From the Guidelines
The best antiemetics for pediatric patients include ondansetron, with the addition of aprepitant for those receiving high-emetic-risk chemotherapy, as this combination has been shown to improve complete response rates and reduce vomiting in pediatric patients 1. The most recent and highest quality study, published in 2020, evaluated the addition of fosaprepitant to ondansetron plus dexamethasone in pediatric patients and found that the 3-drug antiemetic regimen resulted in lower rates of vomiting and improved delayed-phase complete response rates compared to ondansetron plus dexamethasone alone 1. Key points to consider when using antiemetics in pediatric patients include:
- Ondansetron is typically dosed at 0.15 mg/kg per dose (maximum 8 mg) every 8 hours as needed, and is available in oral dissolving tablets which are convenient for children.
- For children under 4 years, dosing should be adjusted based on weight and clinical response.
- Aprepitant can be added to ondansetron and dexamethasone for pediatric patients receiving high-emetic-risk chemotherapy, as this combination has been shown to improve complete response rates and reduce vomiting.
- Non-pharmacological approaches like small, frequent meals, clear liquids, and avoiding strong odors should also be implemented alongside medication therapy. It's also important to monitor for side effects, which can include headache and constipation with ondansetron, and to adjust dosing and treatment plans as needed to minimize adverse effects and optimize treatment outcomes 1.
From the FDA Drug Label
In these trials, 58% of the 170 evaluable patients had a complete response (no emetic episodes) on Day 1 In 2 trials the response rates to ondansetron tablets 4 mg three times a day in patients younger than 12 years was similar to ondansetron tablets 8 mg three times daily in patients 12 to 18 years. The best antiemetics used for pediatrics are ondansetron tablets, with a dosage of 4 mg three times a day for patients younger than 12 years and 8 mg three times daily for patients 12 to 18 years 2.
From the Research
Antiemetics for Pediatrics
- Ondansetron is a widely used antiemetic in children, effective in preventing nausea and vomiting caused by chemotherapy, radiation, and surgery 3, 4, 5.
- Studies have shown that ondansetron is more effective than metoclopramide, chlorpromazine, and other antiemetics in controlling emesis in children 3, 4.
- A single high-dose of ondansetron (0.6 mg/kg) is as effective as multiple standard doses in preventing emesis in pediatric oncology patients 4.
- Oral ondansetron has been shown to reduce vomiting and facilitate oral rehydration in children with gastroenteritis and dehydration 5.
- Other antiemetics such as dimenhydrinate and metoclopramide have also been studied, but their efficacy in pediatrics is less well-established compared to ondansetron 6.
Comparison of Antiemetics
- Ondansetron has been compared to other antiemetics, including metoclopramide, chlorpromazine, and dimenhydrinate, and has been found to be more effective in preventing emesis in children 3, 4, 6.
- A study comparing dimenhydrinate and metoclopramide in adults with nausea and vertigo found similar efficacy between the two medications, but this study was not specific to pediatrics 6.