Physician Survey of Ondansetron (Zofran) use practices
Eric Lusinski MD, Richard Brodsky MD, Evan Weiner MD, Sabina Singh MD
St. Christopher’s Hospital for Children Department of Pediatric Emergency Medicine; Drexel University College of Medicine
INTRODUCTION
Ondansetron is currently used for nausea and/
or vomiting primarily in a hospital setting.
Currently there are no studies that examine
the use of ondansetron in an outpatient setting
and physician prescribing practices. With a
new black box warning of QTc prolongation
there are no studies that study how this
impacted the use of ondansetron among
physicians and its use in the outpatient
setting.
OBJECTIVES
To evaluate the effect of the new black box
warning on prescribing ondansetron. We
hypothesized that the new black box warning
has not affected physician prescribing of
ondansetron and that it is very widely
prescribed for outpatient use after an ER visit
for vomiting.
METHODS
Physicians who are Pediatric trained that work in
the ED or Urgent Care centers were surveyed
across the United States. The data was used to
see how physicians prescribe ondansetron and
what percentage prescribe it for outpatient use.
The data was also analyzed to include
demographics, to see at what age physicians
prescribe ondansetron, what form of
ondansetron most physicians prescribe and
concern if it will mask a sugical emergency.
RESULTS
A total of 303 physicians completed the survey,
50.9% were pediatric trained, 38.9% Pediatric
ER trained, 10.2% other. 100% of the physicians
use ondansetron. 84% use ondansetron in the
ER, 11% in urgent care and 5% in private
practice/clinic.
RESEARCH POSTER PRESENTATION DESIGN © 2012
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Physician practice setting
Dose of ondansetron most commonly used is
0.15mg/kg/dose (51.7%) vs. age based dosing
(24.35%) vs. 0.1mg/kg/dose (23.95%). 54.46%
of physicians start utilizing ondansetron at 6
months of age vs. 22.7% at 3 months of age,
14.5% at 1 year, 6.27% at 1 month of age. Most
common forms of ondansetron used are ODT
(30.8%) vs. IV (29.83%). 93.4% of physician are
very comfortable prescribing ondansetron,
Change in practice due to black box warning
78.55% of physicians are aware of a black
box warning of QTc prolongation for
ondansetron vs. 23.45% that do not. 86.47%
vs. 13.53% have not changed their practice
in the use of ondansetron due to the new
black box warning on ondansetron.
Concern for masking a surgical emergency
Outpatient use of odansetron
Comfortability of prescribing ondanstron
for outpatient use
CONCLUSIONS
The survey shows that most physicians are
comfortable prescribing ondansetron and more
than half prescribe ondansetron for outpatient
use with limited quantities so that if symptoms
persist patients return to the ER or their
prescribing physician. As predicted most
physicians did not change their prescribing
practices due to the black box warning of QTc
prolongation and most physicians are not
concerned that the use of ondansetron will
mask a surgical emergency.
REFERENCES
50.5% prescribe ondansetron for outpatient use
vs. 15.2% do not prescribe for outpatient use
and 34.3% prescribe it on a case by case basis.
Most physicians prescribe 1-5 doses for
home use 55.45% vs. 27.4% prescribe 6-10
doses and 17.15% prescribe >11 doses.
72.28% vs. 27.72% of physicians are not
concerned that using ondansetron will mask a
surgical emergency in case of obstruction,
volvulus, appendicitis and intussusception.
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