From the FDA Drug Label
- 3 Prevention of Further Postoperative Nausea and Vomiting Adults Adult surgical patients receiving general balanced anesthesia (barbiturate: thiopental, methohexital, or thiamylal; opioid: alfentanil or fentanyl; nitrous oxide; neuromuscular blockade: succinylcholine/curare and/or vecuronium or atracurium; and supplemental isoflurane) who received no prophylactic antiemetics and who experienced nausea and/or vomiting within 2 hours postoperatively were evaluated in two double-blind US trials involving 441 patients. Patients who experienced an episode of postoperative nausea and/or vomiting were given Ondansetron Injection (4 mg) intravenously over 2 to 5 minutes, and this was significantly more effective than placebo.
To reduce nausea and vomiting (N&V) after oxytocin administration, consider the following:
- Administer ondansetron (4 mg) intravenously over 2 to 5 minutes if patients experience N&V within 2 hours postoperatively 1.
- Ondansetron has been shown to be significantly more effective than placebo in preventing further episodes of N&V in adult patients 1.
- The use of ondansetron for the prevention of postoperative N&V is supported by clinical trials in patients undergoing surgery, including those receiving general balanced anesthesia 1.
From the Research
To reduce nausea and vomiting after oxytocin administration, premedication with ondansetron 4-8 mg IV is recommended, as it has been shown to be more effective than metoclopramide in preventing postoperative nausea and vomiting 2.
Key Considerations
- Slower infusion rates of oxytocin can also help minimize nausea and vomiting, so consider administering oxytocin at the lowest effective dose and rate.
- Adequate hydration before and during oxytocin administration is important, as dehydration can worsen nausea.
- For patients with persistent symptoms, combining different classes of antiemetics may be more effective than using a single agent.
- These side effects occur because oxytocin can stimulate the chemoreceptor trigger zone in the brain and cause gastrointestinal smooth muscle contractions.
- Additionally, rapid oxytocin administration can cause hypotension, which may contribute to nausea.
Alternative Options
- Metoclopramide 10 mg IV can be considered as an alternative, although it has been shown to be less effective than ondansetron in some studies 3, 4, 2.
- Other antiemetics such as droperidol, tropisetron, and domperidone may also be effective, but their use may be limited by side effects such as sedation 4, 5.
Rescue Antiemetics
- If symptoms persist despite preventive measures, rescue antiemetics such as promethazine 12.5-25 mg IV or dimenhydrinate 50 mg IV can be administered as needed.
- The choice of rescue antiemetic will depend on the individual patient's response to treatment and the presence of any contraindications or side effects.