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The risk is also higher in patients taking other medicines that prolong the QT interval, as well as in patients with congenital long QT syndrome, congestive heart failure, and/or bradyarrhythmias.
As such, single doses of injectable ondansetron should not exceed 16 mg at one time.
Ondansetron is a highly specific and selective serotonin 5-HT3 receptor antagonist, with low affinity for dopamine receptors.
The 5-HT3 receptors are present both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone of the area postrema.
Ondansetron is used off-label to treat morning sickness and hyperemesis gravidarum of pregnancy.
It is typically used after trials of other drugs have failed.
In these patients, ondansetron is cleared from the body at half to one-third the rate as in healthy patients.
Patients are cautioned to seek immediate medical care if symptoms such as irregular heartbeat/palpitations, shortness of breath, dizziness, or fainting occur while taking ondansetron.Intravenous ondansetron 4 mg versus placebo was investigated in 16 reports and three further reports which had been duplicated a total of six times.The number needed to treat (NNT) to prevent vomiting within 24 hours was 9.5, with 95% confidence interval 6.9 to 15, in the 16 nonduplicated reports.Furthermore, patients who had initially received ondansetron were more likely to be admitted on the return visit than patients who had not received the drug.However, this effect may simply be due to the agent being used more frequently in patients who present with more severe illness. It is not necessary to adjust the dosage for elderly patients under 75 years of age.
It is broken down by the hepatic cytochrome P450 system and it has little effect on the metabolism of other drugs broken down by this system.