From the Guidelines
Zofran (ondansetron) is the better choice for acute nausea, as Emgality (galcanezumab) is not indicated for this purpose and has no anti-nausea properties. Zofran works by blocking serotonin receptors in the brain and gut that trigger nausea and vomiting, typically providing relief within 30 minutes 1. For acute nausea, Zofran is commonly prescribed as 4-8mg tablets taken every 8 hours as needed, or as a rapidly dissolving oral tablet placed on the tongue.
Key Points to Consider
- Emgality is a monoclonal antibody designed specifically for migraine prevention that blocks CGRP (calcitonin gene-related peptide) and is administered monthly as a subcutaneous injection 1.
- It has no anti-nausea properties and would not help with acute nausea symptoms.
- Zofran can have side effects including headache, constipation, and rarely heart rhythm changes 1.
- The most recent and highest quality study recommends the use of serotonin receptor antagonists such as granisetron or ondansetron for managing nausea, as they have a lower rate of CNS effects 1.
- Adding dexamethasone to antiemetic regimens containing 5-HT3 antagonists, such as Zofran, can improve efficacy 1.
Additional Considerations
- If nausea persists despite an as-needed regimen, administering antiemetics around the clock for 1 week and then changing dosing as needed may be helpful 1.
- Alternative agents such as scopolamine, dronabinol, or olanzapine may also be considered for management of nausea, especially in cases where opioid-induced nausea is a concern 1.
From the Research
Comparison of Emgality and Zofran for Acute Nausea
- There are no direct studies comparing Emgality and Zofran for acute nausea in the provided evidence.
- However, Zofran (ondansetron) is a well-studied antiemetic medication, and its efficacy has been compared to other antiemetics in various studies 2, 3, 4, 5, 6.
- Ondansetron has been shown to be effective in treating chemotherapy-induced nausea and vomiting, and is often used as a first-line agent for relief of nausea or vomiting in the emergency department 2, 5.
- In a study comparing ondansetron to metoclopramide, ondansetron was found to be more effective in preventing nausea and vomiting induced by chemotherapy 5.
- Another study found that ondansetron was as effective as metoclopramide and promethazine in reducing nausea in emergency department adults, but the study was terminated early and may not have detected a significant difference 6.
- Emgality (galcanezumab) is a medication used to prevent migraine headaches, and its use for acute nausea is not well-studied in the provided evidence.
- Therefore, based on the available evidence, it is not possible to determine whether Emgality or Zofran is better for acute nausea, as there are no direct comparisons between the two medications.