What is the recommended dosing of Zofran (ondansetron) ODT (orally disintegrating tablet) for pediatric patients?

Ondansetron ODT Dosing for Pediatric Patients

The recommended dosing of Zofran (ondansetron) ODT for pediatric patients is 0.15 mg/kg per dose (maximum 8 mg) administered every 4-8 hours as needed for nausea and vomiting. 1

Age-Based Dosing Guidelines

Children 4 Years and Older

• Weight-based dosing: 0.15 mg/kg per dose (maximum 8 mg per dose) 1, 2
• Available ODT strengths: 4 mg and 8 mg tablets
• Frequency: Every 4-8 hours as needed, typically up to 3 doses per day 1

Children Under 4 Years

• Limited data exists for this age group
• Weight-based dosing of 0.15 mg/kg per dose is still recommended when clinically indicated 2
• Consult with pediatric specialist for children under 1 year of age

Dosing Based on Clinical Scenario

Chemotherapy-Induced Nausea and Vomiting

• First dose: Administer 0.15 mg/kg (maximum 8 mg) 30 minutes before chemotherapy 3, 4
• Subsequent doses: Continue every 8 hours for up to 3 doses per day 3
• For moderate to highly emetogenic chemotherapy, consider combination with dexamethasone for enhanced efficacy 1, 2

Acute Vomiting (Emergency Setting)

• Dose: 0.15 mg/kg (maximum 16 mg per dose) for emergency management of moderate-to-severe vomiting in children 6 months and older 1
• ODT formulation is particularly advantageous in this setting as it dissolves instantly on the tongue without requiring water 4

Administration Tips

• ODT tablets should be placed on the tongue where they dissolve rapidly without water
• For young children who cannot manage ODT tablets, consider standard oral liquid formulation
• The ODT formulation has been shown to be equally effective as IV formulation in controlling chemotherapy-induced nausea and vomiting 4
• The ODT formulation is more cost-effective than IV administration (63.2 USD vs 121.3 USD per successfully controlled course) 4

Clinical Considerations

• Higher weight-based doses may be required in children compared to adults due to differences in pharmacokinetics 1, 2
• Pediatric patients have increased clearance of ondansetron compared to adults, which may necessitate more frequent dosing 5
• Monitor for potential side effects including headache, constipation, and diarrhea 2
• Use with caution in patients with congenital long QT syndrome or those taking other QT-prolonging medications 1

Efficacy Data

• Complete and major control of emesis was achieved in 93% of pediatric patients using the ODT formulation, comparable to 92% with IV administration 4
• In clinical trials, ondansetron demonstrated superior efficacy compared to metoclopramide and chlorpromazine for chemotherapy-induced nausea and vomiting in children 2

The ODT formulation offers significant advantages for pediatric patients, including ease of administration without requiring water, comparable efficacy to IV formulation, and better cost-effectiveness while maintaining the same safety profile.