Pharmacology. Ondansetron is a selective serotonin (5-HT3) receptor antagonist with powerful antiemetic activity, both centrally at the chemoreceptor trigger zone and peripherally at vagal nerve terminals. The onset is about 30 minutes after an intravenous dose and 60–90 minutes after an oral dose. The drug is metabolized extensively in the liver. The elimination half-life is 3–5.5 hours, increasing to as long as 20 hours in patients with severe liver disease.

Indications

1. 
   

   FDA-approved for prophylaxis of highly or moderately emetogenic chemotherapy, prophylaxis of postoperative nausea and vomiting, and prophylaxis of radiation-induced nausea and vomiting.

   
   
2. 
   

   Ondansetron is used to treat intractable nausea and vomiting, particularly when the ability to administer activated charcoal or antidotal therapy (eg, N-acetylcysteine) is compromised. Not an FDA-approved indication.

Contraindications

1. 
   

   Hypersensitivity to ondansetron or any component of the formulation. Hypersensitivity reactions have been reported in patients who have experienced hypersensitivity to other selective 5-HT3 receptor antagonists.

   
   
2. 
   

   The concomitant use of apomorphine with ondansetron is contraindicated based on reports of profound hypotension and loss of consciousness.

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