Oral ondansetron for preventing nausea and vomiting

Area of Science:

• Pharmacology
• Clinical Medicine
• Oncology

Background:

• Injectable ondansetron hydrochloride is highly effective for chemotherapy-induced nausea and vomiting (CINV).
• Oral ondansetron hydrochloride dihydrate tablets became available in December 1992.
• Many early trials compared oral ondansetron to placebo, not active comparators.

Purpose of the Study:

• To review available clinical data on oral ondansetron for preventing nausea and vomiting in cancer chemotherapy and surgical patients.
• To assess the efficacy of oral ondansetron compared to other antiemetics and placebo.

Main Methods:

• Review of available clinical data and trials on oral ondansetron.
• Analysis of studies comparing oral ondansetron with placebo, metoclopramide, and dexamethasone combinations.
• Evaluation of data for both chemotherapy-induced and post-operative nausea and vomiting.

Main Results:

• Oral ondansetron shows efficacy compared to placebo, but its effectiveness against acute emesis is attributed to preceding intravenous doses.
• Studies indicate oral ondansetron is at best equal to metoclopramide, with some showing dexamethasone/metoclopramide superiority.
• For post-operative nausea and vomiting, oral ondansetron is more effective than placebo, but routine use may be unnecessary with modern anesthetics.

Conclusions:

• Oral ondansetron demonstrates efficacy beyond 24 hours post-administration.
• It is not superior to traditional antiemetics for CINV or post-operative nausea and vomiting.
• Despite milder side effects, the high cost of oral ondansetron may outweigh its benefits compared to established treatments.