Ondansetron Sublingual Dosing for Children
Ondansetron oral disintegrating tablets (ODT) should be dosed at 0.15 mg/kg per dose (maximum 8 mg) for children, with weight-based dosing preferred for those under 40 kg. 1, 2
Weight-Based Dosing Recommendations
For children ≥12 months, use the following weight-based dosing schedule 1:
- ≤15 kg (≤33 lb): 30 mg twice daily
- >15-23 kg (33-51 lb): 45 mg twice daily
- >23-40 kg (>51-88 lb): 60 mg twice daily
- >40 kg (>88 lb): 75 mg twice daily (adult dose)
Formulation Options
- Oral dissolving tablets are the preferred sublingual formulation, dissolving on the tongue without water 1, 2
- Oral soluble films provide an alternative that also dissolves on the tongue 2
- Standard ondansetron tablets can be used but require swallowing 1
Clinical Context and Administration
For acute gastroenteritis: A single dose of 0.15 mg/kg (maximum 8 mg) has been shown effective in reducing vomiting episodes and decreasing the need for IV rehydration and hospitalization 3, 4
For chemotherapy-induced nausea: The first dose should be given 30 minutes before emetogenic chemotherapy, with subsequent doses 8 hours later, followed by twice daily dosing for 2 days after chemotherapy completion 2
Dose range considerations: Studies demonstrate that doses between 0.13-0.26 mg/kg show similar efficacy without increased side effects, suggesting the lower end of this range is adequate 4
Important Caveats
- No dosage adjustment needed based on age alone in teenagers or for renal impairment 2
- Higher doses (>0.26 mg/kg) are not superior to standard dosing and do not provide additional benefit 4
- Diarrhea may increase with ondansetron use in gastroenteritis patients, though this is generally mild 3
- Revisit rates may be higher in ondansetron-treated gastroenteritis patients, likely due to increased diarrhea 3
Safety Profile
Ondansetron is well-tolerated in children with minimal adverse effects 5. The most common side effects include mild headache, constipation, and diarrhea 5, 6. The oral disintegrating formulation eliminates concerns about IV access and is particularly useful when oral intake is difficult 1, 2.