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- Ondansetron (Zofran) vs. metoclopramide (Reglan): What's the difference?
- What are ondansetron and metoclopramide?
- What are the side effects of ondansetron and metoclopramide?
- What is the dosage of ondansetron vs. metoclopramide?
- What drugs interact with ondansetron and metoclopramide?
- Are ondansetron and metoclopramide safe to use while pregnant or breastfeeding?
Ondansetron (Zofran) vs. metoclopramide (Reglan): What's the difference?
- Ondansetron and metoclopramide are used to prevent and treat nausea and vomiting.
- Ondansetron is most often used to prevent nausea and vomiting caused by cancer chemotherapy and to prevent vomiting and nausea after surgery.
- Metoclopramide is used to relieve heartburn symptoms with gastroesophageal reflux when certain other treatments do not work and to relieve the symptoms of slow stomach emptying in people with diabetes.
- Brand names for ondansetron include Zofran, Zofran ODT, and Zuplenz.
- Brand names for metoclopramide include Reglan and Metozolv ODT.
- Ondansetron and metoclopramide belong to different drug classes. Ondansetron is an anti-nausea medication and metoclopramide is a "prokinetic" drug.
- Side effects of ondansetron and metoclopramide that are similar include fatigue and drowsiness.
- Side effects of ondansetron that are different from metoclopramide include headache, feeling unwell (malaise), constipation, dizziness, diarrhea, and abnormal heart rate and rhythm.
- Side effects of metoclopramide that are different from ondansetron include restlessness, anxiety, insomnia, depression, and sedation.
What are ondansetron and metoclopramide?
Ondansetron is an anti-nausea medication used to prevent nausea and vomiting that results from cancer chemotherapy. Chemotherapy agents cause increased secretion of serotonin, which stimulates serotonin (5-HT3) receptors in the brain, resulting in nausea and vomiting. Ondansetron works by selectively blocking serotonin (5-HT3) receptors, thereby reducing the effect of increased serotonin due to chemotherapy. It is also prescribed for prevention of nausea and vomiting after surgery.
Metoclopramide is a "prokinetic" drug that stimulates the muscles of the gastrointestinal tract including the muscles of the lower esophageal sphincter, stomach, and small intestine by interacting with receptors for acetylcholine and dopamine on gastrointestinal muscles and nerves. It is used in adults to relieve heartburn symptoms with gastroesophageal reflux when certain other treatments do not work and to relieve the symptoms of slow stomach emptying in people with diabetes.
What are the side effects of ondansetron and metoclopramide?
Side effects of ondansetron are
Some individuals may develop abnormal heart rate and rhythm.
Metoclopramide is generally well tolerated when used in low doses for brief periods. Neurological side effects increase with higher doses and longer periods of treatment.
Common side effects of metoclopramide are:
Other important side effects of metoclopramide include serious neurological symptoms that mimic Parkinson's disease such as:
- involuntary muscle movements,
- facial grimacing, and
- dystonic reactions resembling tetanus.
Fortunately, these more serious side effects are infrequent and usually -- though not always -- disappear when metoclopramide is discontinued. Patients with Parkinson's disease can experience worsening of symptoms with metoclopramide. Metoclopramide may impair the mental and/or physical abilities to drive or operate machinery.
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What is the dosage of ondansetron vs. metoclopramide?
Dosing for adults:
- Highly nauseating chemotherapy: 24 mg orally dissolved on tongue 30 minutes prior to start of a single-day chemotherapy.
- Moderately nauseating chemotherapy: Take 8 mg tablet 30 minutes prior to chemotherapy and repeat in 8 hours, then 8 mg every 12 hours for 1 to 2 days after chemotherapy.
- Radiation-induced nausea and vomiting: Take 8 mg orally 1 to 2 hours prior to radiation and every 8 hours after first dose, as needed.
- Post-surgery nausea and vomiting: 16 mg orally 1 hour before anesthesia.
Dosing for children:
- Moderately nauseating chemotherapy (12 years and older): 8 mg orally prior to chemotherapy and repeat in 8 hours, then 8 mg every 12 hours for 1 to 2 days after chemotherapy.
- Moderately nauseating chemotherapy (4 to 11 years): 4 mg orally 30 minutes prior to chemotherapy and repeat in 4 and 8 hours after the first dose, then every 8 hours for 1 to 2 days after chemotherapy.
- Not recommended for children under 4 years old.
The usual dose of metoclopramide for treating GERD is 10-15 mg four times daily, 30 minutes before each meal.
Gastroparesis is treated with 10 mg administered orally four times daily, 30 minutes before each meal and at bedtime.
What drugs interact with ondansetron and metoclopramide?
Dronedarone can increase blood levels of ondansetron by reducing its breakdown in the liver. This may increase side effects of ondansetron. This combination may also increase the risk of abnormal heartbeats.
Since metoclopramide accelerates emptying of the stomach, it can increase or decrease absorption and effects of other drugs that are absorbed in the small intestine. For example, the effects of alcohol, diazepam (Valium) and cyclosporine can be accelerated when used together with metoclopramide.
Metoclopramide should not be used in patients taking MAO inhibitors -- for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane) -- because of the risk of serious adverse effects due to excess release of neurotransmitters.
Concurrent administration of anticholinergic drugs can decrease the effectiveness of metoclopramide.
Are ondansetron and metoclopramide safe to use while pregnant or breastfeeding?
The safety of metoclopramide in pregnancy has not been established.
Metoclopramide is excreted in human breast milk. Nursing mothers should avoid metoclopramide during pregnancy.
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Ondansetron and metoclopramide are used to prevent and treat nausea and vomiting. Ondansetron is most often used to prevent nausea and vomiting caused by cancer chemotherapy and to prevent vomiting and nausea after surgery. Metoclopramide is used to relieve heartburn symptoms with gastroesophageal reflux when certain other treatments do not work and to relieve the symptoms of slow stomach emptying in people with diabetes.
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Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication,prescription medication, and surgery.
GERD (Acid Reflux, Heartburn)
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are: heartburn, regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Nausea and Vomiting
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. There are numerous cases of nausea and vomiting. Some causes may not require medical treatment, for example, motion sickness, and other causes may require medical treatment by a doctor, for example, heart attack, lung infections, bronchitis, and pneumonia. Some causes of nausea and vomiting may be life-threatening, for example, heart attack, abdominal obstruction, and cancers. Treatment of nausea and vomiting depends upon the cause.
Heartburn vs. Acid Reflux (Differences and Similarities)
Heartburn and acid reflux are not the same thing. Heartburn is actually a symptom of acid reflux. Heartburn gets its name because it feels like a burning sensation around the heart. Another symptom that occurs with heartburn is a bitter or sour taste in the mouth, usually when you eat or lye down. Heartburn affects more than 60 million people in the US at least once a month. Acid reflux, or GERD, occurs when stomach acid backs up into the esophagus, which irritates it. Heartburn is just one symptom of acid reflux. Other symptoms of acid reflux include: Belching Nausea after eating A feeling of fullness during or after eating Abdominal bloating Upset stomach Belching Wheezing Reflux laryngitis A tightness in the throat Problems swallowing Indigestion In some people, vomiting Causes of acid reflux and heartburn include: Being obese Slouching (poor posture) Medications like calcium channel blockers, theophylline, nitrates, and antihistamines Foods and drinks like caffeine, citrus fruits and vegetables, alcohol, and chocolate Pregnancy Diabetes Increase in stomach acid Eating a heavy meal Eating before bed The treatment for heartburn and acid reflux is to treat the underlying cause, for example, GERD, with over-the-counter (OTC) medicine, prescription medicine, natural remedies, and lifestyle changes like a eating a healthy, less fatty, spicy diet, not eating big meals, not eating before bed, and getting regular exercise to improve your posture.Sometimes a heart attack can mimic heartburn and acid reflux because they feel very similar. If you have symptoms of chest pain, tightness in the chest, heartburn, acid reflux, jaw, tooth, or head pain; shortness of breath, nausea, vomiting, sweating, discomfort in the upper middle of the abdomen, arm or upper back pain, or the general feeling of being ill, go to the nearest Emergency Department immediately because these are the symptoms of a heart attack.REFERENCES:American College of Gastroenterology. "Acid Reflux." 2017.<http://patients.gi.org/topics/acid-reflux/> familydoctor.org. "Heartburn." Updated: Mar 2014.<https://familydoctor.org/condition/heartburn/> National Library of Medicine; PubMed Health. "Heartburn and GERD: Treatment options for GERD." Updated: Nov 18, 2015.<https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072436/>
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