ondansetron

Generic Name: ondansetron (oral) (on DAN se tron)

Brand Names: Zofran, Zofran ODT, Zuplenz

What is ondansetron?

Ondansetron blocks the actions of chemicals in the body that can trigger nausea and vomiting.

Ondansetron is used to prevent nausea and vomiting that may be caused by surgery or by medicine to treat cancer (chemotherapy or radiation).

Ondansetron may be used for purposes not listed in this medication guide.

What is the most important information I should know about ondansetron?

You should not use this medication if you are allergic to ondansetron or to similar medicines such as dolasetron (Anzemet), granisetron (Kytril), or palonosetron (Aloxi). Do not take ondansetron if you are also using apomorphine (Apokyn).

Before taking ondansetron, tell your doctor if you have liver disease, or a personal or family history of Long QT syndrome.

Ondansetron orally disintegrating tablets may contain phenylalanine. Tell your doctor if you have phenylketonuria (PKU).

The serious side effects of this medication include blurred vision or temporary vision loss (lasting from only a few minutes to several hours), slow heart rate, trouble breathing, anxiety, agitation, shivering, feeling like you might pass out, and urinating less than usual or not at all. Stop taking ondansetron and call your doctor at once if you have any of these side effects. Ondansetron may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

What should I discuss with my health care provider before taking ondansetron?

You should not use this medication if you are allergic to ondansetron, to similar medicines such as dolasetron (Anzemet), granisetron (Kytril), or palonosetron (Aloxi). Do not take ondansetron if you are also using apomorphine (Apokyn).

To make sure you can safely take ondansetron, tell your doctor if you have any of these other conditions:

• liver disease;


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  heart disease, congestive heart failure, a heart rhythm disorder;

  
  


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  an electrolyte imbalance (such as low levels of potassium or magnesium in your blood); or

  
  


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  a personal or family history of Long QT syndrome.

  
  

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether ondansetron passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. ondansetron should not be given to a child younger than 4 years old.

Ondansetron orally disintegrating tablets may contain phenylalanine. Tell your doctor if you have phenylketonuria (PKU).

How should I take ondansetron?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Ondansetron can be taken with or without food.

Take the ondansetron regular tablet with a full glass of water.

To take ondansetron orally disintegrating tablet (Zofran ODT):

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  Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may damage the tablet.

  
  


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  Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away.

  
  


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  Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

  
  


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  Swallow several times as the tablet dissolves. If desired, you may drink liquid to help swallow the dissolved tablet.

  
  

To use ondansetron oral soluble film (strip) (Zuplenz):

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  Keep the strip in the foil pouch until you are ready to use the medicine.

  
  


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  Using dry hands, remove the strip and place it on your tongue. It will begin to dissolve right away.

  
  


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  Do not swallow the strip whole. Allow it to dissolve in your mouth without chewing.

  
  


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  Swallow several times after the strip dissolves. If desired, you may drink liquid to help swallow the dissolved strip.

  
  


• Wash your hands after using Zuplenz.

Measure the liquid form of ondansetron with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Your heart function may need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. Do not miss any follow-up visits to your doctor. Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include sudden loss of vision, severe constipation, feeling light-headed, or fainting.

What should I avoid while taking ondansetron?

Ondansetron may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Ondansetron side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

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  blurred vision or temporary vision loss (lasting from only a few minutes to several hours);

  
  


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  severe dizziness, feeling short of breath, fainting, fast or pounding heartbeats;

  
  


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  slow heart rate, trouble breathing;

  
  


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  anxiety, agitation, shivering;

  
  


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  feeling like you might pass out; or

  
  


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  urinating less than usual or not at all.

  
  

Less serious side effects may include:

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  diarrhea or constipation;

  
  


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  weakness or tired feeling;

  
  


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  fever;

  
  


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  headache; or

  
  


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  dizziness, drowsiness.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Ondansetron Dosing Information

Usual Adult Dose for Nausea/Vomiting -- Chemotherapy Induced:

Initial: 0.15 mg/kg IV given 30 minutes before the start of emetogenic therapy, then repeat the dose at 4 hour intervals for 2 additional doses. A continuous IV dose option consists of 8 mg followed by 1 mg/hr for the next 24 hours.

Alternative therapies:
With highly emetogenic chemotherapy, give a onetime IV dose of 32 mg, 30 minutes before the start of single-day therapy; Infuse over 15 minutes. Alternatively, give a single 24 mg orally 30 minutes before therapy.
With moderate emetogenic chemotherapy, give 8 mg orally 30 minutes before the start of therapy, then 8 mg given 8 hours after the first dose. Thereafter, give 8 mg every 12 hours for 1 to 2 days after emetogenic therapy is complete.

Oral soluble film dosage form: Highly emetogenic cancer chemotherapy: 24 mg given successively as three 8 mg films administered 30 minutes before the start of single-day highly emetogenic chemotherapy, including cisplatin greater than or equal to 50 mg/m2. Moderately emetogenic cancer chemotherapy: One 8 mg soluble film given 2 times a day. The first dose should be administered 30 minutes before the start of emetogenic chemotherapy, with a subsequent dose 8 hours after the first dose.

Usual Adult Dose for Nausea/Vomiting:

Initial: 0.15 mg/kg IV given 30 minutes before the start of emetogenic therapy, then repeat the dose at 4 hour intervals for 2 additional doses. A continuous IV dose option consists of 8 mg followed by 1 mg/hr for the next 24 hours.

Alternative therapies:
With highly emetogenic chemotherapy, give a onetime IV dose of 32 mg, 30 minutes before the start of single-day therapy; Infuse over 15 minutes. Alternatively, give a single 24 mg orally 30 minutes before therapy.
With moderate emetogenic chemotherapy, give 8 mg orally 30 minutes before the start of therapy, then 8 mg given 8 hours after the first dose. Thereafter, give 8 mg every 12 hours for 1 to 2 days after emetogenic therapy is complete.

Oral soluble film dosage form: Highly emetogenic cancer chemotherapy: 24 mg given successively as three 8 mg films administered 30 minutes before the start of single-day highly emetogenic chemotherapy, including cisplatin greater than or equal to 50 mg/m2. Moderately emetogenic cancer chemotherapy: One 8 mg soluble film given 2 times a day. The first dose should be administered 30 minutes before the start of emetogenic chemotherapy, with a subsequent dose 8 hours after the first dose.

Usual Adult Dose for Nausea/Vomiting -- Postoperative:

4 mg IV (undiluted) over 2 to 5 minutes, or IM, immediately before induction of anesthesia or postoperatively if nausea or vomiting occurs immediately after surgery. Alternatively, 16 mg orally 1 hour before induction of anesthesia.

Oral soluble film dosage form: 16 mg given as successively as two 8 mg oral soluble films 1 hour before induction of anesthesia.

Usual Adult Dose for Nausea/Vomiting--Radiation Induced:

8 mg orally every 8 hours, give the first dose 1 to 2 hours prior to radiotherapy.

Oral soluble film dosage form:
One 8 mg soluble film given 3 times a day.
For total body irradiation: One 8 mg soluble film given 1 to 2 hours before each fraction of radiotherapy administered each day.
For single high-dose fraction radiotherapy to the abdomen: One 8 mg oral soluble film given 1 to 2 hours before radiotherapy, with subsequent doses every 8 hours after the first dose for 1 to 2 days after completion of radiotherapy.
For daily fractionated radiotherapy to the abdomen: One 8 mg oral soluble film given 1 to 2 hours before radiotherapy, with subsequent doses every 8 hours after the first dose for each day radiotherapy is given.

Usual Adult Dose for Pruritus:

Study (n=150) - Induced by Intrathecal Fentanyl
8 mg IV before spinal anesthesia.

Usual Adult Dose for Alcohol Dependence:

Study (n=321) - Early onset alcoholism
4 mcg/kg two times daily.

Usual Adult Dose for Postanesthetic Shivering:

Study (n=82)
8 mg IV, 3 to 5 minutes before the induction of anesthesia.

Usual Pediatric Dose for Nausea/Vomiting -- Postoperative:

Child 1 month to 12 years:
40 kg or less: 0.1 mg/kg single dose IV, administered over 2 to 5 minutes, immediately prior to or following anesthesia induction, or postoperatively if nausea and/or vomiting present shortly after surgery.

40 kg or more: 4 mg single dose IV, administered over 2 to 5 minutes, immediately prior to or following anesthesia induction, or postoperatively if nausea and/or vomiting present shortly after surgery.

Usual Pediatric Dose for Nausea/Vomiting -- Chemotherapy Induced:

Child 6 months to 18 years: 0.15 mg/kg as an IV infusion (over 15 minutes) administered 30 minutes before the start of emetogenic therapy, then at 4 and 8 hours after the first dose, respectively.

4 to 11 years: 4 mg orally given 30 minutes before the start of emetogenic therapy, then 4 mg orally 4 and 8 hours after the first dose. Thereafter, 4 mg orally every 8 hours for 1 to 2 days after emetogenic therapy is complete.

11 years or older:: 8 mg orally 3 times daily, or 24 mg orally once daily.

Oral soluble film dosage form: Use of ondansetron oral soluble films is not indicated for treatment of nausea and vomiting associated with highly emetogenic cancer chemotherapy in pediatric patients.
For prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy: For pediatric patients 12 years of age and older, the dosage is the same as for adults. For pediatric patients 4 through 11 years of age, the dosage is one 4 mg oral soluble film given 3 times a day. The first dose should be administered 30 minutes before the start of emetogenic chemotherapy, with subsequent doses 4 and 8 hours after the first dose. One 4 mg oral soluble film should be administered 3 times a day (every 8 hours) for 1 to 2 days after completion of chemotherapy.

Usual Pediatric Dose for Gastroenteritis:

Study (n=145) - Control of emesis during the ED phase of oral rehydration:
6 months to 12 months: 1.6 mg orally every 8 hours
1 year to 3 years: 3.2 mg orally every 8 hours
4 years or older: 4 mg orally every 8 hours

Dosage was administered 15 minutes before the start of oral rehydration.

What other drugs will affect ondansetron?

Tell your doctor about all other medicines you use, especially:

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  arsenic trioxide (Trisenox);

  
  


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  tacrolimus (Prograf);

  
  


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  tramadol (Ultram, Ultracet);

  
  


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  an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), levofloxacin (Levaquin), moxifloxacin (Avelox), pentamidine (NebuPent, Pentam), or rifampin (Rifadin, Rimactane, Rifater);

  
  


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  an antidepressant such as amitriptylline (Elavil, Vanatrip, Limbitrol), clomipramine (Anafranil), or desipramine (Norpramin);

  
  


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  anti-malaria medications such as chloroquine (Aralen) or mefloquine (Lariam);

  
  


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  heart rhythm medicine such as amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), disopyramide (Norpace), dronedarone (Multaq), ibutilide (Corvert), procainamide (Procan, Pronestyl), propafenone (Rythmol), quinidine (Quin-G), or sotalol (Betapace);

  
  


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  medicine to prevent or treat nausea and vomiting such as dolasetron (Anzemet), droperidol (Inapsine), or ondansetron (Zofran);

  
  


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  medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), clozapine (FazaClo, Clozaril), haloperidol (Haldol), pimozide (Orap), thioridazine (Mellaril), or ziprasidone (Geodon);

  
  


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  migraine headache medicine such as sumatriptan (Imitrex, Treximet) or zolmitriptan (Zomig);

  
  


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  narcotic medication such as methadone (Methadose, Diskets, Dolophine); or

  
  


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  seizure medication such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal).

  
  

This list is not complete and other drugs may interact with ondansetron. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More ondansetron resources

• Ondansetron Side Effects (in more detail)
• Ondansetron Use in Pregnancy & Breastfeeding
• Drug Images
• Ondansetron Drug Interactions
• Ondansetron Support Group
• 81 Reviews for Ondansetron - Add your own review/rating

• ondansetron Oral, Injection, Intravenous Advanced Consumer (Micromedex) - Includes Dosage Information


• Ondansetron Prescribing Information (FDA)


• Ondansetron MedFacts Consumer Leaflet (Wolters Kluwer)


• Ondansetron Hydrochloride Monograph (AHFS DI)


• Zofran Consumer Overview


• Zofran Prescribing Information (FDA)


• Zofran ODT Orally Disintegrating Tablets MedFacts Consumer Leaflet (Wolters Kluwer)


• Zofran ODT Prescribing Information (FDA)


• Zuplenz Prescribing Information (FDA)


• Zuplenz Advanced Consumer (Micromedex) - Includes Dosage Information


• Zuplenz Soluble Film MedFacts Consumer Leaflet (Wolters Kluwer)


• Zuplenz Consumer Overview

Compare ondansetron with other medications

• Alcohol Dependence
• Gastroenteritis
• Nausea/Vomiting
• Nausea/Vomiting, Chemotherapy Induced
• Nausea/Vomiting, Postoperative
• Nausea/Vomiting, Radiation Induced
• Obsessive Compulsive Disorder
• Postanesthetic Shivering
• Pruritus

Where can I get more information?

• Your pharmacist can provide more information about ondansetron.

See also: ondansetron side effects (in more detail)