What is ondansetron ODT 4mg used for. How does ondansetron work to prevent nausea and vomiting. What are the common side effects of ondansetron ODT. How can ondansetron interact with other medications.

Understanding Ondansetron ODT 4mg: A Powerful Antiemetic

Ondansetron ODT 4mg is a potent antiemetic medication used to prevent nausea and vomiting associated with various medical treatments. This orally disintegrating tablet is available as both a brand-name drug (Zofran ODT) and a generic version. Ondansetron belongs to a class of drugs called antiemetics, which work by blocking the release of serotonin in the gut and central nervous system.

Key Uses of Ondansetron ODT 4mg

Ondansetron ODT 4mg is primarily prescribed to prevent nausea and vomiting caused by:

• Chemotherapy
• Radiation treatments
• Surgery

By effectively managing these symptoms, ondansetron helps patients better tolerate their medical treatments and maintain a higher quality of life during challenging times.

The Mechanism of Action: How Ondansetron Works

Understanding how ondansetron functions in the body is crucial for appreciating its effectiveness. Ondansetron works by targeting serotonin, a neurotransmitter that plays a role in triggering nausea and vomiting.

Serotonin Blockade

Ondansetron acts as a selective serotonin 5-HT3 receptor antagonist. It blocks the action of serotonin at specific receptor sites in the small intestine and in the area of the brain that controls nausea and vomiting. This blockade prevents the transmission of signals that would otherwise trigger these unpleasant symptoms.

Central and Peripheral Action

The dual action of ondansetron in both the central nervous system and the gastrointestinal tract makes it particularly effective in managing nausea and vomiting from various causes. Its ability to act on multiple sites contributes to its broad spectrum of antiemetic activity.

Dosage Forms and Administration of Ondansetron

Ondansetron is available in several forms to accommodate different patient needs and preferences. The various dosage forms include:

• Oral tablets
• Orally disintegrating tablets (ODT)
• Oral solution
• Intravenous (IV) form (administered by healthcare professionals only)

The orally disintegrating tablet (ODT) form, such as the 4mg dosage, offers convenience and ease of administration, especially for patients who have difficulty swallowing conventional tablets.

Proper Administration of Ondansetron ODT

To ensure maximum efficacy, it’s important to administer ondansetron ODT correctly. Here are the steps:

1. With dry hands, peel back the foil packaging to remove the tablet.
2. Place the tablet on the tongue immediately.
3. Allow the tablet to dissolve without chewing.
4. Swallow the dissolved tablet with saliva.
5. If desired, sip water after the tablet has completely dissolved.

This method of administration allows for rapid absorption of the medication, providing quick relief from nausea and vomiting.

Common Side Effects of Ondansetron ODT 4mg

While ondansetron is generally well-tolerated, it can cause some side effects. Being aware of these potential effects can help patients better manage their treatment and know when to seek medical attention.

Mild Side Effects

The more common side effects of ondansetron ODT 4mg include:

• Headache
• Diarrhea
• Constipation
• Dizziness
• Drowsiness

These side effects are typically mild and often resolve on their own within a few days or weeks. If they persist or become bothersome, it’s advisable to consult with a healthcare provider.

Managing Common Side Effects

To help alleviate some of the common side effects:

• Stay hydrated to combat constipation or diarrhea
• Rest and avoid activities requiring alertness if experiencing dizziness or drowsiness
• Use over-the-counter pain relievers for headaches, as approved by your doctor

Serious Side Effects and Precautions

While rare, ondansetron can potentially cause serious side effects that require immediate medical attention. One of the most significant concerns is the risk of serotonin syndrome.

Serotonin Syndrome: A Rare but Serious Risk

Serotonin syndrome is a potentially life-threatening condition that can occur when there’s an excessive accumulation of serotonin in the body. Symptoms of serotonin syndrome include:

• Agitation
• Hallucinations
• Rapid heartbeat
• Excessive sweating
• Fever
• Muscle rigidity
• Tremors
• Nausea and vomiting
• Diarrhea
• In severe cases, coma

If any of these symptoms occur, it’s crucial to seek immediate medical attention. The risk of serotonin syndrome is higher when ondansetron is combined with other medications that affect serotonin levels.

Other Serious Side Effects

Other rare but serious side effects that warrant immediate medical attention include:

• Allergic reactions (rash, itching, swelling, severe dizziness, difficulty breathing)
• Irregular heartbeat
• Severe dizziness or fainting
• Blurred vision or temporary vision loss

Patients should be informed about these potential risks and instructed to report any unusual symptoms promptly.

Drug Interactions with Ondansetron ODT 4mg

Ondansetron can interact with various medications, potentially altering its effectiveness or increasing the risk of side effects. Understanding these interactions is crucial for safe and effective treatment.

Medications to Avoid

Certain drugs should not be used concurrently with ondansetron due to the risk of dangerous interactions. These include:

• Apomorphine: Can cause a dangerous drop in blood pressure
• Certain antidepressants: Particularly those affecting serotonin levels, due to the increased risk of serotonin syndrome

Medications That May Increase Side Effect Risk

Some medications can increase the concentration of ondansetron in the body, potentially leading to more side effects. These include:

• Certain antibiotics (e.g., erythromycin)
• Antifungal medications (e.g., ketoconazole)
• Some heart medications

It’s essential for patients to provide a complete list of all medications, including over-the-counter drugs and supplements, to their healthcare provider to avoid potential interactions.

Special Considerations and Precautions

While ondansetron is generally safe and effective, certain groups of patients may require special consideration or monitoring when using this medication.

Pregnancy and Breastfeeding

The safety of ondansetron during pregnancy and breastfeeding is not fully established. Pregnant women should use ondansetron only if the potential benefit justifies the potential risk to the fetus. Breastfeeding mothers should consult their healthcare provider before using ondansetron, as it may pass into breast milk.

Elderly Patients

Older adults may be more sensitive to the side effects of ondansetron, particularly dizziness and constipation. Dosage adjustments may be necessary in this population.

Patients with Liver or Kidney Disease

Individuals with impaired liver or kidney function may require dose adjustments or more careful monitoring when taking ondansetron. The drug’s metabolism and elimination can be affected by these conditions.

Patients with Heart Conditions

Ondansetron can potentially affect heart rhythm, particularly in patients with pre-existing heart conditions or electrolyte imbalances. ECG monitoring may be recommended in some cases.

Optimizing Treatment with Ondansetron ODT 4mg

To maximize the benefits of ondansetron ODT 4mg while minimizing potential risks, patients and healthcare providers should consider the following strategies:

Timing of Administration

For optimal effectiveness, ondansetron should be taken at the prescribed times, which may vary depending on the specific medical treatment being used to prevent nausea and vomiting. For instance:

• For chemotherapy-induced nausea and vomiting: Take 30 minutes before the start of treatment
• For post-operative nausea and vomiting: Take 1 hour before anesthesia
• For radiation-induced nausea and vomiting: Follow the specific schedule provided by your healthcare provider

Lifestyle Modifications

In addition to medication, certain lifestyle changes can complement the antiemetic effects of ondansetron:

• Eating small, frequent meals instead of large meals
• Avoiding strong odors that may trigger nausea
• Staying hydrated with clear fluids
• Practicing relaxation techniques to reduce stress and anxiety

Regular Monitoring and Follow-up

Maintaining open communication with healthcare providers is crucial for successful treatment with ondansetron. Regular follow-ups allow for:

• Assessment of medication effectiveness
• Monitoring for side effects
• Adjusting dosage if necessary
• Addressing any concerns or questions about the treatment

Alternative Antiemetic Options

While ondansetron is highly effective for many patients, it may not be suitable for everyone. In cases where ondansetron is ineffective or contraindicated, alternative antiemetic medications may be considered, such as:

• Granisetron
• Palonosetron
• Dolasetron
• Metoclopramide
• Dexamethasone (often used in combination with other antiemetics)

The choice of alternative medication will depend on individual patient factors and the specific cause of nausea and vomiting.

Long-term Use and Safety of Ondansetron ODT 4mg

While ondansetron is primarily used for short-term prevention of nausea and vomiting, some patients may require longer-term use, particularly those undergoing extended chemotherapy or radiation treatments.

Long-term Safety Considerations

For patients using ondansetron over extended periods, additional monitoring may be necessary:

• Regular liver function tests to ensure the medication is being metabolized properly
• Periodic ECG monitoring to check for any changes in heart rhythm
• Assessment of electrolyte levels, particularly in patients at risk of imbalances

Tolerance and Dependence

Unlike some medications, ondansetron is not associated with the development of tolerance or physical dependence. However, psychological dependence on the medication for managing nausea and vomiting is possible. Healthcare providers should address any concerns about long-term use and explore strategies for managing nausea and vomiting beyond medication when appropriate.

Discontinuation

When discontinuing ondansetron after long-term use, it’s generally not necessary to taper the dose. However, patients should be monitored for the return of nausea and vomiting symptoms and provided with alternative management strategies if needed.

Ondansetron ODT 4mg stands as a valuable tool in the management of nausea and vomiting associated with various medical treatments. Its effectiveness, coupled with the convenience of the orally disintegrating tablet form, makes it a preferred choice for many patients and healthcare providers. By understanding its uses, mechanism of action, potential side effects, and important considerations, patients can work closely with their healthcare team to optimize their treatment and improve their quality of life during challenging medical interventions. As with any medication, the key to success lies in informed use, open communication with healthcare providers, and vigilant monitoring for any adverse effects.

Side Effects, Dosage, Uses, and More

Highlights for ondansetron

1. Ondansetron orally disintegrating tablet is available as a brand-name drug and as a generic drug. Brand name: Zofran ODT.
2. Ondansetron comes in three forms that you take by mouth: a tablet, a disintegrating tablet, and a solution. It’s also available in an intravenous (IV) form. This form is only given by a healthcare professional.
3. Ondansetron orally disintegrating tablet is used to prevent nausea and vomiting caused by certain medical treatments.

• Serotonin syndrome warning: Ondansetron raises your risk of a life-threatening condition called serotonin syndrome. This syndrome occurs when the chemical serotonin builds up too much in your body. A high level of serotonin can cause agitation, delirium (confused thinking) and hallucinations (seeing or hearing things that aren’t real). It can also cause sweating, rapid heartbeat, muscle stiffness, tremor, seizures, jerky muscle movements, and coma. Call your doctor right away if you have any of these symptoms. This condition can result from using ondansetron alone. However, it’s more likely to occur when you’re also taking another drug that affects serotonin levels.

Ondansetron is a prescription drug. It comes in three forms that you take by mouth: a tablet, a disintegrating tablet, and a solution. It’s also available in an intravenous (IV) form, which is only given by a healthcare professional.

Ondansetron orally disintegrating tablet is available as the brand-name drug Zofran ODT. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in every strength or form as the brand-name drug.

Ondansetron may be used as part of a combination therapy. This means you may need to take it with other medications.

Why it’s used

Ondansetron orally disintegrating tablet is used to prevent nausea and vomiting caused by certain medical treatments. These treatments include:

• chemotherapy
• radiation treatment
• surgery

How it works

Ondansetron belongs to a class of drugs called antiemetics. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions. Antiemetics are drugs that reduce nausea and vomiting.

Ondansetron works by blocking the release of the chemical serotonin in the gut and the central nervous system. This keeps serotonin from causing nausea and vomiting.

Ondansetron orally disintegrating tablet may cause drowsiness. It can also cause other side effects.

More common side effects

The more common side effects of ondansetron can include:

• headache
• diarrhea
• constipation
• dizziness
• drowsiness

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Serotonin syndrome. Symptoms can include:
  • agitation
  • hallucinations (seeing or hearing things that aren’t real)
  • rapid heartbeat
  • sweating
  • feeling hot
  • muscle rigidity (stiffness)
  • tremor
  • nausea
  • vomiting
  • diarrhea
  • coma

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare professional who knows your medical history.

Ondansetron orally disintegrating tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with ondansetron are listed below.

Drugs you should not use with ondansetron

Do not take these drugs with ondansetron. Doing so can cause dangerous effects in your body. Examples of these drugs include:

• Apomorphine. Taking this drug with ondansetron can cause your blood pressure to drop to unsafe levels. This can cause you to pass out.

Interactions that increase your risk of side effects from ondansetron

Taking ondansetron with certain medications raises your risk of side effects from ondansetron. This is because the amount of ondansetron in your body may be increased. Examples of these drugs include:

• Other drugs that affect serotonin levels, such as fluoxetine and paroxetine.

Interactions that can make ondansetron less effective

Taking these drugs with ondansetron can make ondansetron less effective. This is because the amount of ondansetron in your body may be decreased. Examples of these drugs include:

• Anti-seizure drugs, such as phenytoin or carbamazepine. Your doctor may switch you from ondansetron to a different drug if needed.
• Tuberculosis drugs, such as rifampin, rifabutin, or rifapentine. Your doctor may switch you from ondansetron to a different drug if needed.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare professional about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

Ondansetron can cause a severe allergic reaction. Symptoms can include:

• flushing
• trouble breathing
• swelling of your throat or tongue
• dizziness
• coughing

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Warnings for people with certain health conditions

For people with risk factors for heart arrhythmias: If you have conditions such as heart failure or congenital long QT syndrome, this drug may increase your risk of arrhythmias. Ask your doctor if you have risk factors for arrhythmias.

For people with phenylketonuria: The ondansetron orally disintegrating tablet contains phenylalanine. This amino acid can cause dangerous effects in people with a condition called phenylketonuria. Don’t take the orally disintegrating tablet if you have phenylketonuria.

Warnings for other groups

For pregnant women: There haven’t been enough studies done in humans to be certain how ondansetron might affect a fetus when the mother takes it. Research in animals has not shown a risk to the fetus. However, animal studies do not always predict the way humans would respond.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used in pregnancy if clearly needed.

For women who are breastfeeding: Ondansetron may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This raises your risk of side effects.

For children: This medication has not been studied in children younger than 4 years. It should not be used in children of this age range.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Drug forms and strengths

Generic: Ondansetron

• Form: orally disintegrating tablet
• Strengths: 4 mg, 8 mg

Brand: Zofran ODT

• Form: orally disintegrating tablet
• Strengths: 4 mg, 8 mg
• Dosage for prevention of nausea and vomiting caused by chemotherapy

Adult dosage (ages 18–64 years)

• Typical dosage for chemotherapy that’s highly likely to cause nausea and vomiting: A single 24-mg dose given 30 minutes before chemotherapy.
• Typical dosage for chemotherapy that’s somewhat likely to cause nausea and vomiting: 8 mg, 30 minutes before chemotherapy. Eight hours later, you can take another 8 mg. For 1–2 days after chemotherapy, you can take 8 mg twice per day.

Child dosage (ages 12–17 years)

• Typical dosage for chemotherapy that’s somewhat likely to cause nausea and vomiting: 8 mg given 30 minutes before chemotherapy. Four and eight hours after the first dose, your child can take another 8 mg. For 1–2 days after chemotherapy, they can take 8 mg three times per day.

Child dosage (ages 4–11 years)

• Typical dosage for chemotherapy that’s somewhat likely to cause nausea and vomiting: 4 mg given 30 minutes before chemotherapy. Four and eight hours after the first dose, your child can take another 4 mg. For 1–2 days after chemotherapy, your child can take 4 mg, three times per day.

Child dosage (ages 0–3 years)

It has not been confirmed that ondansetron is safe and effective for use in children younger than 4 years. It should not be used in children of this age range.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dosage or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Dosage for prevention of nausea and vomiting caused by radiation treatment

Adult dosage (ages 18–64 years)

• Typical dosage: 8 mg starting 1–2 hours before radiation, followed by 8-mg doses every 8 hours after that first dose. Continue for 1 to 2 days after you complete radiation treatment. This dosage may vary depending on the type of radiation you receive.

Child dosage (ages 0–17 years)

It has not been established that this drug is safe and effective for this use in children.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dosage or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Dosage for prevention of nausea and vomiting caused by surgery

Adult dosage (ages 18–64 years)

• Typical dosage: 16 mg one hour before you receive anesthesia for surgery.

Child dosage (ages 0–17 years)

It has not been established that this drug is safe and effective for this use in children.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dosage or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special dosage considerations

For people with liver disease: If you have severe liver disease, you should not take more than 8 mg of ondansetron per day.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Ondansetron orally disintegrating tablet is used for short-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: You could have nausea and vomiting that’s not controlled.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

• faintness
• drowsiness
• agitation
• fast heartbeat
• flushing (sudden reddening of the skin)
• seizures

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

How to tell if the drug is working: You should not have nausea or vomiting. If you do, it should be less severe.

Keep these considerations in mind if your doctor prescribes ondansetron for you.

General

• You can take ondansetron with or without food.
• Take this drug at the time(s) recommended by your doctor.
• Do not cut or crush the orally disintegrating tablets.

Storage

• Store the orally disintegrating tablets at a temperature between 36°F and 86°F (2°C and 30°C).
• Keep this drug away from light.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

• When taking the orally disintegrating tablet out of its package, peel the foil back. Don’t try to push the tablet through the foil. This step will help keep the tablet from breaking.
• Place the tablet on your tongue. Leave it there for a few seconds to allow it to dissolve, and then swallow. You don’t need to take the tablet with liquid.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Ondansetron – StatPearls – NCBI Bookshelf

Continuing Education Activity

Ondansetron is one of the medications most commonly used for the empiric treatment of nausea and vomiting. Ondansetron has excellent utility as an antiemetic drug, and it is effective against nausea and vomiting of various etiologies. Common uses of ondansetron include the prevention of chemotherapy-induced and radiation-induced nausea and vomiting, the prevention of postoperative nausea and vomiting, and off-label use for the prevention of nausea and vomiting associated with pregnancy. However, it is not effective for motion sickness-induced nausea. This activity will cover the mechanism of action, pharmacology, adverse event profiles, eligible patient populations, contraindications, and monitoring. It also highlights the interprofessional team’s role in managing patients needing ondansetron therapy.

Objectives:

• Identify the antiemetic mechanism of action of ondansetron.

• Outline the approved and off-label indications for using ondansetron.

• Summarize the adverse event profile of ondansetron.

• Review the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients who can benefit from therapy with ondansetron.

Access free multiple choice questions on this topic.

Indications

Nausea and vomiting are common complaints seen by emergency department physicians and primary care clinicians daily.[1] Ondansetron is on the World Health Organization’s (WHO) List of Essential Medicines, a list of medications considered effective and safe in meeting the essential needs of a health care system. Other antiemetics that appear on this list with ondansetron include dexamethasone and metoclopramide. In 2006 (the last year of its patent), the brand-name version of ondansetron was the 20th highest-selling brand-name drug in the United States, and its popularity continues today. Ondansetron has widespread utility as an antiemetic drug and is effective against nausea and vomiting of various etiologies.

The FDA-approved indications include the prevention of chemotherapy-induced nausea and vomiting(CINV), radiation-induced nausea and vomiting, and the prevention of postoperative nausea and vomiting (PONV).[2] It is considered first-line therapy for the treatment of chemotherapy-induced and radiation-induced nausea and vomiting.[3][4]

Off-label use for the prevention of nausea and vomiting associated with pregnancy. Ondansetron has minimal efficacy against nausea and vomiting caused by motion sickness, mediated by different control centers and pathophysiologic mechanisms. There are limited data available from pediatric populations. Ondansetron is used in pediatric populations for the acute treatment of cyclic vomiting syndrome; however, there is little information available on the efficacy of this disease.[5] Ondansetron is used off-label for severe refractory diarrhea associated with neuroendocrine tumors (carcinoid syndrome). [6]

Mechanism of Action

Ondansetron is a selective 5-HT3 serotonin-receptor antagonist used for its antiemetic properties. It is one of the four FDA-approved 5-HT3 serotonin-receptor antagonists used to combat nausea and vomiting, including granisetron, dolasetron, and the second-generation drug, palonosetron.[7]

Ondansetron acts both centrally and peripherally to prevent and treat nausea and vomiting. Central effects are mediated by the antagonism of 5HT-3 serotonin receptors in the area postrema. The area postrema, located on the fourth ventricle floor, contains the “chemoreceptor trigger zone.” This zone senses neurotransmitters like serotonin, toxins, and other signals and plays a role in mediating the sensation of nausea and subsequent vomiting. Ondansetron also has effects peripherally by acting on the vagus nerve. It works on the 5-HT3 receptors that can be found at the vagus nerve terminals. The vagus nerve can sense nausea and vomiting triggers within the GI tract, such as stomach irritants. It forms synapses within the nucleus tractus solitarius of the brainstem, another region important in vomiting. The peripheral actions of ondansetron are thought to be the predominant mechanism for its antiemetic effects.[8][9]

Pharmacokinetics

Absorption: Ondansetron undergoes rapid absorption from the GI tract, and the peak plasma concentration (Tmax) is approximately 1.5 hours after an 8 mg single oral dose. The absolute bioavailability of ondansetron after oral administration is approximately 60%(50%-70%). The lower bioavailability is attributed to first-pass metabolism. The systemic bioavailability of ondansetron increases nonlinearly with increasing doses from 8 mg, 16 mg, 32 mg, and 64 mg because of saturation of the first-pass metabolism. The bioavailability of ondansetron is significantly higher in patients with cancer (85% to 87%) than in healthy individuals (50%-70%), possibly due to alterations in metabolism.

Distribution: Ondansetron and its metabolites are extensively distributed in tissues. The apparent volume of distribution(Vd) at a steady state is approximately 1.8 L/kg. Ondansetron crosses the blood-brain barrier to a lower extent, with the CSF concentration only about 10%-15% of the plasma concentration in human volunteers. Adenosine binding cassette subfamily 1(ABCB1) is a drug efflux transporter known to transport ondansetron across the blood-brain barrier, thus limiting its accumulation in the CNS. In a patient with decreased activity of ABCB1, the concentration of ondansetron in the brain increases and improves efficacy.[10]

Metabolism: The liver is the primary site of metabolism. The primary mechanism of metabolism is oxidation. 8-hydroxy ondansetron represents the major metabolite (40%), followed by 7-hydroxy ondansetron (< 20%) and 6-hydroxy ondansetron (<5%). Minor metabolism also occurs via N-demethylation to yield N-demethyl ondansetron. The active metabolite of ondansetron is  8-hydroxy ondansetron which is rapidly metabolized to glucuronide and sulfate conjugates in the liver, resulting in low blood concentrations and, thus, a very small contribution to ondansetron’s antiemetic activity. Cytochrome P-450 enzymes, including CYP1A2, CYP2D6, and CYP3A4, are involved in the metabolism of ondansetron. In humans, CYP1A1/2 plays the most crucial role, while CYP2D6 plays a minor role in the metabolism of ondansetron. The role of CYP3A4 is important at higher concentrations of ondansetron.[11]

Excretion: Hepatic metabolism accounts for nearly 95% of ondansetron clearance, and less than 5% is excreted unchanged in the urine. The clearance and elimination half-life of ondansetron vary according to age. The elimination half-life after an 8 mg oral or intravenous dose is approximately 3-4 h in adults, but on average, it is 5.5 hours in the elderly. Clearance ranges from 0.381 L/h/kg to 0.262 L/h/kg, depending on age. In adults, clearance is 0.351 5L/h/kg. The clearance per body weight is higher in younger children. However, the clearance is decreased in infants due to the underdeveloped cytochrome P450 enzyme system.[12]

Administration

Routes of administration include oral, intramuscular (IM), and intravenous (IV). Oral formulations are available in dissolving tablet and soluble film forms. Ondansetron tablets should be administered 1 to 2 hours before radiotherapy, 30 minutes before chemotherapy, and an hour before anesthesia induction. Oral and IV formulations have been shown to have similar efficacy for treating emetogenic chemotherapy.

Dosing varies depending on the route of administration and the etiology. However, 16 mg per dose IV is the maximum recommended single dose due to the risk for QTc prolongation and arrhythmias. Standard dosing to prevent postoperative nausea and vomiting includes 8 mg every 12 hours orally or 4 mg given intravenously. No dosage adjustments are necessary for IV or oral administration in patients with renal impairment. The same holds for patients with mild to moderate hepatic impairment, but the maximum daily dosing is reduced to 8 mg IV or 8 mg orally in patients with severe hepatic impairment. Pediatric dosing is weight-based at 0.15 mg/kg per dose, with a maximum of 16 mg per dose.

Use in Specific Patient Populations

Patients with Hepatic Impairment: No dose adjustments of ondansetron are necessary for mild to moderate hepatic impairment. In patients with severe hepatic impairment, clearance of ondansetron is reduced; the volume of distribution and the plasma half-life is increased. Consequently, ondansetron should be used with caution, and the maximum recommended daily intravenous dose isis reduced to 8 mg.[11]

Patients with Renal Impairment: No dosage adjustments are necessary for IV or oral administration in patients with renal impairment.[11]

Pregnancy Considerations: Ondansetron is a former FDA  “Pregnancy Category B” drug. It should only be used when other medications have been trialed and failed to treat pregnancy-associated nausea, vomiting, and hyperemesis gravidarum.[8] According to ACOG(The American College of Obstetricians and Gynecologists) guidelines, pyridoxine alone or combined with doxylamine is the preferred pharmacological therapy for nausea and vomiting. However, in refractory cases with persistent symptoms, ondansetron, 4 mg orally every 8 hours, may be considered(if there is no dehydration).[13] A possible association between ondansetron use in the first trimester and cleft palate has been reported. Electrolyte and electrocardiogram monitoring are suggested in patients treated with ondansetron having risk factors for arrhythmia, such as a family history of prolonged QT interval, heart failure, and electrolyte disturbances.[14] Recommendations for pregnant women with gynecological cancer suggest that 5HT-3 antagonists (including ondansetron ) can be used as supportive medication.[15]

Breastfeeding Considerations: In a pharmacokinetic study, the relative infant exposure to ondansetron is less.[16] Ondansetron is commonly used for nausea during and after a cesarean section, usually in doses of 4 to 8 mg intravenously. Using ondansetron during cesarean section does not affect the onset of breastfeeding. No adverse drug reactions have been reported in infants. Additionally, ondansetron is indicated for use in infants as young as one month. No specific precautions are required.[17]

Adverse Effects

The most commonly reported side effects (occurring in more than 10% of adults) include headaches, fatigue, dry mouth, malaise, and constipation. Some less common effects range from central nervous system (CNS) manifestations, such as drowsiness and sedation, to local injection site reactions and pruritus.[18][19] A transient increase in liver function tests has been reported as well. The pattern of liver enzyme elevation is normally hepatocellular, with rare cases of clinically apparent acute liver injury or jaundice.[20]

Although typically clinically insignificant, EKG interval changes such as QTc elongation can be seen. These changes typically occur within 1 to 2 hours after administration, returning to baseline within 24 hours. As with any medication that causes QTc elongation, there is a concern for Torsade de Pointes and other arrhythmias. [21] IV administration has a higher risk for arrhythmias; consequently, the FDA does not recommend a single dose greater than 16 mg IV.[22] Isolated cases of sinus bradycardia and asystole have also been reported.[23] Cases of intestinal obstruction due to impaired gut motility have been reported.[24] Stevens-Johnson syndrome has been reported in patients with multiple comorbidities.[25]

Drug-Drug Interactions

Concurrent administration of pimozide with ondansetron should be avoided due to the risk of QTc prolongation.[26] Amiodarone may also prolong the QTc interval; hence administration with ondansetron requires monitoring.[27] There is a risk of serotonin syndrome when taking ondansetron in conjunction with other serotonergic medications.[28][26]

Contraindications

Ondansetron is contraindicated in patients with hypersensitivity to the drug or any components of it.[29] Severe hypersensitivity reactions, including anaphylaxis, have been reported.[30][31] Ondansetron is also contraindicated in patients currently taking apomorphine. Concomitant use of ondansetron and apomorphine can lead to profound hypotension and loss of consciousness, with ondansetron enhancing the hypotensive effects of apomorphine.[32] Patients with phenylketonuria (PKU) should be cautious, as the dissolving tablet formulation can contain phenylalanine, leading to irreversible neurological damage in PKU patients.[33]

Monitoring

Due to the potential for dose-dependent QTc interval elongation, the FDA recommends EKG monitoring along with potassium and magnesium in susceptible populations, such as the elderly or other at-risk groups. These at-risk groups include patients with electrolyte abnormalities such as hypokalemia, hypomagnesemia, heart failure, bradyarrhythmias, or patients on other medications that may prolong the QTc interval.[22][34] 

Pregnant patients should be monitored for adverse fetal outcomes associated with ondansetron therapy.[35][36][37] Current evidence does not suggest routine EKG and electrolyte monitoring for ondansetron without known risk factors.  Monitoring should be done in high-risk patients receiving ondansetron intravenously.[23][35]

Toxicity

There is no known antidote to ondansetron, and supportive measures are used for overdose. A case report describes an ondansetron overdose in an infant presenting with seizures, QTc prolongation, hepatotoxicity, and serotonin syndrome. The patient required endotracheal intubation, supportive care, and lorazepam for seizures.[38]

Enhancing Healthcare Team Outcomes

Ondansetron is a widely prescribed medication for nausea and vomiting from various causes. The drug is relatively safe, but prescribers, including nurse practitioners, primary care providers, internists, surgeons, and emergency department physicians, need to monitor the drug in specific populations. Due to the potential for dose-dependent QTc interval prolongation, clinicians should monitor EKG, potassium, and magnesium levels in a susceptible population. It includes the elderly or patients with electrolyte abnormalities such as hypokalemia, hypomagnesemia, heart failure, bradyarrhythmias, or patients on other medications that may prolong the QTc interval. Current evidence does not demonstrate a need to pre-screen this population before administering ondansetron for patients without any of the above risk factors.

An interprofessional team approach is critical for diagnosing and managing symptoms, treating patients with nausea and vomiting, and managing the adverse effects of the treatments. Clinicians (MDs, DOs, NPs, PAs) usually prescribe ondansetron for labeled indications. Oncologist consultation is necessary for CINV. Pharmacists should ensure proper dose, perform medication reconciliation and consult prescribers about any concerns. Nursing staff should monitor patients administering medicine and inform clinicians of any side effects observed. Emergency department physicians should rapidly stabilize the patient in case of arrhythmia. Severe cases may require consultation with an intensivist and MICU/IMC level of care. Medical toxicologist consultation may become necessary in the overdose. If the overdose is intentional, psychiatric consultation is essential. An interprofessional team approach would maximize the efficacy and minimize potential adverse drug reactions for the patients requiring ondansetron, resulting in better patient outcomes. [Level 5] A prospective study involving 789 patients demonstrated that an interprofessional team approach among clinicians, residents, clinical pharmacists, and oncologists reduced potential medication errors, eventually enhancing patient safety. [Level 3]

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References

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Furyk JS, Meek RA, Egerton-Warburton D. Drugs for the treatment of nausea and vomiting in adults in the emergency department setting. Cochrane Database Syst Rev. 2015 Sep 28;2015(9):CD010106. [PMC free article: PMC6517141] [PubMed: 26411330]

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Dicato MA, Freeman AJ. Experience with ondansetron in chemotherapy- and radiotherapy-induced emesis. Eur J Anaesthesiol Suppl. 1992 Nov;6:19-24. [PubMed: 1425621]

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Kiesewetter B, Raderer M. Ondansetron for diarrhea associated with neuroendocrine tumors. N Engl J Med. 2013 May 16;368(20):1947-8. [PubMed: 23675671]

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Kaplan YC, Richardson JL, Keskin-Arslan E, Erol-Coskun H, Kennedy D. Use of ondansetron during pregnancy and the risk of major congenital malformations: A systematic review and meta-analysis. Reprod Toxicol. 2019 Jun;86:1-13. [PubMed: 30849498]

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He H, Yin JY, Xu YJ, Li X, Zhang Y, Liu ZG, Zhou F, Zhai M, Li Y, Li XP, Wang Y, Zhou HH, Liu ZQ. Association of ABCB1 polymorphisms with the efficacy of ondansetron in chemotherapy-induced nausea and vomiting. Clin Ther. 2014 Aug 01;36(8):1242-1252.e2. [PubMed: 25012726]

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Pasternak B, Svanström H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med. 2013 Feb 28;368(9):814-23. [PubMed: 23445092]

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Amant F, Berveiller P, Boere IA, Cardonick E, Fruscio R, Fumagalli M, Halaska MJ, Hasenburg A, Johansson ALV, Lambertini M, Lok CAR, Maggen C, Morice P, Peccatori F, Poortmans P, Van Calsteren K, Vandenbroucke T, van Gerwen M, van den Heuvel-Eibrink M, Zagouri F, Zapardiel I. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann Oncol. 2019 Oct 01;30(10):1601-1612. [PubMed: 31435648]

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Job KM, Dallmann A, Parry S, Saade G, Haas DM, Hughes B, Berens P, Chen JY, Fu C, Humphrey K, Hornik C, Balevic S, Zimmerman K, Watt K. Development of a Generic Physiologically-Based Pharmacokinetic Model for Lactation and Prediction of Maternal and Infant Exposure to Ondansetron via Breast Milk. Clin Pharmacol Ther. 2022 May;111(5):1111-1120. [PMC free article: PMC10267851] [PubMed: 35076931]

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Drugs and Lactation Database (LactMed®) [Internet]. National Institute of Child Health and Human Development; Bethesda (MD): May 15, 2022. Ondansetron. [PubMed: 29999857]

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Khan RB. Migraine-type headaches in children receiving chemotherapy and ondansetron. J Child Neurol. 2002 Nov;17(11):857-8. [PubMed: 12585731]

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Garsed K, Chernova J, Hastings M, Lam C, Marciani L, Singh G, Henry A, Hall I, Whorwell P, Spiller R. A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut. 2014 Oct;63(10):1617-25. [PMC free article: PMC4173656] [PubMed: 24334242]

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LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda (MD): Jan 15, 2018. Serotonin 5-HT3 Receptor Antagonists. [PubMed: 31643518]

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Patel E, Rosemond D, Afzal A. Ondansetron induced torsades de pointes. Clin Case Rep. 2019 Aug;7(8):1557-1558. [PMC free article: PMC6692972] [PubMed: 31428390]

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Fernandes FM, da Silva Paulino AM, Sedda BC, da Silva EP, Martins RR, Oliveira AG. Assessment of the risk of QT-interval prolongation associated with potential drug-drug interactions in patients admitted to Intensive Care Units. Saudi Pharm J. 2019 Feb;27(2):229-234. [PMC free article: PMC6362170] [PubMed: 30766434]

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Rapp JH, Yuen M, Abraham T. Bradycardia After Intravenous Ondansetron with Asystole on Rechallenge: A Case Report. Hosp Pharm. 2015 Nov;50(10):918-921. [PMC free article: PMC5057199] [PubMed: 27729680]

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Cohen R, Shlomo M, Dil DN, Dinavitser N, Berkovitch M, Koren G. Intestinal obstruction in pregnancy by ondansetron. Reprod Toxicol. 2014 Dec;50:152-3. [PubMed: 25461913]

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Cokan A, Gavrić Lovrec V, Takač I. A Case of Stevens-Johnson Syndrome in Recurrent Late-Stage Ovarian Cancer Patient after Management of Chronic Pain with Elastomeric Pump. Curr Oncol. 2021 Aug 03;28(4):2928-2932. [PMC free article: PMC8395433] [PubMed: 34436022]

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Cada DJ, Leonard J, Baker DE. Netupitant/Palonosetron. Hosp Pharm. 2015 Apr;50(4):310-25. [PMC free article: PMC4589884] [PubMed: 26448661]

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Moffett PM, Cartwright L, Grossart EA, O’Keefe D, Kang CS. Intravenous Ondansetron and the QT Interval in Adult Emergency Department Patients: An Observational Study. Acad Emerg Med. 2016 Jan;23(1):102-5. [PubMed: 26720490]

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Guo MH, Monir RL, Wright A, Holland NP. Case of Serotonin Syndrome Initially Presenting as Diffuse Body Pain. Am J Case Rep. 2018 Oct 15;19:1227-1231. [PMC free article: PMC6196581] [PubMed: 30318504]

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Leung J, Guyer A, Banerji A. IgE-mediated hypersensitivity to ondansetron and safe use of palonosetron. J Allergy Clin Immunol Pract. 2013 Sep-Oct;1(5):526-7. [PubMed: 24565629]

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Sapkota K, Bhagat R. Fatal anaphylaxis to intravenous ondansetron: A case report. Clin Case Rep. 2021 May;9(5):e04110. [PMC free article: PMC8122120] [PubMed: 34026152]

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Goyal P, Paramesh K, Puranik S, Proctor M, Sanghvi M. Delayed diagnosis of anaphylaxis secondary to ondansetron: A case report. Eur J Anaesthesiol. 2016 Feb;33(2):146-7. [PubMed: 26555872]

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Carbone F, Djamshidian A, Seppi K, Poewe W. Apomorphine for Parkinson’s Disease: Efficacy and Safety of Current and New Formulations. CNS Drugs. 2019 Sep;33(9):905-918. [PMC free article: PMC6776563] [PubMed: 31473980]

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Al Hafid N, Christodoulou J. Phenylketonuria: a review of current and future treatments. Transl Pediatr. 2015 Oct;4(4):304-17. [PMC free article: PMC4728993] [PubMed: 26835392]

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Fiedrich E, Sabhaney V, Lui J, Pinsk M. Assessment of ondansetron-associated hypokalemia in pediatric oncology patients. ISRN Oncol. 2012;2012:798239. [PMC free article: PMC3459247] [PubMed: 23050164]

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Romano C, Dipasquale V, Scarpignato C. Antiemetic Drug Use in Children: What the Clinician Needs to Know. J Pediatr Gastroenterol Nutr. 2019 Apr;68(4):466-471. [PubMed: 30540713]

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Balayla J. Comment on: Ondansetron in Pregnancy and the Risk of Congenital Malformations: A Systematic Review. J Obstet Gynaecol Can. 2018 Dec;40(12):1567-1568. [PubMed: 30361157]

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Sridharan K, Sivaramakrishnan G. Interventions for treating hyperemesis gravidarum: a network meta-analysis of randomized clinical trials. J Matern Fetal Neonatal Med. 2020 Apr;33(8):1405-1411. [PubMed: 30173590]

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George M, Al-Duaij N, O’Donnell KA, Shannon MW. Obtundation and seizure following ondansetron overdose in an infant. Clin Toxicol (Phila). 2008 Dec;46(10):1064-6. [PubMed: 18803119]

Disclosure: Alexandria Griddine declares no relevant financial relationships with ineligible companies.

Disclosure: Jeffrey Bush declares no relevant financial relationships with ineligible companies.

Ondansetron Bluefish – instructions for use, dosage, composition, analogs, side effects 006

Dosage and administration Contraindications Side effects Overdose Pharmacodynamics Pharmacokinetics Interaction Pharmacological group Prices

9000 2
Page reviewed by pharmacist Milityan Inessa Mesropovna Last update 2022-03-14

Attention!
The information on this page is for healthcare professionals only!
The information is collected from open sources and may contain significant errors!
Be careful and double-check all the information on this page!

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Name of the medicinal product

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Ondansetron Bluefish

Composition

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Ondansetron

Therapeutic indications

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Nausea and vomiting (prevention and treatment) against the background of cytostatic chemotherapy, radiation therapy, in the postoperative period.

Dosing and Administration

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Coated tablets; Film-coated tablets; Solution for intravenous and intramuscular administration

Solution for injection

Cytostatic therapy

The choice of dosing regimen is determined by the severity of the emetogenic effect of the ongoing antitumor therapy.

For adults, the daily dose is usually 8-32 mg. The following regimens are recommended:

For moderately emetogenic chemotherapy or radiotherapy:

– IV bolus (slow) or IM at a dose of 8 mg, immediately before therapy;

– orally 8 mg 1-2 hours before therapy, then 8 mg more 12 hours after therapy.

For highly emetogenic chemotherapy :

– i.v.

– continuous 24-hour infusion of the drug at a dose of 24 mg at a rate of 1 mg / h;

– 15-minute infusion, immediately before the start of chemotherapy at a dose of 16–32 mg (previously diluted in 50–100 ml of the appropriate infusion solution).

The effectiveness of ondansetron can be increased by a single intravenous administration of a glucocorticoid (dexamethasone 20 mg) before starting chemotherapy; when taken orally, to enhance the effect, a single dose can be increased to 24 mg and administered simultaneously with dexamethasone 12 mg 1-2 hours before the start of chemotherapy.

To prevent delayed vomiting occurring 24 hours after the start of chemotherapy or radiotherapy, it is recommended to continue using the drug by mouth at a dose of 8 mg 2 times a day for 5 days.

For children older than 2 years, the drug is prescribed i.v. after the end of chemotherapy – orally at a dose of 4 mg for 5 days.

Prevention of postoperative nausea and vomiting

Adults: IM or iv bolus (slowly) at a dose of 4 mg at the beginning of anesthesia or orally at a dose of 1 6 mg 1 hour before the onset of anesthesia.

For relief of nausea and vomiting: IM or IM (slowly) at a dose of 4 mg.

Ondansetron can be administered intramuscularly in the same area of ​​the body at a dose not exceeding 4 mg.

Children to prevent postoperative nausea and vomiting – only IV (slowly) in a single dose of 0.1 mg/kg (up to a maximum of 4 mg) during or after anesthesia.

For relief of postoperative nausea and vomiting – IV (slow) in a single dose of 0.1 mg / kg (maximum – up to 4 mg).

There is insufficient experience in the prevention and treatment of postoperative nausea and vomiting in children under 2 years of age .

Elderly patients do not need to change the dosage.

Patients with kidney and liver damage

In case of kidney damage it is not necessary to change the usual daily dose.

With liver damage , the clearance of ondansetron is significantly reduced and its plasma half-life is increased, therefore, a daily dose of 8 mg should not be exceeded.

The following solutions may be used to dilute ondansetron injection: 0. 9% sodium chloride solution, 5% dextrose solution, Ringer’s solution, 0.3% potassium chloride solution in 0.9% sodium chloride solution, 0.3% potassium solution chloride in 5% dextrose solution.

The route of administration and dosing regimen is selected in the range of 8-32 mg/day according to the criteria below.

Inside. Adults for nausea and vomiting during radiotherapy or chemotherapy – 8 mg 1-2 hours before starting anticancer therapy, followed by another 8 mg orally 12 hours later. To prevent late (after 24 hours) or prolonged vomiting, continue taking 8 mg 2 times a day for 5 days after the end of the course of anticancer therapy. To enhance the effect, a single dose can be increased to 24 mg and administered simultaneously with 12 mg of dexamethasone phosphate (in the form of sodium salt) 1-2 hours before the start of chemotherapy. To prevent late (after 24 hours) or prolonged vomiting, continue taking 8 mg 2 times a day for 5 days after the end of the course of anticancer therapy.

Children, IV, immediately before chemotherapy at a dose of 5 mg/m ² followed by oral administration of 4 mg 12 hours later, after the end of chemotherapy, continue ondansetron at a dose of 4 mg 2 times a day for 5 days .

Adults with nausea and vomiting during moderately emetogenic chemotherapy and radiotherapy IV (slow stream), IM – 8 mg (immediately before chemotherapy and radiotherapy).

For highly emetogenic chemotherapy – 8 mg immediately before the administration of the emetogenic drug, and then 2 more intravenous injections of 8 mg, each of which is carried out after 2-4 hours or as a continuous infusion (24 mg) at a rate of 1 mg / h for 24 h. In doses of 16-32 mg, it is possible to administer only by intravenous infusion immediately before the start of chemotherapy (for at least 15 minutes), after preliminary dissolution of the drug in 50-100 ml of saline or other compatible infusion solution. The effect is enhanced by the additional administration (before the start of chemotherapy) of dexamethasone phosphate (in the form of sodium salt) at a dose of 20 mg IV once.

If nausea and vomiting occur more than 24 hours after the start of therapy, the drug is recommended to be used orally at a dose of 8 mg 2 times a day.

In adults, for the prevention and treatment of postoperative nausea and vomiting, is used during the period of induction of anesthesia IM or IV (slowly) at a dose of 4 mg.

Children: IV slowly 0.1 mg/kg (max. 4 mg) as a single dose.

In case of liver damage, the adult dose should be reduced to 8 mg/day.

Contraindications

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Hypersensitivity, pregnancy, lactation, children under 2 years of age (safety and efficacy not established).

Side effects

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From the nervous system and sensory organs: headache, dizziness, movement disorders, convulsions; temporary impairment of visual acuity.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): arrhythmia, bradycardia, chest pain, in some cases with ST segment depression, arterial hypotension.

From the gastrointestinal tract: hiccups, dry mouth, diarrhea or constipation, transient increase in the level of aminotransferases.

Allergic reactions: urticaria, bronchospasm, laryngospasm, angioedema, anaphylaxis.

Local reactions: pain, burning and redness at the injection site.

Other: sensation of heat, flushing of the face, hypokalemia.

Overdose

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Treatment: symptomatic therapy (if taking tablets, do not use ipecac).

Pharmacodynamics

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Prevents and inhibits the gag reflex, eliminates nausea and vomiting caused by the release of serotonin.

Pharmacokinetics

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With intramuscular injection C _max in plasma is reached within 10 minutes. The distribution is the same with the / m and / in the introduction. Protein binding – 70-76%. Metabolized in the liver. Less than 5% of the drug is excreted unchanged in the urine. T _1/2 with parenteral administration is 3 hours, in elderly patients – 5 hours, with severe liver failure – 15-20 hours, with impaired renal function (Cl creatinine less than 15 ml / min) increases by 4-5 hours.

Interactions

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When used with enzymatic inducers of cytochrome P450 (CYP2D6 and CYP3A) – barbiturates, carbamazepine, glutethimide, griseofulvin, nitrous oxide, papaverine, phenylbutazone, phenytoin (and other hydantoins), rifampicin, tolbutamide and inhibitors P450 enzymes (CYP2D6 and CYP3A) – allopurinol, macrolide antibiotics, antidepressants (MAO inhibitors), chloramphenicol, cimetidine, diltiazem, disulfiram, valproic acid, sodium valproate, erythromycin, fluconazole, fluoroquinolones, isoniazid, ketoconazole, lovastat other, metronidazole, omeprazole, propranolol , quinidine, quinine, verapamil requires caution.

Pharmacological group

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• Antiemetics
• Serotonergic drugs

Ondansetron Bluefish price

We do not have exact data on the cost of the drug.
However, we will provide data for each active ingredient.

The average cost of Ondansetron 4 mg per unit in online pharmacies is from $0.63 to $12.6, per package from $33 to $220.

The average cost of Ondansetron 2 mg/ml per unit in online pharmacies is from $18.5 to $18.5, per pack from $37 to $37.

The average cost of Ondansetron 4/5 mg/ml per unit in online pharmacies is from $2.85 to $2.85, per pack from $142 to $142.

The average cost of Ondansetron 8 mg per unit in online pharmacies is from $0.58 to $17.71, per pack from $33 to $310.

Sources:

• https://www.drugs.com/search.php?searchterm=ondansetron-bluefish
• https://pubmed.ncbi.nlm.nih.gov/?term=ondansetron-bluefish

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⚓ All About Seasickness

Differences in resistance to seasickness depend on ship size, sea conditions and previous sailing experience. Thus, if the provocative movement is active for a long time (for example, on board a ship during a storm), then in most people the degree of manifestations of motion sickness gradually decreases as they adapt to the rocking. The dynamics of this adaptation, as well as other characteristics of motion sickness, has individual differences, however, as a rule, noticeable adaptation occurs on the second or third day of swimming, and by the fourth, all symptoms usually completely disappear. Seasickness is rare among professional sailors. This is due to strict professional selection and training of the vestibular apparatus during training and subsequent work. But sometimes a person cannot adapt to rolling on a ship, even for a long sea service. The famous English naval commander Admiral Nelson spent many years at sea and, nevertheless, every time during a storm he suffered greatly from this disease. Approximately 5% of people do not adapt to rolling at sea at all, and they are subject to motion sickness throughout their lives. Persons with innate stability adapt more quickly to provoking accelerations.
Among other factors influencing the resistance to seasickness, personality traits (extroverts are more resistant than introverts), motivation, emotionality and activity of the central nervous system, as well as fear and anxiety are of great importance.
How can the unpleasant symptoms associated with seasickness be alleviated or prevented? First of all, it is necessary to limit head movements to a minimum, which affect the development of motion sickness, this is well known. You can limit the movement of your head arbitrarily, but it is better if it rests on an appropriate support – a headrest, roller, etc. It should be remembered that on board a ship experiencing motion, seasickness will be less pronounced with acceleration acting along the longitudinal axis of the head than along its anteroposterior axis.
It may be useful during swimming to reduce visual-vestibular mismatch. For example, while on a ship, at the first signs of motion sickness, it is advisable to sit with your eyes closed or fix your gaze, as noted above, on the horizon line or visible land.
A tried and tested remedy for nausea is a lemon, a slice of which should be put into the mouth as soon as possible at the first sign of seasickness. Less effective but still helpful are menthol caramel, chewing gum, spices, or anything acidic. It is good if the cabin smells of mint or pine needles (preferably the use of flavors).
Breakfast (lunch, dinner) before going to sea should be light, because both a full stomach and an empty stomach are an additional burden on the body. From food on the road, choose low-fat and hot food. Soda water, cake or cake with a lot of cream are not for you. It is useful to wipe the neck and temples with a damp towel. Hand massage will also help: put one hand on your knee, palm up. Gently massage with the thumb of the other hand under the wrist, and then with the index and thumb, the middle of the palm.
If a person experiences seasickness precisely in the expanses of water, then during pitching, proper breathing helps: the deck lowers – inhale, rises – exhale.
In the long term, various types of vestibular training can be the most effective means of preventing seasickness: special physical and gymnastic exercises, volleyball, swimming, acrobatic trampolining, exercises on sports equipment: the Rhine wheel, triplex, etc. For passive – a swivel chair , swing, etc. With combined methods, active and passive exercises are combined. Such training not only contributes to the suppression of unpleasant vestibular reactions, but also improves orientation in space.
Active vestibular training is carried out daily in the morning before meals (eyes should be open when performing). All head movements are performed at a fast pace (approximately 120 per minute) for one minute, and after 30 seconds of movement, a pause of 5 seconds should follow. The whole set of exercises takes 8 minutes.
Starting from the first exercise, the complex is repeated and, if you feel well, perform for another eight minutes. At the end of the workout, you need to rest for two to three minutes.
The duration of the first classes is two minutes, and it is advisable to carry out the exercises while sitting. Subsequently, with each lesson, the training time should be increased by one to two minutes and, starting from the third to fifth lesson, movements should be performed in a standing position.
During training, coordination disorders (up to a fall) are possible, for the prevention of which it is necessary to provide insurance to the practitioner. If some people have pronounced vestibulo-vegetative reactions (severe pallor, sweating, nausea, etc.), the session must be stopped.
In recent years, for the prevention of seasickness, methods of psychoprophylaxis and psychotherapy, autogenic training with training in self-control of some vegetative reactions, using biofeedback, which allows you to control, prevent or weaken the manifestations of motion sickness, have begun to be used.
A large role in the prevention and relief of seasickness is given to pharmacological agents, the number of which is currently significant.
It should, however, be remembered that almost all drugs used as a means of preventing and relieving motion sickness have their own indications and contraindications. Therefore, before taking this or that drug with you on a trip, you must carefully read the corresponding instructions for its use. And be sure to test it on yourself even before the start of the sea voyage for individual intolerance.

Most often, the so-called antihistamines are used to combat kinetosis – diphenhydramine, suprastin, pipolfen. Many of these drugs are familiar as allergy drugs, and the fight against motion sickness is “part-time work” for them. True, for some of these drugs, it becomes the main one. Aviomarin, bonin and kinedril are only sold as motion sickness remedies.

Kinedryl stands out a little in this group: in addition to the antihistamine, it also contains caffeine. And this supplement allows you to reduce the “inhibitory” effect of the antihistamine component – to reduce lethargy and drowsiness. But even despite the invigorating caffeine, kinedril could not completely get rid of the soporific effect.

It should be remembered that antihistamines do not act immediately (after 2 hours or more), but for a relatively long time. Bonin has a particularly long-lasting effect – up to 12 hours. Therefore, this group of medicines should be taken at least one hour before the trip.

Fast-acting drugs containing belladonna alkaloids can be referred to. Among them is such a well-known drug as Aeron, and not so often used Bellataminal and Bellaspon.

Among the official fighters against motion sickness there are also homeopathic preparations – domestic air-sea and German vertigoheel. These drugs act according to the classic homeopathic principle “like cures like”: they contain those components that provoke symptoms typical of motion sickness – nausea, vomiting, dizziness. But thanks to meager doses, they have a curative, not provocative effect.

Recently a biologically active supplement “Companion” has appeared. This is also an effective remedy for motion sickness, containing natural plant products – peeled ginger rhizome and chamomile flowers. You need to take it 1-2 tablets 30 minutes before the trip. By the way, ginger has long been used by sailors. Chinese sailors chewed it to reduce seasickness.

None of these drugs available? Validol or Valocordin can help: they can be used as sedatives and antiemetics. Peppermint tea or peppermint extract can help in this situation.

To help people overcome sea or air sickness, pharmacologists have invented many remedies. But most of them have many contraindications and side effects. Natural remedies for motion sickness are absolutely safe, but at the same time they are no less effective than drugs.

Homeopathy
The best homeopathic remedy for motion sickness is Nux Vomica. The standard dosage for adults is 10 drops or 3-5 grains to be taken before boarding a vehicle. You can buy Nux Vomica at any homeopathic pharmacy. This component is also part of the complex preparations – the Russian “Avia-Sea” or the German Nux Vomica-Homaccord.

Ginger root
In ancient times, Asian sailors had the habit of chewing ginger during long sea voyages. In the early 1990s, scientists from the US Herbal Medicine Research Laboratory in Salt Lake City decided to test the effectiveness of this ancient custom and conducted an experiment with 36 volunteers who suffered from motion sickness. It turned out that the effectiveness of ginger root powder is superior to known pharmacological drugs for motion sickness. To get rid of seasickness, take one gram of dried ginger root powder before you travel. If you feel nauseous during the trip, it is worth “upping the dose” – drink some ginger beer or eat a couple of gingerbread cookies. Ginger caramels are also suitable – after taking them, do not brush your teeth or rinse your mouth for a while.

Acupuncture
Another piece of advice borrowed from sailors. Before the trip, you need to carefully, but tightly enough, tighten your wrists with elastic bandages, which are sold in any pharmacy. This simple measure will create a pressure drop that will save you from discomfort while traveling. In addition, the bandages will constantly act on a special point in the wrist area, which will help overcome nausea. If you are still seasick, for several minutes rhythmically press with a fingernail or a match on another point under the earlobe.

Proper nutrition
Before traveling, you should neither starve nor indulge in gluttony. The best option is a small amount of lean protein food such as cottage cheese or a piece of fish. During the trip, especially if you are flying by plane, it is better to refresh yourself with food that you have brought from home in advance. On board, they usually offer quite fatty and sweet food, which can only worsen the condition. Therefore, the best option would be to take a bottle of drinking yogurt or kefir with you, a small portion of cold boiled chicken or turkey. Especially salty and sour foods help to cope with motion sickness. Therefore, during the trip, you can enjoy, for example, pickled herring, various pickles. Remember only that food should be taken in very small portions.

Cold compress
Scientists have shown that an ice pack applied to the head and neck during travel can significantly reduce the intensity of unpleasant symptoms, especially nausea. Ice can be replaced with a damp, cold cloth. This method is especially effective in combination with a warm heating pad on the feet.

Inner mood
An important factor is your mood and behavior during the trip. First, before the trip, convince yourself that this time you definitely won’t get seasick. Focus your eyes on some fixed object or horizon line. Try to provide yourself with constant access to a source of fresh air. And remember that the journey will soon end, and you will finally find yourself where you were so eager to get.