- Prevention of chemotherapy and radiation induced nausea and vomiting
- Prevention of post-operative nausea and vomiting
- Available as a 2 mg/mL solution. Store at room temperature or in the fridge
- Diluted with dextrose and saline solutions, stable 7 days at room temperature
- Diluted with D5W or 0.9% NaCl, stable in syringes 48 hrs at room temp, 14 days at 4°C
- Solutions Compatible: D5W, saline solutions and combinations, ringer's solution, ringer's lactate
- Additive/Above Cassette Compatible: no information
- Y-site Compatible: aldesleukin, amifostine, carboplatin, carmustine, ceftazidime, chlorpromazine, cisplatin, cladribine, cyclophosphamide, cytarabine, dactinomycin, daunorubicin, dexamethasone, diphenhydramine, docetaxel, dopamine, doxorubicin, etoposide, fentanyl, filgrastim, fluconazole, fludarabine, gentamicin, heparin, hydrocortisone sodium succinate, hydromorphone, hydroxyzine, ifosfamide, imipenem, magnesium sulfate, mannitol, meperidine, mesna, methotrexate, metoclopramide, mitoxantrone, morphine, paclitaxel, KCl, propofol, ranitidine, teniposide, vancomycin, vincristine, amino acids/dextrose
- Incompatible: acyclovir, allopurinol, amphotericin, ampicillin, fluorouracil, furosemide, ganciclovir, lipids, lorazepam, methylprednisolone sodium succinate, piperacillin, sodium bicarbonate
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct |
YES Max 4 mg/dose IV direct |
| IV Intermittent Infusion |
YES |
| IV Continuous Infusion | NO |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- Prevention of chemotherapy/radiation-induced nausea and vomiting:
- 0.15-0.2 mg/kg/dose IV 30 minutes before the start of chemotherapy
- Administer subsequent doses 4-8 hours after the first dose
- Maximum 3 doses/24 hours
- Prevention of post-operative nausea and vomiting (<40 kg):
- 0.1 mg/kg IV - give immediately before induction of anesthesia, or post-operatively if the patient is symptomatic
Adult:
- Prevention of chemotherapy/radiation-induced nausea and vomiting:
- 16 mg dose/day IV as a single dose or
- Pre-chemotherapy: 8 mg IV given 30 minutes prior to chemotherapy followed by oral therapy
- Post-chemotheray: 1 mg/hr IV infusion for up to 24 hours
- Prevention of post-operative nausea and vomiting (adults and children >40 kg):
- 4 mg IV - give immediately before induction of anesthesia, or post-operatively if the patient is symptomatic
- Ondansetron is dosed 3 times per 24 hour period for highly emetogenic chemotherapy and 2 times per 24 hour period for moderately emetogenic chemotherapy (see definitions in CHEO Hospital Formulary)
- Dosing intervals may vary from q1h to q12h depending on how the chemotherapy is administered. For chemotherapy lasting longer than 24 hours, a q8h interval for the duration of chemotherapy is recommended.
- Headache; may be treated with acetaminophen
- Constipation, transient increases in liver enzymes
- Hypokalemia, tachycardia, bradycardia
- Acute transient EKG changes (increased PR, QRS, QTc) not associated with clinical sequelae (rare with ondansetron)
- One report of heart block but this occurred immediately after an infusion of 32 mg given over 2-3 minutes in an adult patient
- The oral route of administration should be used whenever possible as the oral form is less expensive
- Wastage is strongly discouraged