soluble Film

Other brands

Zofran, Zofran ODT, Zuplenz

Professional resources

• Prescribing Information

Related treatment guides

• Gastroenteritis
• Alcohol Use Disorder
• Nausea/Vomiting
• Nausea/Vomiting, Chemotherapy Induced

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Ondansetron Interactions Checker – Drugs.com

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There are 338 drugs known to interact with
ondansetron, along with
2 disease interactions.

Of the total drug interactions,
122 are major, 212 are moderate, and 4 are minor.

Does ondansetron interact with my other drugs?

Enter other medications to view a detailed report.

• View all 338 medications that may interact with ondansetron
• View ondansetron disease interactions (2)

Most frequently checked interactions

View interaction reports for ondansetron and the medicines listed below.

• Major
• Moderate
• Minor
• Unknown

• Adderall (amphetamine / dextroamphetamine)
• Aspirin Low Strength (aspirin)
• Benadryl (diphenhydramine)
• Cymbalta (duloxetine)
• Eliquis (apixaban)
• Fish Oil (omega-3 polyunsaturated fatty acids)
• Flexeril (cyclobenzaprine)
• Flonase (fluticasone nasal)
• Lexapro (escitalopram)
• Linzess (linaclotide)
• Lyrica (pregabalin)
• Metoprolol Succinate ER (metoprolol)
• Metoprolol Tartrate (metoprolol)
• MiraLAX (polyethylene glycol 3350)
• Nexium (esomeprazole)
• Norco (acetaminophen / hydrocodone)
• Paracetamol (acetaminophen)
• ProAir HFA (albuterol)
• Probiotic Formula (bifidobacterium infantis / lactobacillus acidophilus)
• Singulair (montelukast)
• Symbicort (budesonide / formoterol)
• Synthroid (levothyroxine)
• Tylenol (acetaminophen)
• Ventolin HFA (albuterol)
• Vitamin B12 (cyanocobalamin)
• Vitamin C (ascorbic acid)
• Vitamin D2 (ergocalciferol)
• Vitamin D3 (cholecalciferol)
• Xanax (alprazolam)
• Zyrtec (cetirizine)

Ondansetron disease interactions

There are 2 disease interactions with ondansetron which include:

• QT interval prolongation
• liver disease

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More about ondansetron

• ondansetron consumer information
• Compare alternatives
• Pricing & coupons
• Reviews (473)
• Drug images
• Side effects
• Dosage information
• Patient tips
• During pregnancy
• Support group
• Drug class: 5HT3 receptor antagonists
• Breastfeeding

Related treatment guides

• Gastroenteritis
• Alcohol Use Disorder
• Nausea/Vomiting
• Nausea/Vomiting, Chemotherapy Induced

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Ondansetron: Pediatric Medication | Memorial Sloan Kettering Cancer Center

Pediatric Medicine

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Provided by Lexicomp ^® , this document contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

Zofran; Zuplenz [DSC]

Trade names: Canada

ACCEL-Ondansetron; APO-Ondansetron; ATHENA-Ondansetron ODT; AURO-Ondansetron; Auro-Ondansetron ODT; CCP-Ondansetron; JAMP Ondansetron; JAMP-Ondansetron; Mar-Ondansetron; MAR-Ondansetron ODT; MINT-Ondansetron; MINT-Ondansetron ODT; MYLAN-Ondansetron; NAT-Ondansetron; Ondansetron ODT; Ondissolve ODF; PMS-Ondansetron; PMS-Ondansetron ODT; SANDOZ Ondansetron; TEVA Ondansetron; VAN-Ondansetron [DSC]; Zofran ODT; Zofran [DSC]

What is this drug used for?

• It is used to treat and prevent nausea and vomiting.

What do I need to tell the doctor BEFORE my child takes this drug?

• If your child has an allergy to this drug, any of its ingredients, other drugs, foods, or substances. Tell the doctor about the allergy and how it manifested itself in the child.
• If your child has a prolonged QT interval on the ECG.
• If your child is taking apomorphine.

This list of drugs and conditions that may interact with this drug is not exhaustive.

Talk to your doctor or pharmacist about all medicines your child is taking (prescription and over-the-counter, natural, and vitamins) and any health problems. You need to make sure that this drug is safe to use for your child’s illnesses and in combination with other drugs he or she is already taking. Do not start, stop taking, or change the dosage of any drug your child is taking without the doctor’s approval.

What do I need to know or do while my child is taking this drug?

• Tell all health care providers who care for your child that your child is taking this drug. These are your child’s doctors, nurses, pharmacists and dentists.
• If your child has phenylketonuria, talk to your doctor. Some foods contain phenylalanine.

If your daughter is pregnant or breastfeeding:

• Consult physician if your daughter is pregnant, pregnant, or breastfeeding. The benefits and risks for your daughter and her baby will need to be discussed.

What side effects should I report to my child’s doctor right away?

WARNING/CAUTION: Although rare, some people may have very serious and sometimes deadly side effects of this drug. Call your child’s doctor right away or seek medical attention if your child has any of the following signs or symptoms that could be associated with a very bad side effect:

• Signs of an allergic reaction, such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly accompanied by fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue or throat.
• Obstruction of the urinary tract.
• Dizziness.
• Sudden pain or tightness in the chest.
• A type of abnormal heart rhythm (QT prolongation) has happened with this drug. Sometimes it caused another type of heart rhythm disturbance (polymorphic ventricular tachycardia of the “pirouette” type). Call your doctor right away if your child has tachycardia, abnormal heart rhythms, or fainting.
• A severe and sometimes deadly complication called serotonin syndrome can occur. This risk may be increased if the child is also taking certain other drugs. Call your child’s healthcare provider right away if your child has agitation, balance problems, confusion, hallucinations, high fever, tachycardia or abnormal heart rhythm, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting, a very severe headache.
• This drug may make it difficult to detect signs of bowel obstruction after abdominal surgery, as well as nausea and vomiting after chemotherapy. If your child has abdominal pain or swelling in the abdomen, see a doctor immediately.

What are some other side effects of this drug?

Any drug can cause side effects. However, for many people, side effects are either minor or non-existent. Contact your child’s doctor or seek medical attention if any of these or other side effects bother your child or if they persist:

• Headache.
• Feeling tired or weak.
• Diarrhea or constipation.
• Drowsiness.
• Anxiety.

This list of possible side effects is not exhaustive. If you have any questions about side effects, ask your child’s doctor. Talk to your child’s doctor about side effects.

You can report side effects to the National Health Board.

What is the best way to give this drug?

Give this drug to your child as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

All oral preparations:

• Give this drug with or without food.

Lozenge:

• If the tablets are supplied in a foil blister, do not squeeze the foil tablet when opening it. The tablet should be removed from the foil with dry hands.
• Open immediately before use.
• Put the tablet on the child’s tongue and let it dissolve. It is not necessary to drink water. Make sure that the child does not swallow the drug whole. Make sure that the child does not chew, break or crush the tablet.

Liquid (solution):

• Liquid doses should be measured with caution. Use the dispenser that comes with the medicine. If the dispenser is not provided in the package, ask the pharmacist for a dosing agent for this drug.

Oral strips:

• Open immediately before use.
• Do not touch the preparation with wet hands.
• Place the strip on your tongue and let it dissolve. It is not necessary to drink water. If more than 1 strip is used, it is necessary to wait until the previous strip is completely dissolved before using the next one.
• Do not allow the child to chew or swallow.
• Wash your hands after use.

Injection:

• For intravenous injections.
• This drug can be given intramuscularly or by intravenous infusion over a period of time.

What if my child misses a dose of medication?

All oral preparations:

• If the child takes the drug regularly, give him the missed dose as soon as you remember about it.
• If it is time for your child to take the next dose, do not take the missed dose and then go back to your child’s normal schedule.
• Do not give a double dose at the same time or additional doses.
• In most cases, this drug is used as needed. Do not give your child the drug more often than prescribed by the doctor.

Injection:

• Contact your child’s doctor to find out the next steps.

How do I store and/or discard this drug?

All oral preparations:

• Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.

Oral strips:

• Store in primary container.

Liquid (solution):

• Store upright with cap closed.

Injection:

• If you need to store this drug at home, check with your child’s doctor, nurse, or pharmacist about how to store it.

All forms:

• Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General information about medicines

• If your child’s symptoms or health problems do not improve, or worsen, contact your child’s doctor.
• Do not share your child’s medicine with others and do not give anyone else’s medicine to your child.
• Some medicines may come with other patient information leaflets. If you have questions about this drug, talk with your child’s doctor, nurse, pharmacist, or other health care professional.
• If you think you have overdosed, call a poison control center or get medical help right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment, and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient. It should not be considered medical advice or a substitute for medical advice, diagnosis or treatment provided by a physician based on a medical examination and assessment of the patient’s specific and unique circumstances. Patients should consult with their physician for full information about their health, medical issues, and treatment options, including any risks or benefits regarding the use of medications. This information is not a guarantee that a treatment or drug is safe, effective, or approved for a particular patient. UpToDate, Inc. and its subsidiaries disclaim any warranties or liabilities related to this information or its use. The use of this information is subject to the Terms of Use found at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms.

Last revision date

2021-11-12

Copyright

© UpToDate, Inc. and its affiliates and/or licensors, 2023. All rights reserved.

Date last updated

Monday, December 12, 2022

Nausea and vomiting – Lymphoma Australia

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Nausea (feeling unwell) is a common side effect that many people experience with lymphoma treatment. In some cases, nausea may be a symptom of lymphoma or another disease and may cause vomiting. However, nausea can be managed so that it does not get worse.

As with many things, prevention of nausea is better than cure, so on this page you will find practical advice on how to prevent nausea and vomiting and what to do if you cannot prevent it.

Medicines that help stop nausea (nausea medicines) are often called anti-nausea medicines or antiemetics.

The medical name for vomiting is vomiting, hence the name antiemetic.

On this page:

“You don’t have to suffer from nausea and vomiting because your medical team has wonderful medicines to help with that.”

What causes nausea and vomiting?

Many cancer drugs can cause nausea, which can lead to vomiting if not treated properly. Some treatments that can cause nausea include chemotherapy, surgery, radiation therapy, and some types of immunotherapy.

Vomiting triggers

Vomiting is caused by a part of your brain called the vomiting center. There are several signals that can trigger the vomiting center.

These could be signals from:

• an area in your brain called the chemoreceptor trigger zone that responds to chemicals or drugs in your blood.
• your cerebral cortex and limbic system, which responds to sight, taste and smell, as well as emotions and pain.
• certain other organs and nerves that respond to illness or irritation. Trigger zones in the stomach, esophagus, and intestines can be activated by chemotherapy.

Why is it important to prevent nausea and vomiting?

Prevention of nausea and vomiting is important because they can lead to other complications.

During treatment for lymphoma, a good diet and 2-3 liters of water (or other decaffeinated soft drinks) should be drunk daily. This helps flush the medicine out of your body to prevent too many side effects. It’s also how your body gets the energy to replace healthy cells that have been damaged by your treatment and continue to fight lymphoma.

In addition, if you cannot eat and drink well, you increase your risk of malnutrition and dehydration. This can lead to:

• kidney problems
• increased risk of falling as your blood pressure may drop and you may feel dizzy and dizzy.
• severe headaches
• worsening of nausea and vomiting
• delayed healing of any wounds
• changes in your blood results
• longer recovery after treatment
• changes in blood sugar
• severe fatigue, weakness and drowsiness.

Any of the above complications can lead to a delay in treatment and an extra hospital stay.

Prevention of nausea and vomiting

Nausea and vomiting may occur at any time during treatment for lymphoma. It usually starts a few hours after treatment, but it can also take a few days.

If you have had severe nausea as a result of treatment in the past, you may wake up with nausea on or before the day of treatment. This type of nausea is called expected nausea and affects about 1 in 3 people who have had severe nausea in the past. This is another reason to deal with nausea in time and prevent it from getting worse from the very beginning.

Treatment day

Make sure you eat and drink before your session. An empty stomach can increase your chances of not feeling well, so taking something before your treatment may help you feel better during your treatment.

If your treatment is known to cause nausea, or if you have had severe nausea after treatment in the past, your doctor will prescribe (prescribe) anti-nausea medicine for you. They are often given intravenously (into the bloodstream through a cannula or central catheter) by a nurse before treatment begins. The drug administered intravenously acts faster than the tablet.

After your nausea medicine is given, the nurse will wait a while (usually 30-60 minutes) to make sure the medicine is working before starting treatment. You may also be given medicine to take home.

Oral therapy for lymphoma or CLL is taken by mouth as a tablet or capsule.

Home remedy for nausea

You may be given anti-nausea pills to take home. Take them as your pharmacist tells you to, even if you don’t feel sick. They are designed to prevent further illness and help you eat and drink well.

Some medications need to be taken before every meal, and some only once every 3 days. Others can only be taken if you feel unwell (nausea). Make sure you are ask a nurse, pharmacist or doctor to explain how to take the medicine you have been prescribed.

Questions to ask about your anti-nausea medication

It is very important to take your anti-nausea medication exactly as prescribed. Asking questions is the best way to make sure you get the information you need to take care of yourself when you get home.

Questions you can ask your doctor, nurse or pharmacist about your medicines include:

1. When should I take this medicine?
2. Do I need to eat it with meals, or can I eat it before meals?
3. How often should I take this medicine?
4. Should I keep taking this medicine if I don’t feel sick?
5. What are the side effects of this medicine?
6. What if I vomit shortly after taking this medicine?
7. When should I stop taking this medicine?
8. What should I do if I still feel sick after taking this medicine?
9. Who can I contact if I have further questions about this medicine and what is the contact details?

Types of anti-nausea drugs

You may be given one or more different anti-nausea drugs to help manage your nausea. The table below provides an overview of the different types of anti-nausea medications that you may be offered or that you can ask your doctor about.

If you have been given medicine for nausea and still feel unwell, tell your doctor, as other types of medicine may help.

Practical Tips for Nausea and Vomiting

Everyone is different in terms of what helps them cope with nausea. Make sure you take your anti-nausea medication as directed. But in addition, you may find that some of the practical tips below can also help manage nausea and prevent or reduce vomiting.

C:

• eat a light and tasteless diet
• eat small meals throughout the day
• try foods or drinks with ginger in them, such as ginger ale or ginger fresh beer, gingerbread or hard candy (make sure that it’s real ginger, not just flavored ginger)
• drink plenty of fluids. Avoid hot drinks. Drink through a straw to bypass the taste buds. Carbonated drinks such as ginger ale can help soothe the stomach.
• suck on hard candies, ice blocks or ice during chemotherapy
• stay cool but not cold if possible
• identify and avoid triggers that make you sick.
• relax before and after treatment. Try things like meditation and gentle breathing exercises.
• wear loose clothing.

Not recommended:

• eat heavy, greasy or greasy food
• use strongly scented foods or sprays, including perfumes, sprays, cooking meat
• consume drinks with caffeine or alcohol 900 06
• smoke (if you need help to quit smoking, talk to your doctor about it)

Call your doctor or nurse
If you vomit more than 4 times a day (24 hours) or feel very unwell, ask your doctor or nurse for advice, as you may need to be examined before your next appointment.

Anticipatory nausea

Many patients who experience nausea and vomiting after chemotherapy develop anticipatory symptoms in subsequent cycles of chemotherapy. This means that you may feel nausea or vomiting before you get to the hospital for treatment, or when you arrive there before treatment begins.

Anticipatory nausea is quite common and can affect about 1 out of every 3 patients treated. This is more common if you have had severe nausea during a previous treatment.

Cause of premature nausea

Anticipated nausea and vomiting are considered to be the result of classic psychological conditioning. Sounds and smells in hospitals or clinics can trigger a learned response that associates these experiences with nausea and vomiting. As a result, the same smells, noises, or other triggers can make your body remember that they were nauseating before and make you feel nauseated again. It becomes a pattern.

Anticipatory nausea can affect anyone, but it is more common in people who:

• less than 50 years old
• experienced nausea and vomiting after previous cancer treatment
• had previous anxiety or panic attacks
• got travel sickness
• had severe morning sickness during pregnancy.

Prevention and treatment

Pre-nausea does not improve with standard anti-nausea medications.

Prevention of nausea and vomiting in the first cycle is the best way to prevent the development of anticipatory nausea in subsequent treatment cycles. However, if it doesn’t, anticipatory nausea can be reduced with relaxation techniques, distractions to take your mind off sights and smells, or with anti-anxiety medications such as lorazepam or diazepam.

If you have any of the above risk factors, or if your current anti-nausea medications are not working, ask your doctor if these medications might be right for you.

Other practical things that can help with anticipatory nausea include:

• distractions – focus your attention on something other than your surroundings, such as coloring, reading, watching a movie, needlework, sewing, or talking with surrounding.
• relaxation – ask if there is a quieter place where you can wait for an appointment or receive treatment (if possible), focus on your breathing and how it feels when your breath fills and leaves your lungs. Download and listen to visualization apps on your phone.
• Bring along a cloth, napkin, pillow, or something else that can be sprinkled with soothing essential oil to minimize odors.

Video – Diet and nutrition

Video – Free and alternative treatment

• Medicines to prevent or relieve nausea and vomiting may be called antiemetics, antiemetics, or antiemetics.
• Nausea is a common side effect of many cancer drugs.
• You don’t have to “put up” with nausea, there are many ways to manage it to reduce nausea and prevent vomiting.
• Prevention is better than cure, so take your medicines as directed.
• Nausea can lead to vomiting, which can cause many problems. Talk to your doctor if your medication isn’t working – there are other options that may work better for you.
• The practical tips listed above can help reduce nausea and make you feel better.
• If you have any questions or concerns about nausea or vomiting, call our lymphoma nurses.