Alternatively, a reasonable weight-based oral dosing regimen for infants and children is the following: 8 kg to 15 kg: 2 mg; 15 kg to 30 kg: 4 mg; Greater than 30 kg: 6 mg to 8 mg 15-30 kg 4mg ... Ondansetron wafer dose 8 -15 kg 4 mg IV/IM immediately before anesthesia or after procedure or 16 mg PO 1 hr before anesthesia; patients >80 kg may need additional 4 mg IVTotal body radiation therapy: 8 mg PO 1-2 hours before radiation therapy; administered each daySingle high-dose fraction therapy to abdomen: 8 mg PO 1-2 hr before radiation therapy; administer subsequent doses every 8 hr after first dose 1-2 days after completion of therapyDaily fractions to abdomen: Administer 8 mg PO 1-2 hr before radiotherapy; administer subsequent doses every 8 hr after first dose each day radiotherapy is givenSevere hepatic impairment (Child-Pugh score ≥10): Not to exceed 8 mg/day8 mg divided q12hr or 8 mg q8-12hr PO for 7 days up to 5 monthsAlternatively, 4-8 mg intermittent short-term IV dosing used in adults; single dose of 4 mg single dose used in pregnancy8 mg divided q12hr or 8 mg q8-12hr PO for 14 days up to 5 monthsProphylaxis: 4-8 mg IV 20-30 min prior to spinal opioid therapy; may repeat dosing at 12, 24, 36, 48 hr after spinal opioid dosingOndansetron inhalation powder: Prevention of chemotherapy-induced nausea and vomiting due to highly emetogenic chemotherapy in pediatric patients (aged birth through 16 yr)Cardiac: Arrhythmias (including ventricular and supraventricular tachycardia, premature ventricular contractions, and atrial fibrillation), bradycardia, electrocardiographic alterations (including second-degree heart block, QT/QTc interval prolongation, and ST segment depression), palpitations, and syncope; rarely and predominantly with intravenous ondansetron, transient ECG changes including QT/QTc interval prolongation have been reportedECG alterations: Arrhythmias; prolongation of PR, QRS, and QT intervalsHepatobiliary: Specific hepatic enzyme abnormalities, hepatic necrosis, and abnormal hepatic functionGeneral: Flushing, rare cases of hypersensitivity reactions, sometimes severe (eg, anaphylactic reactions, angioedema, bronchospasm, cardiopulmonary arrest, hypotension, laryngeal edema, laryngospasm, shock, shortness of breath, stridor)Local reactions: Pain, redness, and burning at injection siteNeurological: Oculogyric crisis, appearing alone, as well as with other dystonic reactions; transient dizziness during or shortly after intravenous infusionSkin and subcutaneous tissue: Urticaria, Stevens-Johnson syndrome, and toxic epidermal necrolysisEye Disorders: Transient blindness (predominantly during IV administration) reported to resolve within a few minutes up to 48 hr; transient blurred visionCoadministration with apomorphine; combination reported to cause profound hypotension and loss of consciousnessHypersensitivity reactions including anaphylaxis and bronchospasm may occur: discontinue therapy if suspected; monitor and treat promptly per standard of care until signs and symptoms resolveOndansetron may mask progressive ileus or gastric distention in patients who are undergoing abdominal surgery or experiencing chemotherapy-induced nausea and vomiting; monitor for decreased bowel activity, particularly in patients with risk factors for gastrointestinal obstructionOndansetron is not a drug that stimulates gastric or intestinal peristalsis; should not be used instead of nasogastric suctionSerotonin syndrome reported with 5-HT3 receptor antagonists alone but particularly with concomitant use of serotonergic drugs including SSRIs, SNRIs, MAO inhibitors, lithium, tramadol, methylene blue IV, and mirtazapine; if concomitant use with other serotonergic drugs is clinically warranted, patients should be made aware of potential increased risk for serotonin syndromeCross-sensitivity among selective serotonin antagonists may occurZofran ODT contains phenylalanine (caution for phenylketonurics)Dose-dependent QT prolongation; avoid in patients with congenital long QT syndrome; ECG monitoring recommended in patients who have electrolyte abnormalities, CHF, or bradyarrhythmias or who are also receiving other medications that cause QT prolongationPregnancy: Available data do not reliably inform of association with adverse fetal outcomes; published epidemiological studies on the association between ondansetron and fetal outcomes have reported inconsistent findings and have important methodological limitations hindering interpretationLactation: It is not known whether ondansetron is present in human milk; there are no data on effects of ondansetron on breastfed infant or effects on milk production; the developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for ondansetron and any potential adverse effects on breast-fed infant from therapy or from the underlying maternal conditionA: Generally acceptable.
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