Name /bks_53161_deglins_md_disk/ondansetron
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Use Cautiously in: Hepatic impairment (daily dose not to exceed 8 mg); Abdominal surgery (may mask ileus); OB, Lactation, Pedi: Pregnancy, lactation, or children ⱕ3 yr (PO) or ⬍1 mo (parenteral) (safety not established) .
ondansetron (on-dan-se-tron)
Ondissolve ODF, Zofran, Zofran ODT, Zuplenz
Classification
Therapeutic: antiemetics
Pharmacologic: 5-HT3 antagonists
Pregnancy Category B
Adverse Reactions/Side Effects
CNS: headache, dizziness, drowsiness, fatigue, weakness. CV: TORSADE DE POINTES,
QT interval prolongation. GI: constipation, diarrhea, abdominal pain, dry mouth,q
liver enzymes. Neuro: extrapyramidal reactions.
Indications
consciousness; concurrent use contraindicated. Carbamazepine, phenytoin, and
rifampin mayplevels.
Interactions
Drug-Drug: Use with apomorphineqrisk of severe hypotension and loss of
Prevention of nausea and vomiting associated with highly or moderately emetogenic
chemotherapy. PO: Prevention of nausea and vomiting associated with radiation
therapy. Prevention and treatment of postoperative nausea and vomiting.
Action
Blocks the effects of serotonin at 5-HT3 – receptor sites (selective antagonist) located
in vagal nerve terminals and the chemoreceptor trigger zone in the CNS. Therapeutic Effects: Decreased incidence and severity of nausea and vomiting following
chemotherapy or surgery.
Pharmacokinetics
Absorption: IV administration results in complete bioavailability; 100% absorbed
following oral administration.
Distribution: Unknown.
Metabolism and Excretion: Extensively metabolized by the liver (primarily by
CYP3A4); 5% excreted unchanged by the kidneys.
Half-life: Adults— 3.5– 5.5 hr; Children 5 mo– 12 yr— 2.9 hr.
TIME/ACTION PROFILE (antiemetic effect)
ROUTE
ONSET
PEAK
DURATION
PO, IV
IM
rapid
rapid
15–30 min
40 min
4–8 hr
unknown
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Orally disintegrating tablets contain aspartame and should not be used in patients with phenylketonuria; Congenital long QT
syndrome; Concurrent use of apomorphine.
⫽ Canadian drug name.
⫽ Genetic Implication.
Route/Dosage
PO (Adults): Prevention of nausea/vomiting associated with highly-emetogenic
chemotherapy— 24 mg 30 min prior to chemotherapy.
PO (Adults and Children ⬎11 yr): Prevention of nausea/vomiting associated
with moderately emetogenic chemotherapy— 8 mg 30 min prior to chemotherapy
and repeated 8 hr later; 8 mg q 12 hr may be given for 1– 2 days following chemotherapy. Prevention of radiation-induced nausea/vomiting— 8 mg 1– 2 hr prior
to radiation; may be repeated q 8 hr, depending on type, location, and extent of radiation. Prevention of postoperative nausea/vomiting— 16 mg 1 hr before induction
of anesthesia.
PO (Children 4– 11 yr): Prevention of nausea/vomiting associated with moderately emetogenic chemotherapy— 4 mg 30 min prior to chemotherapy and repeated 4 and 8 hr later; 4 mg q 8 hr may be given for 1– 2 days following chemotherapy.
IV (Adults): Prevention of chemotherapy-induced nausea/vomiting— 0.15 mg/
kg (max dose ⫽ 16 mg) 30 min prior to chemotherapy, repeated 4 and 8 hr later.
IM, IV (Adults): Prevention of postoperative nausea/vomiting— 4 mg before induction of anesthesia or postoperatively.
IV (Children 6 mo– 18 yr): Prevention of chemotherapy-induced nausea/vomiting— 0.15 mg/kg (max dose ⫽ 16 mg) 30 min prior to chemotherapy, repeated 4
and 8 hr later.
IV (Children 1 mo– 12 yr and ⬎40 k g): Prevention of postoperative nausea/
vomiting— 4 mg.
IV (Children 1 mo– 12 yr and ⱕ40 kg): Prevention of postoperative nausea/
vomiting— 0.1 mg/kg.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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● Y-Site Compatibility: acetaminophen, aldesleukin, alemtuzumab, alfentanil,
2
Hepatic Impairment
PO, IM, IV (Adults): Severe hepatic impairment— Not to exceed 8 mg/day.
NURSING IMPLICATIONS
Assessment
● Assess patient for nausea, vomiting, abdominal distention, and bowel sounds prior
to and following administration.
● Assess patient for extrapyramidal effects (involuntary movements, facial grimac-
ing, rigidity, shuffling walk, trembling of hands) periodically during therapy.
● Monitor ECG in patients with hypokalemia, hypomagnesemia, HF, brad-
yarrhythmias, or patients taking concomitant medications that prolong
the QT interval.
● Lab Test Considerations: May cause transientqin serum bilirubin, AST, and
ALT levels.
Potential Nursing Diagnoses
Imbalanced nutrition: less than body requirements (Indications)
Diarrhea (Side Effects)
Constipation (Side Effects)
Implementation
● First dose is administered prior to emetogenic event.
● PO: For orally disintegrating tablets, do not attempt to push through foil backing;
with dry hands, peel back backing and remove tablet. Immediately place tablet on
tongue; tablet will dissolve in seconds, then swallow with saliva. Administration of
liquid is not necessary.
IV Administration
● Direct IV: Administer undiluted (2 mg/mL) immediately before induction of an-
esthesia or postoperatively if nausea and vomiting occur shortly after surgery.
Rate: Administer over at least 30 sec and preferably over 2– 5 min.
● Intermittent Infusion: Diluent: Dilute doses for prevention of nausea and
vomiting associated with chemotherapy in 50 mL of D5W, 0.9% NaCl, D5/0.9%
NaCl, D5/0.45% NaCl. Solution is clear and colorless. Stable for 7 days at room
temperature following dilution. Concentration: 1 mg/mL. Rate: Administer
each dose over 15 min.
amifostine, amikacin, aminocaproic acid, anakinra, anidulafungin, argatroban,
ascorbic acid, atropine, azithromycin, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride,
calcium gulconate, carboplatin, carmustine, caspofungin, cefazolin, cefotaxime,
cefoxitin, ceftaroline, ceftazidime, cefuroxime, chlorpromazine, ciprofloxacin,
cisatracurium, cisplatin, cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, daunorubicin,
dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doripenem, doxorubicin, doxorubicin liposome, doxycycline, droperidol, enalaprilat, ephedrine,
epinephrine, epirubicin, epoetin alfa, eptifibatide, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, filgrastim, floxuridine, fluconazole, fludarabine, folic acid, fosaprepritant, gemcitabine, gentamicin, glycopyrrolate, heparin, hetastarch, hydrocortisone sodium succinate,
hydrocortisone sodium phosphate, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, magnesium sulfate, mannitol, mechlorethamine, melphalan,
meperidine, mesna, methotrexate, methoxamine, methyldopate, metoclopramide, metoprolol, metronidazole, midazolam, mitomycin, mitoxantrone, morphine, moxifloxacin, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide,
oxacillin, oxaliplatin, oxytocin, paclitaxel, pamidronate, pancuronium, papaverine, penicillin G, pentamidine, pentazocine, pentostatin, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potassium
chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, ranitidine, remifentanil, rocuronium,
sodium acetate, sodium phosphates, streptokinase, streptozocin, succinylcholine,
sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiotepa, ticarcillin/
clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, topotecan, vancomycin,
vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid.
● Y-Site Incompatibility: acyclovir, allopurinol, aminophylline, amphotericin B
cholesteryl, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin/sulbactam, azathioprine, cefepime, cefoperazone, chloramphenicol, dantrolene, diazoxide, ertapenem, furosemide, ganciclovir, indomethacin, lorazepam, micafungin, milrinone, pantoprazole,
䉷 2015 F.A. Davis Company
CONTINUED
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CONTINUED
ondansetron
pemetrexed, pentobarbital, phenobarbital, phenytoin, rituximab, sargramostim,
sodium bicarbonate, thiopental, trastuzumab, trimethoprin/sulfamethoxazole.
Patient/Family Teaching
● Instruct patient to take ondansetron as directed.
● Advise patient to notify health care professional immediately if symptoms of irreg-
ular heart beat or involuntary movement of eyes, face, or limbs occur.
Evaluation/Desired Outcomes
● Prevention of nausea and vomiting associated with emetogenic cancer chemother-
apy.
● Prevention of postoperative nausea and vomiting.
● Prevention of nausea and vomiting due to radiation therapy.
Why was this drug prescribed for your patient?
⫽ Canadian drug name.
⫽ Genetic Implication.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.