Anesth Analg. 2005 Feb;100(2):373-7.
Dolasetron versus ondansetron for the treatment of postoperative
nausea and vomiting.
Meyer TA, Roberson CR, Rajab MH, Davis J, McLeskey CH.
Department of Pharmacy, Scott & White Memorial Hospital, 2401 S. 31st
Street, Temple, TX 76508, USA.
The management of postoperative nausea and vomiting (PONV) remains a persistent
problem. Despite the use of prophylactic antiemetics, breakthrough nausea
and vomiting still frequently occur. There have been no published studies
comparing dolasetron and ondansetron for the treatment of PONV. This was
a prospective, randomized, double-blind, active-controlled study in adult
outpatient surgery patients. We screened 559 consecutive adult surgery patients,
with 92 patients randomized to either ondansetron or dolasetron. The objectives
of the study were 1) to determine whether treatment of PONV with ondansetron
4 mg IV or dolasetron 12.5 mg IV would result in better outcomes in patients
undergoing day surgery and 2) to compare the cost of drugs used for treating
PONV. Thirty-three (70%) of 47 patients given ondansetron required rescue
medication, compared with 18 (40%) of 45 patients given dolasetron (P <
0.004). Dolasetron was approximately 40% less expensive than ondansetron,
and the costs of the study drug plus rescue antiemetics were 30% less in
the dolasetron group than in the ondansetron group. Dolasetron provided
greater efficacy for antiemetic treatment because of the need for less rescue
therapy. Because of the decreased use of rescue antiemetics and acquisition
cost at our hospital, costs in the dolasetron group were less than costs
in the ondansetron group. |
| J Clin Anesth. 2005
Feb;17(1):62-5.
The effectiveness of rescue antiemetics after failure
of prophylaxis with ondansetron or droperidol: a preliminary report.
Habib AS, Gan TJ.
Department of Anesthesiology, Duke University Medical Center, Durham,
NC 27710, USA.
STUDY OBJECTIVES: To compare the effectiveness of treating established
postoperative nausea and vomiting (PONV) with an antiemetic acting at
a different receptor with that of treating PONV with the antiemetic used
for prophylaxis. DESIGN: Analysis of data collected in a previously published
randomized, double-blind, placebo-controlled study. SETTING: Outpatient
surgical procedures from 50 institutions in North America. PATIENTS: Patients
(N = 2061) undergoing outpatient surgical procedures planned to last no
more than 2 hours. INTERVENTIONS: Patients were randomized to receive
ondansetron 4 mg, droperidol 1.25, droperidol 0.625 mg, or placebo. In
the postoperative anesthesia care unit, patients who developed PONV received
rescue antiemetics at the discretion of the attending anesthesiologist.
The following antiemetics were used for rescue: ondansetron 4 mg, droperidol
0.625 to 1.25 mg, metoclopramide 10 mg, promethazine 6.25 to 25 mg, and
dimenhydrinate 25 to 50 mg. MEASUREMENTS: The complete response rate (no
nausea, no emesis, and no need for further rescue) after administration
of the rescue antiemetic in patients with established PONV was calculated.
The complete response rate after administration of each of the different
rescue antiemetics was compared with that after administration of the
same antiemetic used for PONV prophylaxis. MAIN RESULTS: In patients who
failed prophylaxis with ondansetron 4 mg, the complete response rate was
significantly higher (P = .02) after rescue with promethazine 6.25 to
25 mg (78%) than after rescue with ondansetron 4 mg (46%). In patients
who failed prophylaxis with droperidol 0.625 and 1.25 mg, the complete
response rate was significantly higher after rescue with promethazine
6.25 to 25 mg (77%; P = .02) and dimenhydrinate 25 to 50 mg (78%; P =
.04) than after rescue with droperidol 0.625 to 1.25 mg (56%). CONCLUSION:
In patients who failed prophylaxis with ondansetron or droperidol, promethazine
was significantly more effective than the agent used for prophylaxis for
the treatment of PONV. In patients who failed prophylaxis with droperidol,
dimenhydrinate was also more effective than droperidol for the treatment
of established PONV in the postoperative anesthesia care unit. |
| Brand name: Zofran
Generic name: ondansetron
Why is this drug prescribed?
Zofran is used for the prevention of nausea and vomiting caused by radiation
therapy and chemotherapy for cancer, and, in some cases, to prevent these
problems following surgery.
Most important fact about this drug
To ensure the maximum effect, it is important to take all doses of Zofran
exactly as prescribed by your doctor.
How should you take this medication?
Your doctor will tell you how much drug to take and how often, depending
on the type of therapy you will be having. Zofran is available in three
forms: an oral solution, tablets that you swallow with water, and orally
disintegrating tablets that can be swallowed with saliva alone (Zofran
ODT). If you're taking the orally disintegrating tablets, don't remove
them from the blister pack until it's time for a dose. Then peel off the
foil backing with dry hands, gently remove the tablet, and immediately
place it on your tongue. Do not attempt to push the tablets through the
foil.
--If you miss a dose... Take the forgotten dose as soon as you
remember.
--Storage instructions.. Store Zofran at room temperature. Protect
from light. Keep the drug in the carton it came in. Store oral solution
bottles upright.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity,
inform your doctor as soon as possible. Only your doctor can determine
if it is safe for you to continue taking Zofran.
· More common side effects may include:
Constipation, diarrhea, dizziness, fatigue, headache
· Less common side effects may include:
Anaphylaxis (severe allergic reaction), anxiety, fever, flushing, gynecological
disorders, hiccups, hives, itching, rash, rolling eyes, urinary difficulties,
wheezing
· When Zofran is used to prevent nausea and vomiting after surgery,
the following side effects may occur:
Anxiety, difficulty breathing, difficulty urinating, dizziness, drowsiness,
female reproductive disorders, fever, headache, itching, low blood pressure,
shivers, slow heartbeat
Why should this drug not be prescribed?
If you are sensitive to or have ever had an allergic reaction to ondansetron
hydrochloride, you should not take this medication. Make sure that your
doctor is aware of any drug reactions that you have experienced.
Special warnings about this medication
If drugs similar to Zofran (for instance, Anzemet or Kytril) have given
you a reaction, Zofran may cause one too. If you suffer from phenylketonuria
(an excess of the amino acid phenylalanine) remember that Zofran contains
this substance.
Possible food and drug interactions when taking this
medication
No interactions with Zofran have been reported.
Special information if you are pregnant or breastfeeding
The effects of Zofran during pregnancy have not been adequately studied.
If you are pregnant or plan to become pregnant, inform your doctor immediately.
Zofran may appear in breast milk and could affect a nursing infant. If
this medication is essential to your health, your doctor may advise you
to discontinue breastfeeding until your treatment with this medication
is finished.
Recommended dosage
Dosage is the same for both regular and orally disintegrating tablets.
If you have poor liver function, you should take no more than 8 milligrams
of Zofran per day.
PREVENTION OF NAUSEA AND VOMITING DUE TO CHEMOTHERAPY
Adults and Children 12 Years of Age and Older
The recommended dose of Zofran is one 8-milligram tablet or 2 teaspoonfuls
of oral solution taken twice a day. The first dose should be taken 30
minutes before the start of treatment. The other dose should be taken
8 hours after the first dose. One 8-milligram tablet or 2 teaspoonfuls
should be taken twice a day (every 12 hours) for 1 to 2 days after completing
chemotherapy.
If the chemotherapy is especially likely to cause nausea and vomiting,
the recommended dosage is one 24-milligram tablet taken 30 minutes before
the treatment.
Children 4 through 11 Years of Age
The recommended dose of Zofran is one 4-milligram tablet or 1 teaspoonful
of oral solution taken 3 times a day. The first dose should be taken 30
minutes before the start of chemotherapy. The other 2 doses should be
taken 4 and 8 hours after the first dose. One 4-milligram tablet or 1
teaspoonful should be taken 3 times a day (every 8 hours) for 1 to 2 days
after completing chemotherapy.
PREVENTION OF NAUSEA AND VOMITING DUE TO RADIATION THERAPY
Adults
The usual dosage is one 8-milligram tablet or 2 teaspoonfuls of oral solution
taken 3 times a day. You will take the first dose 1 to 2 hours before
therapy; the other intervals will depend on the type of radiation therapy
you are receiving.
Children Zofran has not been used for this purpose in children.
PREVENTION OF NAUSEA AND VOMITING AFTER SURGERY
Adults The usual dose is two 8-milligram tablets or 4 teaspoonfuls of
oral solution taken 1 hour before undergoing anesthesia.
Children Zofran has not been used for this purpose in children.
Overdosage
Any medication taken in excess can have serious consequences. If you suspect
an overdose, seek medical attention immediately.
· Symptoms of Zofran overdose may include:
Low blood pressure and fainting, sudden blindness, severe constipation
Caution! Before starting
to take this medicine, it is vital that you should consult your doctor!
Do not use it on your own initiative, without medical advice.
|
