From the Guidelines
The best antiemetics for pediatric patients include ondansetron, aprepitant, and palonosetron, with ondansetron generally being the first-line choice, as supported by the American Society of Clinical Oncology clinical practice guideline update 1.
Key Considerations
- 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.
- Aprepitant can be added to a 5-HT3 receptor antagonist, such as ondansetron, for pediatric patients who receive high-emetic-risk chemotherapy, as it has been shown to improve complete response rates during both the 0- to 24-hour and 24- to 120-hour periods after chemotherapy 1.
- Palonosetron is a viable alternative to ondansetron, with a noninferiority trial showing its effectiveness in children during initial and repeat courses of emetogenic chemotherapy, including high-emetic-risk chemotherapy 1.
Medication Options
- Ondansetron: blocks serotonin receptors
- Aprepitant: blocks substance P receptors
- Palonosetron: blocks serotonin receptors
- Other options, such as promethazine, metoclopramide, and dimenhydrinate, may be considered, but their use should be cautious due to potential side effects, such as respiratory depression and extrapyramidal side effects.
Important Factors
- Patient age: medication dosing and form (liquid, tablet, injection) should be considered
- Cause of vomiting: chemotherapy-induced nausea and vomiting (CINV) requires a different approach than other causes of vomiting
- Potential side effects: should be carefully weighed against the benefits of each medication The choice of antiemetic should be individualized based on these factors, with the goal of minimizing morbidity, mortality, and improving quality of life for pediatric patients.
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 in various settings, including chemotherapy, radiotherapy, and surgery 3.
- In comparative trials, ondansetron was significantly more effective than metoclopramide or chlorpromazine in reducing nausea and vomiting in children receiving chemotherapy 3.
- Ondansetron has also been shown to be effective in preventing postoperative nausea and vomiting (PONV) in children undergoing surgery, with a significant reduction in vomiting episodes compared to placebo or other antiemetics 3, 4.
- In the treatment of gastroenteritis, ondansetron has been found to reduce vomiting and facilitate oral rehydration in children, with a single dose being effective in reducing vomiting and improving outcomes 5, 4.
Comparison of Antiemetics
- A study comparing the efficacy of dimenhydrinate and metoclopramide in the treatment of nausea due to vertigo found that both medications had similar efficacy in reducing nausea and vertigo symptoms 6.
- Ondansetron has been compared to other antiemetics, including prochlorperazine and dimenhydrinate, and has generally shown greater prophylactic antiemetic efficacy 3.
- The combination of ondansetron with dexamethasone has been found to be more effective than ondansetron or dexamethasone alone in preventing nausea and vomiting in children receiving chemotherapy or undergoing surgery 3.
Use of Ondansetron in Pediatrics
- Ondansetron is generally well tolerated in children, with mild to moderate headache, constipation, and diarrhea being the most frequently reported adverse events 3.
- The use of ondansetron in pediatric emergency departments has been found to be effective in reducing vomiting and improving outcomes in children with gastroenteritis and other conditions 5, 7, 4.
- Ondansetron has been used in a variety of settings, including chemotherapy, radiotherapy, surgery, and gastroenteritis, and has been found to be effective in preventing nausea and vomiting in children 3, 5, 7, 4.