From the FDA Drug Label
The clinical efficacy of ondansetron hydrochloride, the active ingredient of Ondansetron Injection, was assessed in clinical trials as described below. 14.1 Chemotherapy-induced Nausea and Vomiting Adults In a double-blind trial of three different dosing regimens of Ondansetron Injection, 0.015 mg/kg, 0.15 mg/kg, and 0. 30 mg/kg, each given three times during the course of cancer chemotherapy, the 0.15-mg/kg dosing regimen was more effective than the 0.015-mg/kg dosing regimen.
The best anti-nausea medicine in the ER for someone having bad nausea and vomiting following chemotherapy for pancreatic cancer is ondansetron (IV), given at a dose of 0.15 mg/kg. This is based on clinical trials that have shown ondansetron to be effective in preventing nausea and vomiting induced by chemotherapy, including cisplatin-based chemotherapy 1.
- Key points:
- Ondansetron is effective in preventing chemotherapy-induced nausea and vomiting
- The recommended dose is 0.15 mg/kg, given three times during the course of cancer chemotherapy
- Ondansetron has been shown to be more effective than metoclopramide in some clinical trials 1
From the Research
Ondansetron (Zofran) is the most effective IV antiemetic medication for managing severe chemotherapy-induced nausea and vomiting in the ER setting, particularly for patients with pancreatic cancer, as evidenced by the most recent and highest quality study 2. The standard dose is 4-8 mg given as a slow IV push over 2-5 minutes. For patients experiencing post-chemotherapy emesis, this 5-HT3 receptor antagonist works by blocking serotonin receptors both peripherally and in the chemoreceptor trigger zone. Some key points to consider when using ondansetron include:
- It is a highly effective medication for preventing nausea and vomiting, with a response rate of 56.1% in the delayed phase, as shown in the study 2.
- It can be used in combination with other medications, such as dexamethasone or metoclopramide, for enhanced efficacy.
- Patients should be monitored for potential side effects, including headache, constipation, or QT interval prolongation.
- Adequate hydration is essential, as these patients are often dehydrated from vomiting. Other options, such as metoclopramide or palonosetron, may also be considered, but ondansetron remains the first-line choice due to its efficacy and safety profile, as demonstrated in the study 2. In particular, the study 2 showed that ondansetron plus metoclopramide or palonosetron are noninferior to multiple-day dexamethasone in terms of delayed total control rate in patients undergoing moderately emetogenic chemotherapy. Therefore, ondansetron should be the primary choice for IV antiemetic therapy in the ER setting for patients with pancreatic cancer experiencing chemotherapy-induced nausea and vomiting, due to its proven efficacy and safety profile 2.