Names and pronunciation
(on-dan-seh′tron) Zofran , Zofran ODT , Zuplenz
Source page 986
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Individual generic drug information
Extracted information for ondansetron only.
(on-dan-seh′tron) Zofran , Zofran ODT , Zuplenz
Source page 986
Func. class.: Antiemetic
Source page 986
Chem. class.: 5-HT3 antagonist
Source page 986
Do not confuse: Zofran/Zantac
Source page 986
ACTION: Prevents nausea, vomiting by blocking serotonin peripherally, cen- trally, and in the small intestine
Source page 986
USES: Prevention of nausea, vomiting associated with cancer chemotherapy, radiotherapy; prevention of postoperative nausea, vomiting
Source page 986
Extracted information for ondansetron only.
CONTRAINDICATIONS: Hyper- sensitivity; phenylketonuric hypersensi- tivity (oral disintegrating tab), torsades de pointes Precautions: Pregnancy, breastfeeding, children, geriatric patients, granisetron hypersensitivity, QT prolongation, tor sades de pointes
Source page 987
SIDE EFFECTS CNS: Headache, dizziness, drowsiness, fatigue GI: Diarrhea, constipation, abdominal pain, dry mouth MISC: Rash, bronchospasm (rare), mus- culoskeletal pain, wound problems, shiv- ering, fever, hypoxia, urinary retention
Source page 988
INTERACTIONS Increase: unconsciousness, hypoten- sion—apomorphine, do not use together Increase: QT prolongation—other prod- ucts that prolong QT Increase: serotonin syndrome— SSRIs, SSNRIs, MAOIs, tricyclics, monitor closely Drug/Herb Decrease: ondansetron effect—St. John's wort Decrease: ondansetron effect—rifampin, carBAMazepine, phenytoin Drug/Lab Test Increase: LFTs
Source page 988
Extracted information for ondansetron only.
DOSAGE AND ROUTES Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy: • Day of chemotherapy: Give before chemotherapy with a neurokinin 1 (NK1) receptor antagonist, dexamethasone, with/without olanzapine • Adult: IV 8 mg or 0.15 mg/kg, max 16 mg/dose; PO (not film) 8 mg bid × 2 doses with the first dose given before chemotherapy; oral soluble film: 24 mg (three 8-mg doses given together) as a single dose • Infants ≥6 mo, children, and ado- lescents: IV 0.15 mg/kg/dose; max dose: 16 mg/dose; give first dose 30 min before chemotherapy, then doses given 4 and 8 hr after the first dose (3 total doses) Moderately emetogenic with carbo- platin-based doses • Day of chemotherapy: Give before chemotherapy with an NK1 receptor an- tagonist and dexamethasone • Adult: IV 8 mg or 0.15 mg/kg, max 16 mg/dose, as a single dose; PO 8 mg bid × 2 doses with the first dose given before chemotherapy Moderately emetogenic chemotherapy with non-carboplatin-based doses • Day of chemotherapy: Give before and with dexamethasone • Adult: IV 8 mg or 0.15 mg/kg, max 16 mg/dose, as a single dose; PO 8 mg bid × 2 doses with the first dose given before chemotherapy • Children 4-11 yr: PO 4 mg 30 min before chemotherapy; repeat 4 and 8 hours after initial dose, then 4 mg q8hr × 1-2 days after chemotherapy • Children ≥12 yr and adolescents: PO 8 mg 30 min before chemotherapy; then 8 hr after initial dose, then 8 mg q12hr × 1-2 days after chemotherapy Highly emetogic chemotherapy Adult: PO 24 mg given 30 min prior to use of single-dose highly emetogic che- motherapy, including 50 mg/m2 or more Radiation therapy–associated nau- sea and vomiting, prevention • Adult: PO 8 mg daily to bid given 1-2 hr before each fraction of radiation; give with dexamethasone Hepatic dose • Adult: PO/IM/IV max dose 8 mg/day
Source page 987
Available forms: Inj 2 mg/mL, 4-mg/2 mL; tabs 4, 8, 24 mg; oral sol 4 mg/5 mL; oral disintegrating tabs 4, 8 mg; oral dis- solving film 4, 8 mg
Source page 987
Administer: PO route • Regular tab: protect from light (4-mg tab) • Oral disintegrating tab: do not push through foil; gently remove; immediately place on tongue to dissolve; swallow with saliva • Oral dissolving film: fold pouch along dotted line to expose tear notch; tear and O remove film; place film on tongue until dissolved; swallow after dissolved; to reach desired dose, administer succes- sive films, allowing each to dissolve be- fore using another • Oral solution: protect from light; mea- sure in calibrated oral syringe or other calibrated device IM route • Visually inspect for particulate or dis- coloration • May give 4 mg undiluted IM; inject deeply in large muscle mass; aspirate Direct IV route • Give undiluted, max 16 mg Intermittent IV infusion • Check for discoloration or particulate; if particulate is present, shake to dissolve • After diluting single dose in 50 mL NS or D5W, 0.45% NaCl or NS; give over 15 min • Do not use IV 32 mg/dose in chemo- therapy nausea/vomiting due to QT pro- longation, max 16 mg/dose (adult) • Store at room temperature for up to 48 hr after dilution Y-site compatibilities: Aldesleukin, ami fostine, amikacin, aztreonam, bleomycin, CARBOplatin, carmustine, ceFAZolin, cefmetazole, cefotaxime, cefOXitin, cefTAZi- dime, ceftizoxime, cefuroxime, chlorproM- AZINE, cimetidine, cisatracurium, CISpla- tin, cladribine, clindamycin, cyclophosphamide, cytarabine, dacarba- zine, DACTINomycin, DAUNOrubicin, dexa- methasone, diphenhydrAMINE, DOPamine, DOXOrubicin, DOXOrubicin liposome, doxycycline, droperidol, etoposide, famoti- dine, filgrastim, floxuridine, fluconazole, fludarabine, gallium, gentamicin, haloperi- dol, heparin, hydrocortisone, HYDROmor- phone, hydrOXYzine, ifosfamide, imipe- nem-cilastatin, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, methotrexate, meto- clopramide, miconazole, mitoMYcin, mito- XANTRONE, morphine, PACLitaxel, pento- statin, piperacillin/tazobactam, potassium chloride, prochlorperazine, promethazine, raNITIdine, remifentanil, streptozocin, teni- poside, thiotepa, ticarcillin, ticarcillin- clavulanate, vancomycin, vinBLAStine, vin- CRIStine, vinorelbine, zidovudine
Source pages 987, 988
Extracted information for ondansetron only.
Assess: • Absence of nausea, vomiting during chemotherapy • Hypersensitivity reaction: rash, bron- chospasm (rare) • EPS: shuffling gait, tremors, grimac- ing, rigidity periodically • QT prolongation: monitor ECG in those with hypokalemia, hypomagnesemia, car- diac disease or in those receiving other products that increase QT • Serotonin syndrome: occurs when other products are given that increase CNS or peripheral serotonin levels; assess for agitation, confusion, dizziness, diaphoresis, flushing, tremor, seizures, nausea, vomiting, diarrhea; product should be discontinued • Pregnancy/breastfeeding: identify whether pregnancy is planned or suspected; avoid use in pregnancy, cardiac malforma- tions, oral clefts may occur if used in 1st trimester; cautious use in breastfeeding
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Evaluate: • Therapeutic response: absence of nau- sea, vomiting due to chemotherapy, surgery
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report diarrhea, constipation, rash, changes in respirations, discomfort at inser- tion site, serotonin symptoms, EPS symptoms • That headache requiring analgesic is common • Drink with whole glass of water (PO) • Oral disintegrating tabs: remove strip from pouch, place on tongue, and allow to dissolve; drink water
Source page 988
Extracted information for ondansetron only.
PHARMACOKINETICS IV: Mean elimination half-life 3.5-4.7 hr, plasma protein binding 70%-76%, exten- sively metabolized in the liver, excreted 45%-60% in urine
Source page 988
Filter the extracted dose blocks for this individual drug.
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Day of chemotherapy: Give before chemotherapy with a neurokinin 1 (NK1) receptor antagonist, dexamethasone, with/without olanzapine
Candidate age grouping · source page 987
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Adult: IV 8 mg or 0.15 mg/kg, max 16 mg/dose; PO (not film) 8 mg bid × 2 doses with the first dose given before chemotherapy; oral soluble film: 24 mg (three 8-mg doses given together) as a single dose
Candidate age grouping · source page 987
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Infants ≥6 mo, children, and ado- lescents: IV 0.15 mg/kg/dose; max dose: 16 mg/dose; give first dose 30 min before chemotherapy, then doses given 4 and 8 hr after the first dose (3 total doses) Moderately emetogenic with carbo- platin-based doses
Candidate age grouping · source page 987
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Day of chemotherapy: Give before chemotherapy with an NK1 receptor an- tagonist and dexamethasone
Candidate age grouping · source page 987
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Adult: IV 8 mg or 0.15 mg/kg, max 16 mg/dose, as a single dose; PO 8 mg bid × 2 doses with the first dose given before chemotherapy Moderately emetogenic chemotherapy with non-carboplatin-based doses
Candidate age grouping · source page 987
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Day of chemotherapy: Give before and with dexamethasone
Candidate age grouping · source page 987
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Adult: IV 8 mg or 0.15 mg/kg, max 16 mg/dose, as a single dose; PO 8 mg bid × 2 doses with the first dose given before chemotherapy
Candidate age grouping · source page 987
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Children 4-11 yr: PO 4 mg 30 min before chemotherapy; repeat 4 and 8 hours after initial dose, then 4 mg q8hr × 1-2 days after chemotherapy
Candidate age grouping · source page 987
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Children ≥12 yr and adolescents: PO 8 mg 30 min before chemotherapy; then 8 hr after initial dose, then 8 mg q12hr × 1-2 days after chemotherapy Highly emetogic chemotherapy Adult: PO 24 mg given 30 min prior to use of single-dose highly emetogic che- motherapy, including 50 mg/m2 or more Radiation therapy–associated nau- sea and vomiting, prevention
Candidate age grouping · source page 987
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Adult: PO 8 mg daily to bid given 1-2 hr before each fraction of radiation; give with dexamethasone Hepatic dose
Candidate age grouping · source page 987
Chemotherapy-induced nausea and vomiting, prevention; highly emeto- genic chemotherapy:
• Adult: PO/IM/IV max dose 8 mg/day
Candidate age grouping · source page 987