Zofran: Effective Relief from Nausea and Vomiting
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Synonyms
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Zofran (ondansetron) is a prescription medication classified as a 5-HT3 receptor antagonist, specifically developed to manage and prevent nausea and vomiting induced by chemotherapy, radiotherapy, and postoperative conditions. It is widely recognized in clinical practice for its efficacy, rapid onset of action, and favorable safety profile. By selectively blocking serotonin receptors in the central nervous system and gastrointestinal tract, Zofran addresses the physiological pathways responsible for emesis, offering reliable symptom control for patients undergoing challenging medical treatments.
Features
- Active ingredient: ondansetron hydrochloride
- Available formulations: oral tablets, orally disintegrating tablets, oral solution, and injectable solution
- Mechanism of action: selective 5-HT3 (serotonin) receptor antagonist
- FDA-approved for prevention of nausea and vomiting associated with highly emetogenic chemotherapy, moderately emetogenic chemotherapy, radiotherapy, and postoperative nausea and vomiting
- Rapid onset of action, with effects typically observed within 30–60 minutes for oral forms
- Multiple administration routes allow flexibility in clinical settings and patient preference
Benefits
- Provides highly effective prevention and treatment of chemotherapy-induced nausea and vomiting, improving quality of life during cancer treatment
- Reduces postoperative nausea and vomiting, facilitating smoother recovery and earlier discharge
- Minimizes radiotherapy-induced gastrointestinal side effects, supporting treatment adherence
- Offers flexible dosing options suitable for various clinical scenarios and patient populations
- Demonstrates a generally favorable side effect profile compared to older antiemetic agents
- Helps maintain nutritional intake and hydration by controlling emetic episodes
Common use
Zofran is primarily indicated for the prevention of nausea and vomiting associated with cancer chemotherapy, including both highly emetogenic (e.g., cisplatin-based regimens) and moderately emetogenic chemotherapeutic agents. It is also approved for prevention of postoperative nausea and vomiting in patients undergoing surgical procedures. Additionally, it is used off-label for management of nausea and vomiting in other clinical contexts, including hyperemesis gravidarum (under careful obstetric supervision), gastroenteritis, and migraine-associated nausea. The selection of Zofran is typically based on the emetogenic potential of the treatment regimen and patient-specific risk factors.
Dosage and direction
Dosage varies based on indication, patient age, and renal/hepatic function:
Chemotherapy-induced nausea and vomiting:
- Adults: 8 mg orally 30 minutes before chemotherapy, followed by 8 mg every 8 hours for 1–2 days after chemotherapy
- Alternatively: single 16 mg dose orally 30 minutes before chemotherapy
- Pediatric patients (4–18 years): 4 mg orally before chemotherapy and every 8 hours after as needed
Radiotherapy-induced nausea and vomiting:
- Adults: 8 mg orally three times daily
Postoperative nausea and vomiting:
- Adults: 16 mg orally 1 hour before anesthesia induction
Hepatic impairment: Maximum daily dose should not exceed 8 mg in patients with severe hepatic impairment.
Tablets should be swallowed whole with water; orally disintegrating tablets are placed on the tongue and dissolve without water. Injectable formulations are administered by healthcare professionals.
Precautions
Patients should inform their healthcare provider of any history of congenital long QT syndrome, electrolyte abnormalities (e.g., hypokalemia, hypomagnesemia), or heart failure. Use with caution in patients taking other medications that prolong QT interval. Electrocardiographic monitoring may be necessary in at-risk populations. Zofran may cause dizziness or drowsiness; patients should avoid driving or operating machinery until they know how the medication affects them. In elderly patients, consider age-related decreases in hepatic function and potential for increased sensitivity. Use during pregnancy only if clearly needed and under medical supervision.
Contraindications
Zofran is contraindicated in patients with known hypersensitivity to ondansetron or any component of the formulation. Concomitant use with apomorphine is contraindicated due to risk of profound hypotension and loss of consciousness. The injectable form contains benzyl alcohol and is contraindicated in neonates.
Possible side effects
Common side effects (≥1%) include:
- Headache (5–27%)
- Constipation (4–11%)
- Diarrhea (1–16%)
- Fatigue (5–13%)
- Dizziness (4–12%)
Less common but serious side effects may include:
- QT interval prolongation
- Serotonin syndrome (especially when used with other serotonergic drugs)
- Extrapyramidal symptoms
- Allergic reactions including anaphylaxis
- Transient visual disturbances
Drug interaction
Zofran may interact with:
- Drugs that prolong QT interval (e.g., antiarrhythmics, antipsychotics, antibiotics) - increased risk of cardiac arrhythmias
- Serotonergic drugs (e.g., SSRIs, SNRIs, tramadol) - increased risk of serotonin syndrome
- Apomorphine - contraindicated due to risk of hypotension
- Phenytoin, carbamazepine, rifampin - may decrease ondansetron concentrations
- Tramadol - may reduced analgesic efficacy
Missed dose
If a dose is missed, take it as soon as remembered unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed one. For chemotherapy prophylaxis, if a dose is missed before treatment, contact healthcare provider for guidance.
Overdose
Symptoms of overdose may include sudden visual loss, severe constipation, syncope, and electrocardiographic changes (including QT prolongation). There is no specific antidote for ondansetron overdose. Treatment is supportive and symptomatic, with close monitoring of cardiac function. Hemodialysis is not likely to be effective due to high protein binding.
Storage
Store at controlled room temperature (20–25°C or 68–77°F). Protect from light and moisture. Keep orally disintegrating tablets in blister package until use. Keep all medications out of reach of children. Do not use after expiration date.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Zofran is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Dosage and administration should be determined by a physician based on individual patient characteristics. Patients should discuss their medical history and current medications with their healthcare provider before starting treatment.
Reviews
Clinical studies demonstrate Zofran’s efficacy in preventing chemotherapy-induced nausea and vomiting, with complete response rates of 50–70% in highly emetogenic chemotherapy and 70–80% in moderately emetogenic chemotherapy. Postoperative nausea and vomiting prevention shows similar efficacy, with number needed to treat of approximately 5. The drug is generally well-tolerated, though headache remains the most frequently reported adverse effect. Many oncologists consider Zofran a cornerstone of antiemetic therapy, particularly when used as part of combination regimens for highly emetogenic chemotherapy.