Generic Name: ondansetron
Drug Class: Antiemetics, Selective 5-HT3 Antagonist
What is ondansetron, and what is it used for?
Ondansetron is an antiemetic medication prescribed to prevent nausea and vomiting caused by cancer treatments such as chemotherapy and radiation, and anesthetic medications used during surgeries. Ondansetron is also used to treat extreme and persistent nausea and vomiting during pregnancy, and itching caused by opioid medications and certain specific conditions.
Ondansetron works by blocking the activity of serotonin, a chemical messenger (neurotransmitter) that is involved in inducing nausea and vomiting. Chemotherapy and radiotherapy are associated with the release of serotonin in the gastrointestinal (GI) tract, which stimulate serotonin 5-HT3 receptors on nerve cells (neurons), triggering the vomiting reflex.
Ondansetron prevents the vomiting reflex by selectively blocking the serotonin 5-HT3 receptors on the vagus nerve which regulates GI activity. Ondansetron also blocks 5-HT3 receptors in the area postrema in the brain stem, which induces vomiting in response to serotonin and toxins. Ondansetron is also used to treat itching from certain liver and kidney diseases, which is mediated by serotonin.
The uses of ondansetron include the following:
- Prevention (prophylaxis) of chemotherapy-induced nausea and vomiting
- Radiation-induced nausea and vomiting
- Post-operative nausea and vomiting
Off-label uses include:
- Itching due to liver disease (cholestatic pruritus)
- Itching due to kidney disease (uremic pruritus)
- Itching caused by spinal opioid therapy
- Itching from rosacea, a skin condition
- Severe nausea and vomiting in pregnancy (hyperemesis gravidarum)
- Prevention (prophylaxis) of chemotherapy-induced nausea and vomiting
- Post-operative nausea and vomiting
- Do not administer with apomorphine; the combination has been reported to cause severe drop in blood pressure and loss of consciousness
- Do not administer to patients who are hypersensitive to ondansetron or any of its components
- Do not administer to patients who have had hypersensitivity to other selective 5-HT3 antagonists
- Hypersensitivity can cause severe reactions including anaphylaxis and bronchospasm; discontinue immediately and institute supportive and symptomatic therapy
- Reduce dose in patients with impaired liver function
- Ondansetron can cause ECG changes; ECG should be monitored in patients with congestive failure, electrolyte imbalance or slow, irregular heartbeat (bradyarrhythmia)
- Ondansetron can increase serotonin levels and lead to serotonin syndrome; concomitant use with drugs that increase serotonin levels can increase the risk, and in some cases, has been fatal. Drugs that are serotonergic include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), lithium, fentanyl, tramadol, methylene blue IV, and mirtazapine
- Reduced blood flow to the heart muscle (myocardial ischemia) has been reported in patients treated with ondansetron
- Ondansetron does not stimulate the muscle contraction that move gastrointestinal contents (peristalsis); should not be used instead of nasogastric suction
- Ondansetron may mask progressive lack of movement in the intestines (ileus) or gastric distention in patients who are undergoing abdominal surgery or experiencing chemotherapy-induced nausea and vomiting; monitor for decreased bowel activity, particularly in patients with risk factors for gastrointestinal obstruction
- Ondansetron orally disintegrating tablets contain phenylalanine, an amino acid; should be used with caution in patients with phenylketonuria, an inherited disorder that causes phenylalanine buildup in the body
What are the side effects of ondansetron?
Common side effects of ondansetron include:
- Feeling unwell (malaise)
- Low tissue oxygen levels (hypoxia)
- Gynecological disorder
Less common side effects of ondansetron include:
- Urinary retention
- Elevated liver function test results
- Injection site pain, redness and burning sensation
- Itching (pruritus)
- Cold sensation
- Prickling sensation (paresthesia)
Rare side effects of ondansetron may include:
- Nausea and vomiting
- Abnormal liver function
- Specific liver enzyme abnormalities
- Liver tissue death (necrosis)
- Irregular heart rhythm conditions (arrhythmias) including
- Abnormal ECG
- Reduced blood flow to the heart muscle (myocardial ischemia), predominantly with intravenous ondansetron
- Fainting (syncope)
- Neurologic reaction with spasm in eye muscle (oculogyric crisis), sometimes with other involuntary muscle movements
- Transient dizziness during or shortly after intravenous infusion
- Transient blindness predominantly with IV infusion
- Transient blurred vision
- Joint pain (arthralgia)
- Hives (urticaria)
- Serious skin reactions that can be life-threatening such as:
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
- Severe hypersensitivity reactions (anaphylaxis) including:
- Swelling of tissue under skin and mucus membranes (angioedema)
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.
Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.
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What are the dosages of ondansetron?
Oral Soluble Film
Orally Disintegrating Tablets
Postoperative Nausea and Vomiting
- 4 mg intravenously/intramuscular immediately before anesthesia or after the procedure or 16 mg orally 1 hour before anesthesia; patients over 80 kg may need an additional 4 mg intravenously
Radiation-Induced Nausea and Vomiting
- Total body radiation therapy: 8 mg orally 1-2 hours before radiation therapy; administered each day
- Single high-dose fraction therapy to the abdomen: 8 mg orally 1-2 hours before radiation therapy; administer subsequent doses every 8 hours after first dose 1-2 days after completion of therapy
- Daily fractions to the abdomen: Administer 8 mg orally 1-2 hours before radiotherapy; administer subsequent doses every 8 hr after first dose each day radiotherapy is given
- Renal impairment: Dose adjustment not necessary
- Severe hepatic impairment (Child-Pugh score equal to 10): Not to exceed 8 mg/day
Cholestatic Pruritus (Off-label)
- 8 mg divided every 12 hours or 8 mg every 8-12 hours orally for 7 days up to 5 months
- Alternatively, 4-8 mg intermittent short-term intravenous dosing is used in adults; a single dose of 4 mg single dose used in pregnancy
Uremic Pruritus (Off-label)
- 8 mg divided every 12 hours or 8 mg every 8 to 12 hours orally for 14 days up to 5 months
Spinal Opioid-Induced Pruritus (Off-label)
- 4-8 mg intravenously 20-30 min before spinal opioid therapy; may repeat dosing at 12, 24, 36, 48 hours after spinal opioid dosing
- 4-8 mg intravenously
- 4-8 mg orally every 12 hours for up to 3 weeks
- Alternatively, 12 mg IV daily for 4 days
Hyperemesis Gravidarum (Off-label)
- 10 mg IV every 8 hours as needed
Chemotherapy-Induced Nausea and Vomiting
Prophylaxis, Oral Dosing
- Children under 4 years old: Safety and efficacy not established
- Children 4-12 years: 4 mg started 30 min before chemotherapy, then 4 and 8 hours after the first dose, then every 8 hours for 1-2 days after chemotherapy
- Children over 12 years: 8 mg started 30 min before chemotherapy, then every 12 hours for 1-2 days after chemotherapy or single dose of 24 mg
- Children under 6 months: Safety and efficacy not established
- Children 6 months or older: 0.15 mg/kg over 15 min administered 30 min before chemotherapy, then repeated 4 and 8 hours after the first dose; not to exceed 16 mg/dose (32 mg no longer recommended because of increased risk of QT prolongation)
Postoperative Nausea and Vomiting
1 month-12 years
- Under 40 kg, 0.1 mg/kg intravenously
- Over 40 kg, 4 mg intravenously
Under 12 years
- 4 mg intravenously/intramuscularly immediately before anesthesia or after the procedure or 16 mg orally 1 hour before anesthesia; patients over 80 kg may need an additional 4 mg intravenously
- Ondansetron overdose can increase serotonin levels and lead to serotonin syndrome.
- There is no specific antidote for ondansetron overdose.
- Overdosage must be treated with symptomatic and supportive therapy. In case of overdose, get medical help or contact Poison Control Center immediately.
What drugs interact with ondansetron?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Severe interactions of ondansetron include:
- Ondansetron has serious interactions with at least 147 different drugs.
- Ondansetron has moderate interactions with at least 83 different drugs.
- Ondansetron has minor interactions with at least 25 different drugs.
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.
Pregnancy and breastfeeding
- Use of ondansetron may be acceptable. Animal studies do not show evidence of fetal harm and studies on ondansetron use during pregnancy have reported inconsistent findings on major birth defects in the newborn. Available postmarketing data do not reveal a drug-associated risk of miscarriage or adverse maternal outcomes.
- It is not known if ondansetron is present in human breast milk; however, it is present in rat’s milk, and likely also present in human milk. There is no data on its effects on milk production or the breastfed infant. Use with caution in nursing mothers, based on the mother's clinical needs and the potential adverse effects on the infant.
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Ondansetron is an antiemetic medication prescribed to prevent nausea and vomiting caused by cancer treatments (chemotherapy and radiation, and anesthetic medications used during surgeries). It is also used to treat extreme and persistent nausea and vomiting during pregnancy, and itching caused by opioid medications and certain specific conditions. Common side effects of ondansetron include headache, feeling unwell (malaise), fatigue, constipation, low tissue oxygen levels (hypoxia), drowsiness, dizziness, and gynecological disorder. Consult your doctor before taking ondansetron if pregnant or breastfeeding.
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Taking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some medications that have been found to cause no problems in pregnancy, however, medications such as Accutane for acne, should never be taken during pregnancy.
What Are Anemia Symptoms During Pregnancy?
Anemia during pregnancy is a common issue that affects many women. Learn the signs of anemia, what causes anemia, how doctors diagnose anemia, and what you can do to treat anemia in pregnancy.
What Should Father to Be Do During Pregnancy?
A father plays a crucial role in his partner’s pregnancy. You may have to change your daily routine to follow a healthy diet, exercise, and get sufficient rest.
What Can Cause Amenorrhea Other Than Pregnancy?
Amenorrhea is a common issue that affects some women even when they're not pregnant. Learn the signs of amenorrhea, what causes amenorrhea, how doctors diagnose amenorrhea, and what you can do to address amenorrhea.
What Causes a Molar Pregnancy?
Molar pregnancy is usually caused by a faulty or abnormal fertilization process. Although some studies have linked molar pregnancy with dietary or genetic factors, the real cause of molar pregnancy is still unknown.
Pain Relief Options for Childbirth
Women experience and tolerate pain differently. For some pregnant women, focused breathing is all they need to get through labor and childbirth; but for others, numbing of the pain is desired. There are a number of different medications a woman can take during labor and childbirth. It is important for you to learn what pain relief options are available. Please discuss the options with your health care professional well before your "birth day" so that when you are in labor you understand the choices.
Safest Rheumatoid Arthritis Drugs During Pregnancy
None of the drugs used in the treatment of rheumatoid arthritis (RA) is completely safe during pregnancy. You must discuss with your physician regarding the decision to use, modify, or stop any medications.
Is Rituximab Safe During Pregnancy?
Rituxan (Rituximab) may not be completely safe during pregnancy and should be stopped at least 12 months before attempting to conceive.
How Does Pregnancy Affect Mental Health?
Pregnancy can be a time of great joy and happiness. Different women respond to pregnancy differently, but pregnancy can affect some womens' mental health negatively.
Is Sex Safe During Pregnancy?
You should talk to a healthcare provider if you feel like your situation is unique, but the general answer is yes—sex is safe during pregnancy!
How Can I Avoid Stretch Marks on My Stomach During Pregnancy?
Medically known as striae gravidarum, stretch marks on the stomach are a common sign during pregnancy. They may also appear in other regions of the body, such as the thighs, hips, buttocks and chest. Pregnancy stretch marks are reddish or violet streaks that eventually turn grey, white or silvery.
What Causes Melasma During Pregnancy?
What is melasma, and what causes it during pregnancy? Learn the signs of melasma during pregnancy and how to treat the condition.
How Early Do Pregnancy Symptoms Start?
Some people notice pregnancy symptoms as early as 1 week after pregnancy begins, which occurs about 2-3 weeks after sex.
Preeclampsia (Pregnancy Induced Hypertension)
Preeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.
When Should I Take Birthing Classes During Pregnancy?
Birthing classes are generally recommended in the last three months (last trimester) of pregnancy. You may, however, enroll in a birthing class anytime during pregnancy. Some women feel that joining a birthing class early in the pregnancy gives them enough time to learn, adapt, and prepare for the delivery. Early registration also gives the advantage of choosing the dates and time schedules according to individual preferences.
Is It Normal to Have Swollen Feet During Pregnancy?
Swollen feet affect many pregnant women. Learn the causes of swollen feet and how they can be treated.
What Is the Management of Ectopic Pregnancy?
Ectopic pregnancy is the medical condition in which the implantation of an embryo occurs outside of the uterine cavity (the womb), most commonly in the fallopian tube. Ectopic pregnancy is usually managed through medications, surgery or observation. The type of management depends on the severity of the condition.
Sexually Transmitted Diseases and Pregnancy (STDs)
When you are pregnant, many sexually transmitted diseases (STDs) can be especially harmful to you and your baby. These STDs include herpes, HIV/AIDS, genital warts (HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis. Symptoms include bumps, sores, warts, swelling, itching, or redness in the genital region. Treatment of STDs while pregnant depends on how far along you are in the pregnancy and the progression of the infection.
Can Pregnancy Symptoms Start at 1 Week?
Most women do not experience discernable pregnancy symptoms at week 1, since many early pregnancy symptoms are similar to premenstrual symptoms.
What Blood Tests Are Done in First Trimester of Pregnancy?
When you are pregnant, your doctor will do blood tests to check complete blood count, blood type, Rh factor, infections, birth defects, and more.
Smoking During Pregnancy
Smoking during pregnancy increases the risk of miscarriage, stillbirth, low birth weight, premature birth and more. Secondhand smoke also increases your baby's risk of developing lung cancer, heart diseases, emphysema, asthma, allergies and SIDS.
Is It OK to Exercise and Workout in the First Trimester of Pregnancy?
You should talk to your doctor to make sure it's safe for you to exercise during pregnancy. However, in most cases, exercising during pregnancy will benefit you and your baby.
What Should I Be Feeling at 19 Weeks of Pregnancy?
The 19th week of pregnancy or the 5th month of pregnancy is when most of the major organs and organ systems have formed in the fetus. The formed organ system continues to grow and form its respective shapes in the following months. The weight of the fetus increases each month to become a baby that can survive outside of the uterus.
How Does Anemia Affect Pregnancy?
Anemia is a condition in which your body doesn't make enough red blood cells. The most common type is iron-deficiency anemia which 50% of women develop during pregnancy.
How Do I Deal With Pregnancy in the Summer Heat?
When you’re dealing with a summer pregnancy, it’s important to limit activities that raise your core temperature.
What Happens in the Third Trimester Pregnancy?
In the third trimester, you and your baby undergo many changes. In the third trimester, you may experience acid reflux, trouble breathing, tender breasts, varicose veins, hemorrhoids, edema, low blood pressure and other symptoms.
How Does Anemia Affect Your Baby During Pregnancy?
Anemia occurs when you don't have enough red blood cells to transport adequate oxygen or iron. Anemia during pregnancy may contribute to early delivery or failure of the baby to grow to a healthy weight.
How Does High Blood Pressure Affect Pregnancy?
High blood pressure during pregnancy can cause serious complications. Learn more about the signs of and risks associated with the condition.
What Happens in the 2nd Trimester Pregnancy?
The second trimester of pregnancy is often the most comfortable for women. In the second trimester of pregnancy, a woman experiences a growing belly, body pains, melasma, bleeding gums, dizziness, carpel tunnel syndrome, swelling and other changes.
What Causes a Cleft Palate During Pregnancy?
A cleft palate is a facial defect in babies that occurs when they are developing inside the womb. A baby’s facial features develop in the first 3 months. Their lips form first, followed by the mouth and palate. Clefts occur if the tissues and cells don’t form in the right way.
How Much Weight Should I Gain During My Pregnancy in the First Trimester?
Weight gain during pregnancy supports the developing baby. You should gain less than five pounds during the first trimester of your pregnancy.
What Is the Surgical Management of Ectopic Pregnancy?
The surgical management of ectopic pregnancy entails operating and removing the pregnancy while you are sedated.
Breast Cancer During Pregnancy
Breast cancer occurs in about 1 in every 1,000 pregnant women. Treatment of breast cancer during pregnancy involves surgery, but it is very difficult to protect the baby from the dangerous effects of radiation and chemotherapy. It can be an agonizing to decide whether or not to undergo breast cancer treatment while one is pregnant.
How Can I Care for My Hair During Pregnancy?
As your hair changes during pregnancy, taking care of it may involve avoiding harsh chemicals and eating a balanced diet. Here are 7 pregnancy hair care tips.
What Vitamins and Supplements Should I Take During Pregnancy?
Even if you eat a variety of nutritious foods, you may need to take pregnancy vitamins and supplements. This is especially true if you have a restricted diet, are pregnant with twins or multiples, have food allergies, or nutrient deficiencies. Talk to your doctor about your needs.
4 Common Discomforts of Pregnancy
Pregnancy comes with huge hormonal changes that can cause discomfort, including morning sickness, heartburn, constipation and headaches. Learn what causes these symptoms and how you can cope with them.
Treatment & Diagnosis
- Pregnancy: Trying to Conceive: After Birth Control
- Ectopic Pregnancy
- Pregnancy-Induced Hypertension
- Pregnancy: Preparing for Pregnancy
- Pregnancy: Conceive High Risk Conditions
- Pregnancy: Trying to Conceive: Is Something Wrong?
- Pregnancy: Fertility Charting 101
- Sexuality Education and Pregnancy Prevention
- Intrahepatic Cholestasis of Pregnancy
- Pregnancy: Trying to Conceive: Feeling Frustrated
- Pregnancy: Trying to Conceive: Getting Help
- Pregnancy: Trying to Conceive: Just Starting Out
- Pregnancy: Trying to Conceive: Worries
- Pregnancy: Am I Fertile? Tests and Treatments
- Pregnancy: Trying to Conceive: Ovulation Issues
- Pregnancy: Trying to Conceive: When to Get Help
- Trying to Conceive. Amos Grunebaum, MD.
- Pregnancy: Trying to Conceive: Getting Started - Amos Grunebaum, MD
- Pregnancy and Parenting: Expecting Triplets
- Fertility and High-Risk Pregnancy
- Pregnancy: Conceive With a Chronic Condition
- Pregnancy: Fertility Charting: Plotting Success
- Pregnancy Recovery & Staying in Shape
- Pregnancy: Trying to Conceive Amos Grunebaum, MD
- Pregnancy: High Risk Pregnancy - Amos Grunebaum, MD.
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- Adolescent Pregnancy Prevention:The Role of Family
- Pregnancy, Fitness After
- Pregnancy:The Unofficial Guide to Having a Baby
- Pregnancy After 35: Glade Curtis, MD
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- Early Pregnancy Symptoms FAQs
- Pregnancy Myths and Facts FAQs
- Pregnancy Due Date Calculator
- Pregnancy After Miscarriage
- Why Does Pregnancy Affect the Course of Rheumatoid Arthritis (RA)?
- How Does Pregnancy Affect the Course of Rheumatoid Arthritis (RA)?
- Paxil & Pregnancy, Possibilty of Birth Defect
- Patient Story: Rheumatoid Arthritis and Pregnancy
- Kidney Infections During Pregnancy
- Ankylosing Spondylitis and Pregnancy
- Asthma in Women, Asthma in Pregnancy
- Pregnancy - Ectopic Pregnancy Risk After Tubal Sterilization
- Pregnancy Planning - Vaginal Infection Can Cause Premature Birth
- Pregnancy - Labor Pain And Walking
- GERD: Safe GERD medications for pregnancy?
- GERD Acid reflux during pregnancy?
- Weight Control After Pregnancy
- What Are Sickle Cell Trait and G6pd Deficiency During Pregnancy?
- Does Scleroderma Cause Infertility in Women?
- What is acute fatty liver of pregnancy?
- Is Fifth Disease Dangerous if You're Pregnant?
- Is It Safe to Travel to Malaria Risk Areas During Pregnancy?
- How Does Mixed Connective Tissue Disease (MCTD) Affect Pregnancy?
- Can Having Polycystic Ovaries Cause Miscarriage?
- Can You Still Get Pregnant After Ectopic Pregnancy?
- Is Herpes During Pregnancy Dangerous to the Baby?
- How Long Does It Take to Recover From an Ectopic Pregnancy?
- Can an Ectopic Pregnancy Affect Fertility?
- What Causes Ectopic Pregnancy?
- Can Laparoscopy Treat Ectopic Pregnancy?
- How Can I Reduce My Risk of Miscarriage?
- Is It Safe to Exercise During Pregnancy?
- Can We Eat Potatoes During Pregnancy?
- 12 Common Pregnancy Cravings to Avoid
- Pregnancy Planning and Lifestyle Changes
- Shingles During Pregnancy
- Anemia During Pregnancy
- Low Blood Pressure During Pregnancy
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- Post Pregnancy Fitness: Lose Postpartum Pounds
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