What is the use of Zofran (Ondansetron)?

From the Guidelines

Zofran (ondansetron) is not the most effective option for preventing nausea and vomiting caused by chemotherapy, as palonosetron has been shown to be superior in preventing delayed emesis 1. The typical adult dose of palonosetron is 0.50 mg oral or 0.25 mg IV, and it is recommended for preventing acute and delayed emesis associated with moderately emetogenic chemotherapy. Palonosetron works by blocking serotonin receptors in the brain and gut that trigger nausea, and it has a longer half-life compared to other 5-HT3 antagonists, which makes it more effective in preventing delayed emesis. Common side effects of palonosetron include headache, constipation, and dizziness, and it is generally well-tolerated but should be used with caution in patients with heart rhythm disorders or liver problems. For maximum effectiveness, palonosetron should be taken before nausea begins when possible, such as 30 minutes before chemotherapy or 1 hour before surgery. Some key points to consider when using palonosetron include:

• It is FDA-approved as a single dose on day 1 for the prevention of acute and delayed nausea and vomiting associated with moderately emetogenic chemotherapy 1.
• It is superior to other 5-HT3 antagonists in preventing delayed emesis 1.
• It can be delivered orally or intravenously, but oral palonosetron is not available in the United States 1.
• The granisetron transdermal system is also an option for chemotherapy-induced nausea and vomiting, and it is applied approximately 24 to 48 hours before the first dose of chemotherapy 1. In terms of dosing, the following options are available:
• Palonosetron: 0.50 mg oral or 0.25 mg IV
• Granisetron: 2 mg oral or 1 mg or 0.01 mg/kg IV or 1 transdermal patch or 10 mg subcutaneous
• Ondansetron: 8 mg oral twice daily or 8 mg oral dissolving tablet twice daily or three 8 mg oral soluble films or 8 mg or 0.15 mg/kg IV
• Dexamethasone: 8 mg oral or IV, with the dose adjusted based on the specific chemotherapy regimen and the use of other antiemetic agents 1.

From the FDA Drug Label

Ondansetron tablets are indicated for the prevention of nausea and vomiting associated with: highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2. initial and repeat courses of moderately emetogenic cancer chemotherapy. radiotherapy in patients receiving either total body irradiation, single high-dose fraction to the abdomen, or daily fractions to the abdomen. Ondansetron tablets are also indicated for the prevention of postoperative nausea and/or vomiting. Ondansetron tablets are a 5-HT 3receptor antagonist indicated for the prevention of: nausea and vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2. ( 1) nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy. ( 1) nausea and vomiting associated with radiotherapy in patients receiving either total body irradiation, single high-dose fraction to the abdomen, or daily fractions to the abdomen. ( 1) postoperative nausea and/or vomiting. ( 1) Ondansetron tablets are a 5-HT 3receptor antagonist indicated for the prevention of: nausea and vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2. ( 1) nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy ( 1) nausea and vomiting associated with radiotherapy in patients receiving either total body irradiation, single high-dose fraction to the abdomen, or daily fractions to the abdomen. ( 1) postoperative nausea and/or vomiting. ( 1)

The Zophran is actually Ondansetron, which is used for the prevention of:

• Nausea and vomiting associated with highly emetogenic cancer chemotherapy
• Nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy
• Nausea and vomiting associated with radiotherapy
• Postoperative nausea and/or vomiting 2, 2, 2

From the Research

Zophran (Ondansetron) Overview

• Zophran, also known as ondansetron, is a medication used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, and surgery 3, 4, 5, 6.
• It is a selective serotonin 5-HT3 receptor antagonist, which works by blocking the action of serotonin, a natural substance that may cause nausea and vomiting 5.

Efficacy of Ondansetron Compared to Metoclopramide

• Studies have compared the efficacy of ondansetron with metoclopramide in preventing nausea and vomiting in patients undergoing chemotherapy and surgery 3, 4, 7, 6.
• A randomized, double-blind study found that ondansetron was more effective than metoclopramide in preventing nausea and vomiting in patients receiving chemotherapy 3.
• A meta-analysis of six randomized controlled trials also found that ondansetron was more effective than metoclopramide in preventing acute nausea and emesis associated with chemotherapy 4.
• However, another study found that ondansetron and metoclopramide had similar efficacy in reducing nausea and vomiting in adult emergency department patients 7.
• A comparative study found that both ondansetron and metoclopramide were effective in reducing postoperative nausea and vomiting after laparoscopic cholecystectomy, with ondansetron being more effective in preventing nausea 6.

Side Effects and Safety

• Ondansetron is generally well-tolerated, with common side effects including headache, constipation, and dizziness 3, 4, 7, 5.
• Metoclopramide has been associated with a higher risk of extrapyramidal effects and diarrhea compared to ondansetron 4.
• A review of ondansetron's pharmacokinetics and clinical experience in postoperative nausea and vomiting found that it has a favorable safety profile 5.