Ondansetron

What is ondansetron?

Ondansetron is used to treat and prevent nausea and vomiting, such as following a surgical operation, or due to cancer medication or radiation therapy. It blocks the actions of chemicals in your body that can trigger nausea and vomiting.

In New Zealand, ondansetron is available as tablets (4 mg and 8 mg) and can be given as an injection in the hospital.

Dose

• The dose of ondansetron will be different for different people, depending on its use.
• If you are due to have chemotherapy or radiotherapy treatment that could cause you to feel sick, your doctor will prescribe you a dose of ondansetron an hour or so before the treatment. You may then need to continue taking ondansetron for up to five days.
• If you are being prescribed ondansetron because you are due to have an operation, you will be given a dose shortly before the surgery, and then prescribed a few doses to take afterwards, if you need it.
• Always take your ondansetron exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it, and any special instructions.

How to take ondansetron

You can take ondansetron with or without food. Ondansetron should start to work within 30 minutes to an hour. Ondansetron tablets are available in two different forms – tablets or oral disintegrating tablets (also called ODT). 

• Tablets: swallow the tablets with a glass of water. Do not halve or crush the tablets. 
• Oral disintegrating tablets: these tablets are designed to dissolve in your mouth very quickly. Place the tablet on your tongue, allow it to dissolve or melt, then swallow.  

Precautions before taking ondansetron

• Do you have problems with your liver?
• Do you have problems with your heart such as an irregular heartbeat?
• Are you pregnant or breastfeeding?

If so, it’s important that you tell your doctor or pharmacist before you start ondansetron. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

What are the side effects of ondansetron?

Like all medicines, ondansetron can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Serotonin syndrome

Serotonin syndrome occurs when the level of serotonin in your brain, gets too high. It can happen with the use of some medicines such as ondansetron. You are at risk of serotonin syndrome if you just started taking or increased the dose of your ondansetron, or also take other medicines or herbal supplements that increase serotonin levels such as triptans for migraines or St John's Wort. Symptoms can range from mild such as shivering and diarrhoea (runny poos) to severe such as muscle rigidity, fever and seizures. Milder forms of serotonin syndrome may go away within a few days of stopping the medicines that caused your symptoms. Severe serotonin syndrome needs hospital admission and can be fatal if not treated. Read more about serotonin syndrome.

Other possible side effects

Interactions

Ondansetron interacts with some medicines and herbal supplements, so check with your doctor or pharmacist before starting ondansetron or before starting any new medicines.

Learn more

The following links have more information on ondansetron.

Ondansetron New Zealand Formulary Patient Information

References

1. Ondansetron New Zealand Formulary

Additional resources for healthcare professionals

Onrex Medsafe, NZ
Ondansetron ODT-DRLA Medsafe, NZ
Ondansetron – new dose restrictions Medsafe, NZ, 2012
Ondansetron – safe prescribing – relieve the heave SafeRx, NZ, 2019
Irritable bowel syndrome in adults BPAC, NZ, 2014
Nausea and vomiting in pregnancy BPAC, NZ, 2011